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Uterine Myoma Position-based Radiofrequency Ablation (UMP-b RFA): 36 months follow-up clinical outcomes

Published:December 06, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.12.006

      Abstract

      Objective

      To assess the efficacy of Uterine Myoma Position-based Radiofrequency Ablation (UMP-b RFA) at 36 months. An analysis of a new uterine fibroid ablation technique that allows personalized access of delivering radiofrequency energy (transvaginal, hysteroscopic or laparoscopic) based on myoma localization.

      Study Design

      Prospective observational cohort study in a community-based secondary care medical center enrolled 61 premenopausal women with 112 symptomatic uterine myomas. 112 fibroids were ablated in 5 ways with single or combined accesses: 82 Vaginal Ultrasound (VU)-guided RFA, 19 Laparoscopic (L)-RFA, 5 Hysteroscopic (H)-RFA, 5 VU+H-RFA, and 1 VU+L-RFA. The primary endpoint of this study was to evaluate the 3-year clinical outcome of UMP-b RFA. The secondary endpoint was the possible identification of predictors of its success. The outcomes evaluated at 12, 24, and 36 months after UMP-b RFA were myoma size, type of symptomatology suffered, quality of life based on the “Uterine Fibroid Symptom and Quality of Life” questionnaire, and interviews on the degree of satisfaction with this surgery. The reintervention and complication rates were also recorded and analyzed.

      Results

      Fibroids volume and diameter were significantly reduced by −90.2 % / −55.7 % at 36 months post-intervention (p < 0.001) and the reduction of Symptom Severity scores was −71.8 % three years after UMP-b RA (p < 0.001). The overall improvement in the quality of life was demonstrated by an increase in the Quality-of-Life score of + 26.0 % at the third follow-up (p < 0.001). 88.5 % of the patients interviewed would have the surgery done again if they went back in time. The reintervention rate was 10/61 (16.4 %): 3 hysterectomies, 3 myomectomies, 3 operative hysteroscopies and 1 VU-RFA reoperation. In this group of unsuccessful surgeries, the mean diameter of the dominant myomas was found to be greater than that of the successes (5.3 vs 4.4 cm.). Out of the 61 cases, no major complications occurred, and the 2 minor complications observed were self-limiting.

      Conclusion

      Uterine Myoma Position-based Radiofrequency Ablation is a safe, effective, and minimally invasive solution for the treatment of symptomatic fibroids. Indeed, these clinical outcome data at 36 months shows how UMP-b RFA can treat the symptomatology of uterine fibromatosis. Hysterectomies or myomectomies were successfully avoided in more than 80 % of women bearing myomas with an average diameter of less than 5 cm.

      Keywords

      Abbreviation:

      RFM (RadioFrequency Myolysis)
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      References

