Long Term Outcomes of MR-guided Focused Ultrasound for Treatment of Symptomatic Uterine Fibroids

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Meghan R. Clark, MD (she/her/hers)

Interventional Radiology Resident
University of Virginia Health System

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

SM

Sandeep Murthy, M.S. (he/him/his)

Medical Student
University of Virginia School of Medicine
EL

Emily Lin, BS (she/her/hers)

Medical student
University of Virginia
Alan H. Matsumoto, MD, MA, FSIR (he/him/his)

Professor & Chair
University of Virginia Health System
Amy Taylor, MD (she/her/hers)

Assistant Professor
University of Virginia

Disclosure(s):

Meghan R. Clark, MD: No financial relationships to disclose

Alan H. Matsumoto, MD, MA, FSIR: Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); Brightwater Medical: Stock owner (Ongoing); Cook Medical: Speaking and Teaching (Ongoing); Endologix: Advisory Committee or Review Panel Member (Ongoing); PENUMBRA INC: Advisory Committee or Review Panel Member (Terminated, June 30, 2021); W.L. Gore & Associates: Advisory Committee or Review Panel Member (Terminated, June 30, 2021)

Amy Taylor, MD: No financial relationships to disclose

Purpose:

Purpose of this study is to determine long term ( >5 years) outcomes in women who underwent magnetic resonance-guided focused ultrasound (MRgFUS) treatment for symptomatic uterine fibroids.

Uterine fibroids are benign tumors that occur in up to 50% of women and cause heavy bleeding, pain, bulk symptoms, and miscarriage. Treatment options include medical management, myomectomy, hysterectomy, thermal ablation, uterine artery embolization, and MRgFUS. In MRgFUS, high-intensity focused ultrasound (US) converges multiple US beams to a focal point, where the energy is converted to heat, resulting in coagulative necrosis. MR guidance allows for precise targeting and monitoring of the treated fibroid(s).

Reported rates of symptom improvement after MRgFUS are 75-90% in those with >50% non-perfused volume (NPV), with reintervention rates of 13-30% at 2 years and up to 66% at 5 years {1-3}. Published long term data is lacking.

Materials and Methods: Following IRB approval, retrospective chart review was performed on all patients who underwent MRgFUS treatment of fibroids from May 2010 to November 2020. Procedure details, including % NPV, were recorded. Patients were then contacted and asked to complete a survey assessing outcomes, including additional treatments, subsequent pregnancy, recurrent fibroid symptoms, overall procedure experience, and whether they would recommend MRgFUS as a treatment option for other women.

Results: Of the 38 patients identified, 12 (31.5%) completed the survey. Average patient age at treatment was 42.7 yr (range 28-52 yr) and average time since MRgFUS was 8 yr (range 1.3 - 11.4 yr). 8 (67%) underwent additional treatment for fibroids, 6 (50%) within two years, primarily for recurrent bleeding (88%). Of those who underwent additional treatments, 4 (50 %) had myomectomy and 4 (50%) had hysterectomy. There was no statistical significance in the mean % NPV between those who required further intervention and those who did not (45% vs 55%, p=0.404). 3 patients (25%) desired pregnancy; 1 was able to conceive and delivered at full term. The mean satisfaction rating was 4.4/10; however, 7/12 (58%) would recommend MRgFUS as a treatment option to other women.

Conclusion: While total reintervention rates after MRgFUS in this study were similar to published rates, the early reintervention rate was much higher, possibly due to the high number of patients with < 50% NPV. Overall satisfaction with the procedure was low, though more than half said they would recommend it as a treatment option to other women with fibroids. Study is limited by the low response rate.