Uterine Artery Embolization or MRI-guided Focused Ultrasound for Uterine Leiomyoma Treatment?
BACKGROUND AND PURPOSE:
Laughlin-Tommaso et al. (AJOG, 2019) compared uterine artery embolization vs MRI-guided focused ultrasound surgery for the treatment of fibroids
Randomized controlled trial (RCT)
Fibroid Interventions: Reducing Symptoms Today and Tomorrow study (FIRSTT) study
Women who declined to be randomized were also followed as a observational cohort group
Symptomatic uterine fibroids
Women either received
Uterine artery embolization
MRI-guided focused ultrasound surgery
Primary outcome: Re-intervention for fibroids within 36 months
Change in serum AMH levels to assess ovarian function | Fibroid symptoms | Quality of life | Pain | Sexual function
Results analyzed using a comprehensive cohort design
83 women (mean age, 44.4 years) were treated and analyzed using the comprehensive cohort design
43 in the magnetic resonance imaging–guided focused ultrasound surgery group
40 in the uterine artery embolization group
Baseline characteristics the same between treatment groups, except for higher fibroid load in the uterine artery embolization arm
The MRI ultrasound group had a higher risk of reintervention
Hazard ratio (HR) 2.81 (95% CI, 1.01–7.79)
Uterine artery embolization showed a significantly greater absolute decrease in AMH levels at 24 months compared with MRI ultrasound group (P=0.03)
While quality of life and pain scores improved in both arms, uterine artery embolization arm showed greater benefit (P≤0.006)
Differences persisted even after adjusting for baseline quality of life and pain scores
Higher pretreatment AMH level and younger age at treatment increased the overall risk of reintervention
Authors acknowledge a limitation of this study is that they did not meet their desired sample size and many women preferred to be in an observational cohort rather than be randomized
Uterine artery embolization led to lower uterine leiomyoma associated re-intervention rates and greater improvement in symptoms, compared to MRI-guided ultrasound
AMH was a predictor of outcome and authors suggest that impairment of ovarian reserve may mediate fibroid treatment
More robust ovarian reserve may mitigate the treatment effect
Authors also point out that since the study’s completion, there is newer technology available for MRI-guided ultrasound surgery and reintervention rates may be more comparable to uterine artery embolization
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