Pregnancy outcome after magnetic resonance–guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids

Rabinovici, Jaron; David, Matthias; Fukunishi, Hiroaki; Morita, Yutaka; Gostout, Bobbie S.; Stewart, Elizabeth A.

doi:10.1016/j.fertnstert.2008.10.001

Cited by 216 publications

(146 citation statements)

References 42 publications

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“…Larger intramural fibroids can be treated through myomectomy for women who desire fertility; focused ultrasonographic therapy is also an option if patients are counseled about the limited but promising fertility data. [21][22][23] Uterine artery embolization and hysterectomy are effective treatments that are recommended for women who have completed childbearing. 24,25 AUB AssociAted WitH AnovUlAtory cycles Anovulatory cycles are caused by a disturbance of the normal hypothalamic-pituitary-ovarian axis, resulting in an absent luteal phase and failure of the ovary to produce the increased progesterone levels needed for endometrial stabilization.…”

Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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). © 2011 Mayo Foundation for Medical Education and ResearchB reast cancer is the leading cause of cancer death in women in the United States who are aged 20 to 59 years. 1 In 2010, an estimated 207,090 new cases of breast cancer were identified in the United States. 2 Although breast cancer risk increases with age, approximately 35% of breast cancers occur during the reproductive and perimenopausal years. 3 The 5-year relative survival rate for women of all ages with breast cancer diagnosed between 1999 and 2005 is 89%. 3 Of the premenopausal breast cancers diagnosed, approximately 58% are both estrogen receptor (ER) and progesterone receptor (PR) positive, 6% are ER positive only, 17% are PR positive only, and 20% are both ER and PR negative. 4 The management and treatment of breast cancer in premenopausal women can affect menstruation, reproduction, and gynecologic health. Breast cancer treatment can have a marked affect on fertility in women who have delayed childbearing and have fewer remaining reproductive years. Among premenopausal women with breast cancer, more than 50% wish to retain their fertility. 5 AUB = abnormal uterine bleeding; E2 = estradiol; EA = endometrial ablation; EC = endometrial cancer; ER = estrogen receptor; FDA = Food and Drug Administration; GnRH = gonadotropin-releasing hormone; IUD = intrauterine device; LNG = levonorgestrel; NSAID = nonsteroidal anti-inflammatory drug; PR = progesterone receptor; SHBG = sex hormone-binding globulin gynecologic issues and conditions are prevalent in reproductive-age women. In the general population, more than 30% of reproductive-age women fulfill criteria for the diagnosis of menorrhagia, 6 25% have symptomatic fibroids, 7 and nearly 67% have an underlying uterine disorder with potential to cause abnormal uterine bleeding (AUB). 8 Among premenopausal women with breast cancer, management of menstrual disorders, contraception, vasomotor symptoms, and fertility presents a challenge. Common and effective hormonal options are less well studied in this population because of significant concern about recurrence of breast cancer. Herein,we present the challenges and discuss management options for young women with breast cancer who present with various common gynecologic conditions.Articles for this review were identified by searching the PubMed database with no date limitations. PREMENoPAUSAL SEx STERoIDS AND THEIR PHARMACoLoGyPhysiologically, premenopausal women with regular cycles have cyclic variation in levels of estradiol (E2) (15-350 pg/ mL [to convert to pmol/L, multiply by 3.671]) and progesterone (0.2-27 ng/mL [to convert to nmol/L, multiply by 3.18]). These "free" (unbound) hormones are biologically active and can enter a target cell and activate its receptor.

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Section: Aub Caused By Anatomic Abnormalitiesmentioning

confidence: 99%

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Bakkum-Gamez

Laughlin

Jensen

et al. 2011

Mayo Clinic Proceedings

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“…Women with the desire for future pregnancy were counseled with respect to the limited data for pregnancy after MRgFUS treatment. 17 Relative exclusion criteria, according to the screening MRI examination, were extensive scars within the anterior abdominal wall, bowel interposed along the ultrasound beam pathway, and fibroids located near the sacral surface.…”

Section: Patientsmentioning

confidence: 99%

Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids

Trumm¹,

Stahl²,

Clevert³

et al. 2013

Investigative Radiology

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Objectives: The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)Yguided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. Materials and Methods: This is a retrospective analysis of 115 women (mean age, 42 years; range, 27Y54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean T SD total volume and number of treated fibroids (per patient) were 89 T 94 cm 3 and 2.2 T 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Results: Magnetic resonance imagingYguided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% T 15% (range, 38%-100%). Mean applied energy level was 5400 T 1200 J, and mean number of sonications was 74 T 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. Conclusions: With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

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“…This has since been removed, as there have been more than 54 post FUS pregnancies reported world-wide, with a high rate of successful full term delivered pregnancies [32]. This data would suggest that MRgFUS is a safe fibroid treatment option in women who decide to become pregnant, as there are no significant complications from the procedure in women seeking pregnancy as with existing fibroid therapies.…”

Section: Clinical Outcome With Mrgfusmentioning

confidence: 95%

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

Fennessy

Tempany

2013

Curr Radiol Rep

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Magnetic resonance-guided high focused ultrasound surgery (MRgFUS) is a non-invasive treatment option for uterine fibroids. In addition to offering excellent anatomical depiction of the uterine fibroids and uterus, magnetic resonance imaging offers functional imaging and thermal guidance for safe delivery of the focused ultrasound beam. Once appropriately selected for treatment, this out patient treatment option is well tolerated by patients and results in sustained symptom relief. More recent advances in this technology allows for quicker treatment times, allowing for greater nonperfused volumes to be attainable within the allotted scanner time. Also, upon review of fibroid and patient characteristics, the optimal candidates for successful MRgFUS are becoming more established.

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Pregnancy outcome after magnetic resonance–guided focused ultrasound surgery (MRgFUS) for conservative treatment of uterine fibroids

Cited by 216 publications

References 42 publications

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Challenges in the Gynecologic Care of Premenopausal Women With Breast Cancer

Magnetic Resonance Imaging–Guided Focused Ultrasound Treatment of Symptomatic Uterine Fibroids

An Update on Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of Uterine Fibroids

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