The FAST-EU trial: 12-month clinical outcomes of women after intrauterine sonography-guided transcervical radiofrequency ablation of uterine fibroids

Abstract

The FAST-EU Trial was designed to establish the effectiveness and confirm the safety of transcervical intrauterine sonography-guided radiofrequency ablation with the VizAblate™ System in the treatment of symptomatic uterine fibroids. This was a multicenter, prospective, single-arm trial involving academic and community hospitals in the United Kingdom, the Netherlands, and Mexico. Women with qualifying uterine fibroids and heavy menstrual bleeding underwent intrauterine sonography-guided transcervical radiofrequency ablation (RFA) with the VizAblate System; anesthesia was individualized. Patients were required to have up to five fibroids from 1 to 5 cm in diameter. The primary trial endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months by an independent core laboratory. Secondary endpoints, evaluated at 6 and 12 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score, and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life (UFS-QOL) questionnaire, along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, nonsurgical reintervention for abnormal uterine bleeding, anesthesia regimen, patient satisfaction, and pain during the recovery period. An additional MRI study was performed at 12 months on a subgroup of patients. Fifty patients (89 fibroids) underwent transcervical radiofrequency ablation with the VizAblate System. At 3 and 12 months, perfused fibroid volumes were reduced from baseline by an average of 68.1 ± 28.6 and 67.4 ± 31.9 %, respectively, while total fibroid volumes were reduced from baseline by an average of 54.7 ± 37.4 and 66.6 ± 32.1 %, respectively (all P < .001 compared with baseline; Wilcoxon signed-rank test). At 12 months, mean MP score and SSS decreased by 53.8 ± 50.5 and 55.1 ± 41.0 %, respectively; the mean HRQOL score increased by 277 ± 483 %. There were four surgical reinterventions (8 %) within 12 months. This is the first report of the 12-month follow-up for patients in the FAST-EU Trial. In concert with previously reported 3- and 6-month endpoint data, the 12-month results of the FAST-EU Trial suggest that in addition to substantially reducing the perfused and total volume of targeted uterine fibroids, the VizAblate System is safe and effective through 12 months in providing relief of abnormal uterine bleeding associated with submucous, intramural, and transmural fibroids.

Radiofrequency Ablation of Uterine Fibroids: a Review

“…Brölmann et al [39] in 2016 reported 12-month results with the same device in 50 patients with 118 target fibroids (mean 2.4 fibroids/patient), fibroids with a mean fibroid diameter of 2.9 cm (range 1.0 to 6.9 cm). Ablations were achieved in 92 (78 %) of 118 target fibroids with an average reduction in perfused volume of 68.1 and 67.4% at 3 and 12 months, respectively.…”

Nonresective treatments for uterine fibroids: a systematic review of uterine and fibroid volume reductions

“…The commercial laparoscopic system (Acessa V R , (Halt Medical, Brentwood, CA) was associated with a 45.1% reduction in total fibroid volume at 12 months [16]. A transcervical device (the Sonata V R System, Gynesonics, Redwood City, CA), which is in commercial use in Europe and the United States, demonstrated a 66.6% reduction in total fibroid volume at 12 months [17,18]. Table 2 reports pooled data of fibroid volume reductions from the RFA studies.…”

Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review

“…Most charts referenced the scoring system of Higham et al and, to a lesser extent, Janssen et al, although several modifications were made. The brand(s) of sanitary products were stated for some PBACs [15,[41][42][43][44][45] but not for others [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65]. The icon illustrations were often different and/or the individual scores were altered, whether by error or by design [41, 43, 46-49, 51, 52, 55-57, 60-63, 66, 67].…”

“…50 points [15,[96][97][98]. Others have advocated a percentage reduction in score; values of 20-50% have been reported [36,58,59,63,[99][100][101][102][103][104][105]. If the treatment goal is amenorrhea (PBAC score < 2), the endpoint is clearly defined [54,[106][107][108][109].…”

“…Medical treatments designed to rapidly reduce MBL tend to have short follow-up times of between 1 month and 12 months [44,[110][111][112][113], whereas surgical interventions, such the levonorgestrel intrauterine system and endometrial ablation, are designed for long-term reduction of MBL. Monitoring of menstrual loss has been reported for up to 5 years after surgery at various time intervals, depending on the study [59,106,107,114]. The post-treatment time point(s) for MBL measurement should be clearly defined in the trial design.…”