        • Downes E.
        • Sikirica V.
        • Gilabert-Estelles J.
        • Bolge S.C.
        • Dodd S.L.
        • Maroulis C.
        • et al.
        The burden of uterine fibroids in five European countries.
        Eur J Obstet Gynecol Reprod Biol. 2010; 152 (Available from:): 96-102https://doi.org/10.1016/j.ejogrb.2010.05.012
        • Dolmans M.M.
        • Donnez J.
        • Fellah L.
        Uterine fibroid management: today and tomorrow.
        J Obstet Gynaecol Res. 2019; 45: 1222-1229
        • Gracia M.
        • Carmona F.
        Uterine myomas: clinical impact and pathophysiological bases.
        Eur J Obstetr Gynecol Reprod Biol. 2019; 2020 (Available from:)https://doi.org/10.1016/j.ejogrb.2020.01.043
        • Cope A.G.
        • Young R.J.
        • Stewart E.A.
        Non-extirpative treatments for uterine myomas: measuring success.
        J Minimally Invas Gynecol. 2021; 28 (Available from:): 442-452.e4https://doi.org/10.1016/j.jmig.2020.08.016
        • Lee B.B.
        • Yu S.P.
        Radiofrequency ablation of uterine fibroids: a review.
        Curr Obstetr Gynecol Rep. 2016; 5 (Available from:): 318-324https://doi.org/10.1007/s13669-016-0183-x
        • Kim G.A.
        • Shim J.H.
        • Kim M.J.
        • Kim S.Y.
        • Won H.J.
        • Shin Y.M.
        • et al.
        Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas.
        Br J Surg. 2016; 103: 126-135
        • Takaki H.
        • Nakatsuka A.
        • Uraki J.
        • Yamanaka T.
        • Fujimori M.
        • Hasegawa T.
        • et al.
        Renal cell carcinoma: radiofrequency ablation with a multiple-electrode switching system–a phase II clinical study.
        Radiology. 2013; 267 (Available from): 285-292
        • Turtulici G.
        • Orlandi D.
        • Corazza A.
        • Sartoris R.
        • Derchi L.E.
        • Silvestri E.
        • et al.
        Percutaneous radiofrequency ablation of benign thyroid nodules assisted by a virtual needle tracking system.
        Ultrasound Med Biol. 2014; 40: 1447-1452
        • Bradley L.D.
        • Pasic R.P.
        • Miller L.E.
        Clinical performance of radiofrequency ablation for treatment of uterine fibroids: systematic review and meta-analysis of prospective studies.
        J Laparoendosc Adv Surg Tech. 2019; 29: 1507-1517
      1. Kronche T, David M. MR-Guided Focused Ultrasound * in Fibroid Treatment – Results of the 4 th Radiological-Gynecological Expert Meeting Magnetresonanz-geführter fokussierter Ultraschall * zur Expertentreffens Structural requirements for performing MRgFUS treatment Examinatio. 2019;626–9.

        • Ierardi A.M.
        • Savasi V.
        • Angileri S.A.
        • Petrillo M.
        • Sbaraini S.
        • Pinto A.
        • et al.
        Percutaneous high frequency microwave ablation of uterine fibroids.
        Systematic Review. 2018;
        • Zupi E.
        • Centini G.
        • Sabbioni L.
        • Lazzeri L.
        • Argay I.M.
        • Petraglia F.
        Nonsurgical Alternatives for Uterine Fibroids.
        Clinical Obstetrics and Gynaecology, Best Practice and Research2016
        • Sandberg E.M.
        • Tummers F.H.M.P.
        • Cohen S.L.
        • van den Haak L.
        • Dekkers O.M.
        • Jansen F.W.
        Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis.
        Fertil Steril. 2018; 109 (Available from:): 698-707.e1https://doi.org/10.1016/j.fertnstert.2017.11.033
        • Fasciani A.
        • Turtulici G.
        • Siri G.
        • Ferrero S.
        • Sirito R.
        A Prospective Intervention Trial on Tailored Radiofrequency Ablation of Uterine Myomas. 2020; : 1-11
        • Munro M.G.
        • Critchley H.O.D.
        • Broder M.S.
        • Fraser I.S.
        FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age.
        Int J Gynecol Obstetr. 2011; 113 (Available from:): 3-13https://doi.org/10.1016/j.ijgo.2010.11.011
        • Spies J.B.
        • Coyne K.
        • Guaou Guaou N.
        • Boyle D.
        • Skyrnarz-Murphy K.
        • Gonzalves S.M.
        The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata.
        Obstet Gynecol. 2002; 99: 290-300
        • Turtulici G.
        • Orlandi D.
        • Dedone G.
        • Mauri G.
        • Fasciani A.
        • Sirito R.
        • et al.
        Ultrasound-guided transvaginal radiofrequency ablation of uterine fibroids assisted by virtual needle tracking system: a preliminary study.
        Int J Hyperthermia. 2018; (Available from): 1-8
        • Ciavattini A.
        • Delli Carpini G.
        • Clemente N.
        • Moriconi L.
        • Gentili C.
        • Di Giuseppe J.
        Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study.
        Fertil Steril. 2016; 105: 1255-1260
        • Gomez E.
        • Nguyen M.L.T.
        • Fursevich D.
        • Macura K.
        • Gupta A.
        MRI-based pictorial review of the FIGO classification system for uterine fibroids.
        Abdom Radiol. 2021; 46 (Available from:): 2146-2155https://doi.org/10.1007/s00261-020-02882-z