| HOPE FOR FIBROIDS | ||||||||||||||||||||||||
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Goodwin and his team analyzed the short- and long-term effectiveness and safety of uterine artery embolization in 1,278 women treated at 27 sites across the United States. Before treatment, women with fibroids reported average symptom scores of 58.61 and a health-related quality of life score of 46.95. By six months after treatment, the average symptom score had fallen to 19.87, and continued to drop until it averaged 16.54 three years after treatment. A similar return to normal range was seen for health-related quality of life scores; patients' average score had risen to 85.04 after six months, and reached 89.55 at three years. Fewer than 3 percent of the women required surgery to remove fibroids during follow-up, while 9.79 percent required hysterectomy and 1.83 percent had an additional uterine artery embolization procedure. Nearly 86 percent said they "strongly agreed" that they would recommend the procedure to family and friends. "At three years after treatment, uterine embolization appears to be a safe, effective, and durable treatment in a variety of practice settings, with substantial improvement in symptoms and quality of life for the large majority of patients," the researchers write, adding that "any experienced community or academic interventional radiology practice" should be able to achieve similarly good results. SOURCE: Obstetrics & Gynecology, January 2008. http://www.nlm.nih.gov/medlineplus/news/fullstory_60230.html
September 2006 I have just returned from the meeting of the Cardiovascular and Interventional Radiology Society of Europe. Needless to say, I paid special attention to fibroid-related projects. There was much less about MRgFUS than at previous meetings. None of these reports showed anything new. One of the complaints that some have raised over the years about UAE has been a lack of "Level 1" scientific evidence (although (a) there is a lot of Level 2-4 evidence published and (b) there is no Level 1 evidence supporting many surgical therapies for fibroids). At the CIRSE meeting there were 2 studies reported which do present Level 1 evidence about UAE compared to hysterectomy. Both studies report essentially the same conclusions. 1 - Quality of Life 1-2 years after UAE and after hysterectomy are essentially the same. This is the primary outcome and suggests that (at least at 1-2 years) UAE is as good as hysterectomy. 2 - When you consider secondary outcomes, UAE is generally better than hysterectomy - lower risk of significant or severe complications, faster recovery, shorter hospitalizations. 3 - There is an incidence of further interventions necessary after UAE that are not seen after hysterectomy - management of sloughing fibroids, patients who go on to myomectomy or even hysterectomy for a variety of reasons. These occur in ~10% of patients (which is what the UAE literature has said all along). 4 - Even considering the cost of all imaging studies and further interventions, UAE is much less of a burden on the system than hysterectomy - costing 1200-1400 Euros (US$1700-2000) less than hysterectomy per case. Given the differences in health-care systems this may or may not also be true in the USA. The conclusion of one of the presenters was that ALL patients with symptomatic fibroid disease should be evaluated for and (if appropriate) offered UAE, and that not to do so is an ethical breach. Both of these studies should be published in the peer-reviewed literature within the next 12-18 months (this is one reason why physicians go to meetings like this). I hope that everyone finds this helpful. |
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