Improvement of fibroid-associated symptoms and quality of life after US-guided high-intensity focused ultrasound (HIFU) of uterine fibroids

Abstract

Uterine fibroids are the most common benign uterine tumors and can cause various severe symptoms as abnormal menstrual bleeding or pelvic pain. Therefore, the primary objective in the treatment of uterine fibroids is a sufficient symptom relief. Ultrasound (US)-guided High-intensity focused ultrasound (HIFU) is an effective non-invasive treatment strategy for ablation of uterine fibroids that can achieve a significant tumor volume reduction. The aim of the study is to evaluate if US-guided HIFU treatment can reduce fibroid-associated symptoms leading to an improvement of health-related quality of life. Fifty-five women with symptomatic uterine fibroids underwent US-guided HIFU ablation. Clinical evaluation was performed on the basis of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) at baseline, 6 weeks, 3, 6, 9 and 12 months after HIFU. Imaging follow-up included contrast-enhanced ultrasound (CEUS) and contrast-enhanced MRI. A significant reduction of the Symptom Severity Scale (SSS) was observed between 6 weeks and 12 months after HIFU (49.9 ± 19.4 at baseline vs. 42.2 ± 20.1 at 6 weeks and 23.6 ± 12.7 at 12 months after treatment, p < 0.001) correlating with a significant improvement (p < 0.001) of Health-related Quality of Life (HRQL) (52.5 ± 22.7 at baseline vs. 59.8 ± 22 at 6 weeks and 77.9 ± 17.3 at 12 months after treatment). Significant postinterventional improvement was observed in every subscale of HRQL. In the majority of patients, only minor, short-lasting and self-limiting side effects were observed, e.g. soft tissue edema of the anterior lower abdominal wall in the acoustic pathway or transient moderate lower abdominal pain as during menstruation. One patient with a very large fibroid experienced strong short-lasting pain after the procedure; two patients experienced post-procedurally a transient sciatic nerve irritation. US-guided HIFU of uterine fibroids reduces disease-related symptoms and improves health-related quality of life.

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU)

“…Side effects are rare and less frequent than after surgical procedures like myomectomy and hysterectomy [ 16 ]. Moderate pain during the procedure, which is performed under conscious sedation, may last for a few hours in some cases, and cutaneous/subcutaneous edema of the anterior lower abdominal wall in the acoustic pathway are common side effects [ 21 ]. However, fever, urinary tract infections, hematuria, bowel lesions, and back pain are possible, but these are very rare nowadays.…”

The advantages of focused ultrasound ablation for uterine fibroids and the use of MRI in management

“…Ultrasound (US) guided high-intensity focused ultrasound (HIFU) is an effective non-invasive treatment strategy for uterine fibroid ablation that significantly reduces tumor volume, and the results of HIFU for uterine fibroids have been shown to be repeatable and a promising therapeutic alternative. It has the advantages of accuracy, non-inventiveness, rapid recovery, preservation of uterus and fertility [10][11][12][13][14] . Tonguc et al [12] followed up 55 patients with symptomatic uterine fibroids after HIFU treatment at 6 weeks, 3, 6, 9 and 12 months, respectively.…”

“…It has the advantages of accuracy, non-inventiveness, rapid recovery, preservation of uterus and fertility [10][11][12][13][14] . Tonguc et al [12] followed up 55 patients with symptomatic uterine fibroids after HIFU treatment at 6 weeks, 3, 6, 9 and 12 months, respectively. Clinical assessment was conducted according to uterine fibroid symptoms and health-related quality of Life Questionnaire (UFS-QOL), and imaging follow-up was conducted according to contrast-enhanced ultrasound (CEUS) and MRI.…”

Numerical Study on the Application of Near-Infrared Temperature Distribution Measurement of HIFU

“…High-intensity focused ultrasound (HIFU) is an emerging tumor treatment method with the potential for a wide range of medical applications due to its non-invasive nature. In clinical practice, HIFU technology can be used in various treatment areas, including the thermal ablation of uterine fibroids [1], thrombolysis [2], drug delivery [3], and gene activation [4]. This technique utilizes the propagation of ultrasound waves within the human body to convert the mechanical energy of ultrasound into thermal energy.…”