Uterine Fibroids: Response to novel treatment modalities

摘要

IntroductionudMagnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive, thermal ablation treatment for uterine fibroids. There is currently limited data regarding the long-term efficacy of this method and the effect of this treatment on circulating cytokine and growth factors.udIn this thesis I have:ud1. Presented the most accurate method of measuring fibroid volumes, and propose a new classification system for describing fibroid uteri.ud2. Reviewed the characteristics of a cohort of uterine fibroid subjects and perform a longitudinal analysis of MRgFUS results.ud3. Assessed the fibroid volume treated, pain scores and cytokine levels and growth factor levels following MRgFUS and UAE.udResultsudThe Parallel Plannimetric method is an accurate and reliable method of measuring uterine, fibroid and non-perfused volumes. Classifying fibroid uteri by numbers of fibroids and the presence of dominant fibroids is useful for distinguishing between those cases to be treated by MRgFUS or UAE. Since the introduction of MRgFUS to our unit the percentage non-perfused volumes (NPV) achieved have increased from 41.22 to 50.49 (p=0.038), however the re-intervention rate at 5 years remains high at 50%. MRgFUS has an excellent safety record, and the introduction of the new ExAblate 2100 system also appears to be safe and well tolerated, with encouraging initial NPVs achieved. Following both MRgFUS and UAE circulating interleukin-6 (IL-6) is significantly raised, although this is not affected by the degree of pain experienced or the volume of fibroid treated. Following UAE there is rise in circulating vascular endothelial growth factor (VEGF) seen at one week, however no significant change in VEGF levels is seen following MRgFUS. These changes in VEGF are not related to fibroid volume.udDiscussionudMRgFUS is a safe, well tolerated treatment for uterine fibroids, although re-intervention rate is high. Further developments in this treatment modality may continue to improve outcomes, however at present its routine use cannot be recommended.