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Starving Fibroids Staves Off Surgery

New technology treats fibroid tumors faster, easier

FRIDAY, July 6, 2001 (HealthDayNews) -- Most women with fibroid tumors can now say no to having a hysterectomy and opt for a far less traumatic treatment.

A new study shows that a new technique, which starves the tumors by cutting off their blood supply, works well in the short term and offers the same important long-term benefits of hysterectomy, with a faster, easier recovery.

Known as uterine artery embolization, the technique involves threading a thin tube into a large artery in the groin that leads to the major blood vessels of the uterus. Tiny particles are injected through the tube into the uterine blood vessels, which lead to the fibroids, says lead study author Dr. James Spies, chief of interventional radiology at Georgetown University Medical Center. The particles help form tiny clot-like blockages in the vessels, blocking nourishment for the tumors. Because the fibroids are rich in blood vessels, the particles rush to the growths, leaving other parts of the uterus unaffected.

"When the blood supply to the tumor is shut down, the fibroid can't survive so it eventually shrivels and dies," says Spies.

While the technique has been studied and used in the past, patient groups were small and follow-up was limited, he says. His study, which included some 200 women and a detailed three-year follow-up, resolved many questions about the procedure.

"In general we found that if a woman gets better from this procedure, and the fibroid does die, then it's likely she will have a good long-term benefit, with very few recurrences likely," says Spies.

Dr. Ziv Haskal, director of interventional radiology at Columbia-Presbyterian Medical Center, in New York City, says, "The results strongly substantiate the remarkably high rate of symptomatic improvement ... and their response rate for follow-up is something to be commended."

Haskal says, "There is almost nothing in medicine that has such a high satisfaction rate as was noted here. It's very good news for women."

Fibroid tumors are largely benign growths that develop in or around the uterus, usually during childbearing years. They range from the size of a pea to as large as a melon. They also can appear as a single growth or more often in clusters.

Some women with the tumors have no symptoms and no problems, while others experience pain, heavy menstrual bleeding, urinary problems, pain during sex and, in some instances, infertility.

For many years the treatment of choice was hysterectomy, complete removal of the uterus. In fact, studies show that fibroid tumors still are the most prevalent reason for the operation.

In recent years a second surgical procedure known as a myomectomy, which removes only the tumors, has become popular. Still, it is considered a major operation, often causing significant blood loss and usually requiring extensive recovery time.

Uterine artery embolization, however, is far less dramatic on all fronts.

"Most women were discharged within less than 24 hours after treatment, and most were able to return to their normal activities within eight days," says Spies. In comparison, both hysterectomy and myomectomy can require up to 10 days of hospitalization and up to six weeks of at-home recovery.

All women in the study were diagnosed with fibroid tumors of varying sizes and in varying amounts. All underwent imaging procedures including ultrasound and MRI, and each was treated with artery embolization. They were then sent detailed questionnaires two weeks, three months, six months and 12 months after treatment.

In addition, imaging was also done three months and 12 months after treatment, and any other gynecologic interventions during that time were recorded.

The average follow-up was 21 months, with a minimum of 12 months and a maximum of nearly 36 months. The results: Heavy bleeding abated in 87 percent of the women at three months, and in 90 percent after one year. Other symptoms, including pain, urination problems and pain during sex were gone in 93 percent of the patients at three months.

Only one patient reported a serious complication, a blood clot in the lung that was cleared with medication. Slightly more than 10 percent of the patients required an additional gynecologic treatment during follow-up, including five who required treatment for infection or severe bleeding.

The researchers say the technique does not work for every woman. The fibroid tumors in seven women in the study did not respond, and ultimately they had to have a hysterectomy.

Experts say women with extremely large or many fibroid tumors may benefit more from traditional treatment. They also cite a lack of evidence about whether the treatment interferes with future attempts to have a baby.

What To Do

To learn more about this new technique, click here or check the New York United Hospital Medical Center.

For a detailed image of how fibroid tumors look and to learn about other treatment options, click here.

SOURCES: Interviews with James B. Spies, M.D., chief, interventional radiology, Georgetown University Medical Center, Washington, D.C.; Ziv Haskal, M.D., director, interventional radiology, Columbia Presbyterian Medical Center, New York City; July 1, 2001, Obstetrics and Gynecology
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