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Clinical predictors of successful magnetic resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma.

Gorny KR, Borah BJ, Weaver AL, Brown D, Woodrum DA, Stewart EA, Hesley GK - J Ther Ultrasound (2013)

Bottom Line: Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months.Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Uterine Fibroids, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA ; Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.

ABSTRACT

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) is a relatively new minimally invasive treatment, approved by the US Food and Drug Administration in 2004 for treatments of symptomatic uterine leiomyomas (fibroids). The purpose of this work is to present retrospective cohort analysis of women that underwent commercial MRgFUS treatment between 2005 and 2009 at a single center, to identify baseline patient characteristics that predict successful MRgFUS fibroid treatment. Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.

Methods: One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months. The main outcome measure of the follow-up was to identify patients who required additional fibroid treatment due to continued fibroid symptoms. Additionally, patient medical history and radiological findings obtained prior to MRgFUS were reviewed, and statistical analysis was performed to identify factors associated with reduced risk of having additional fibroid treatment.

Results: Twenty-nine patients (22.3%) underwent additional fibroid treatment due to continued or recurrent fibroid symptoms during the follow up. Cumulative incidence of additional fibroid treatment was 9.7%, 29.3%, and 44.7% at 1, 2, and 3 years following MRgFUS, respectively. In multivariable Cox proportional hazard regression analyses, older age (hazard ratio (HR) 0.54 per 5-year increase in age, 95% confidence interval 0.39 to 0.76, p < 0.001), greater number of fibroids (HR 0.19 for more than three vs. one fibroid, 95% CI 0.05 to 0.67, p = 0.033), and greater fibroid volume (HR 0.70 per doubling in volume, 95% CI 0.51 to 0.96, p = 0.025) were significantly associated with less risk of having additional fibroid treatment.

Conclusions: Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimates of cumulative incidence of additional fibroid treatment by age subgroups.
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Figure 1: Kaplan-Meier estimates of cumulative incidence of additional fibroid treatment by age subgroups.

Mentions: Table 3 summarizes patient and fibroid characteristics that were evaluated using univariate Cox models for an association with subsequent treatment for fibroids. As illustrated in Figure 1, women who were initially treated at an older age were significantly less likely to have subsequent treatment; the estimated hazard or risk ratio was 0.63 per 5-year increase in age (p = 0.003), implying that an increase in age of 5 years is associated with 37% less likelihood of having an additional procedure. Women with a history of pelvic or uterine surgery were 2.3 times more likely to have subsequent treatment for fibroids compared to women without a prior surgery (p = 0.042). In addition, (n = 7) women who previously used GnRH agonist (e.g., Lupron) therapy were 3.9 times more likely to have subsequent treatment for fibroids compared to (n = 123) women who never used GnRH agonist (p = 0.013). The median NPV values were not significantly between the two groups (115.7 (n = 7) vs. 126 (n = 123), Wilcoxon rank sum test p = 0.31).


Clinical predictors of successful magnetic resonance-guided focused ultrasound (MRgFUS) for uterine leiomyoma.

Gorny KR, Borah BJ, Weaver AL, Brown D, Woodrum DA, Stewart EA, Hesley GK - J Ther Ultrasound (2013)

Kaplan-Meier estimates of cumulative incidence of additional fibroid treatment by age subgroups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265948&req=5

Figure 1: Kaplan-Meier estimates of cumulative incidence of additional fibroid treatment by age subgroups.
Mentions: Table 3 summarizes patient and fibroid characteristics that were evaluated using univariate Cox models for an association with subsequent treatment for fibroids. As illustrated in Figure 1, women who were initially treated at an older age were significantly less likely to have subsequent treatment; the estimated hazard or risk ratio was 0.63 per 5-year increase in age (p = 0.003), implying that an increase in age of 5 years is associated with 37% less likelihood of having an additional procedure. Women with a history of pelvic or uterine surgery were 2.3 times more likely to have subsequent treatment for fibroids compared to women without a prior surgery (p = 0.042). In addition, (n = 7) women who previously used GnRH agonist (e.g., Lupron) therapy were 3.9 times more likely to have subsequent treatment for fibroids compared to (n = 123) women who never used GnRH agonist (p = 0.013). The median NPV values were not significantly between the two groups (115.7 (n = 7) vs. 126 (n = 123), Wilcoxon rank sum test p = 0.31).

Bottom Line: Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months.Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Uterine Fibroids, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA ; Department of Radiology, Mayo Clinic and Mayo Clinic College of Medicine, 200 First St, SW, Rochester, MN 55901, USA.

ABSTRACT

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) is a relatively new minimally invasive treatment, approved by the US Food and Drug Administration in 2004 for treatments of symptomatic uterine leiomyomas (fibroids). The purpose of this work is to present retrospective cohort analysis of women that underwent commercial MRgFUS treatment between 2005 and 2009 at a single center, to identify baseline patient characteristics that predict successful MRgFUS fibroid treatment. Identifying these clinical predictors of MRgFUS would be helpful to clinicians choosing the optimal patient for this treatment modality.

Methods: One hundred thirty women with symptomatic uterine leiomyomas who underwent MRgFUS were followed up with a mean length of follow up of 17.4 ± 10.3 months. The main outcome measure of the follow-up was to identify patients who required additional fibroid treatment due to continued fibroid symptoms. Additionally, patient medical history and radiological findings obtained prior to MRgFUS were reviewed, and statistical analysis was performed to identify factors associated with reduced risk of having additional fibroid treatment.

Results: Twenty-nine patients (22.3%) underwent additional fibroid treatment due to continued or recurrent fibroid symptoms during the follow up. Cumulative incidence of additional fibroid treatment was 9.7%, 29.3%, and 44.7% at 1, 2, and 3 years following MRgFUS, respectively. In multivariable Cox proportional hazard regression analyses, older age (hazard ratio (HR) 0.54 per 5-year increase in age, 95% confidence interval 0.39 to 0.76, p < 0.001), greater number of fibroids (HR 0.19 for more than three vs. one fibroid, 95% CI 0.05 to 0.67, p = 0.033), and greater fibroid volume (HR 0.70 per doubling in volume, 95% CI 0.51 to 0.96, p = 0.025) were significantly associated with less risk of having additional fibroid treatment.

Conclusions: Older age at treatment and having multiple fibroids with larger volume are associated with a lower risk of additional intervention following MRgFUS treatment for uterine fibroids.

No MeSH data available.


Related in: MedlinePlus