BEIJING, Jan. 25 (Xinhuanet) -- A
new study suggests uterine artery embolization for the treatment of uterine
fibroids is not only less invasive than surgery, including hysterectomy, but
perhaps effective.
However, the study found there were some trade-offs
to the popular procedure. While embolization patients spent far less time in the
hospital, they also were more likely to need a repeat treatment.
Uterine fibroids are common among women of
child-bearing age. Nearly 40 percent develop these noncancerous growths in the
uterus that often don't cause any symptoms. While the most common treatment is
surgery to remove tumors that cause extreme pain, some women choose a gentler
procedure that allows them to keep their uterus.
Although the study did not address whether
embolization can preserve fertility, it adds to growing evidence that this less
drastic approach is a safe alternative to hysterectomy.
"For some women, retaining a uterus is much more
important than avoiding repeat surgery, particularly for younger women," said
Dr. James Spies, a Georgetown University radiologist who had no role in the new
research. Spies successfully treated Condoleezza Rice, who was then U.S.
national security adviser, with fibroid embolization in 2004.
Fibroids are noncancerous growths of muscle fibers
inside the uterus that can range from a quarter inch in size to as large as a
cantaloupe. In serious cases, uterine fibroids can cause heavy menstrual
bleeding, pelvic soreness and pain during sex.
For decades, hysterectomy -- removal of the uterus --
was the only option. Of the roughly 600,000 hysterectomies performed yearly in
the United States, about a third are due to fibroids.
Since the 1990s, the popularity of uterine artery
embolization has steadily grown. An estimated 13,000 to 14,000 embolizations are
done each year in the U.S., according to the Society of Interventional
Radiology.
The American College of Obstetricians and
Gynecologists says that while embolization is an option for women with fibroids,
there's not enough evidence to show that it's safe for women who want to get
pregnant.
The procedure involves making a small nick in the
groin and inserting a catheter in the artery. Using real-time imaging, doctors
then blast tiny pellets into the uterine artery to cut off the blood supply that
feeds the fibroids. Over time, these tumors shrink and die.
Patients typically stay overnight in the hospital and
are usually sedated or under local anesthesia during the procedure.
Embolization, which is covered by most major insurers, tends to be cheaper than
surgery at the outset. The costs even out during follow-up care, according to
various estimates.
The new study published in Thursday's New England
Journal of Medicine randomly assigned 106 women to embolization and 51 to
surgery. The patients were in 27 hospitals across the United Kingdom. Most in
the surgery group had hysterectomies while a few had myomectomies, surgical
removal of the fibroids while leaving the uterus intact. Many women can get
pregnant after having a myomectomy, but there's a chance the fibroids might
return.
Both groups of patients rated pain levels, mental
health and recovery process among other factors. After a year of follow-up,
researchers found no significant difference in the quality of life for either
group.
However, the embolization group recovered faster,
with the median hospital stay one day, compared with five days in the surgery
group.
Despite the faster recovery, 13 percent in the
embolization group were re-admitted to the hospital after a year, including 10
percent who needed a repeat procedure or hysterectomy because of recurrent
symptoms.
"The results of our study make clear that the choice
between surgery and uterine artery embolization ... involves trade-offs," wrote
lead author Richard Edwards of Gartnavel Hospital in Glasgow, Scotland.
The study had some limitations. The hysterectomies
performed involved making large incisions in the body that prolonged recovery
time. Advanced medicine now allows surgeons to make small cuts during the
operation, allowing for faster recuperation.
The study's re-treatment rate was higher than
statistics kept by a U.S. national registry.
The ideal candidate for embolization is a woman who
does not plan to get pregnant and whose symptoms make it risky for her to have
surgery, said Dr. Michael Miller, a Duke University radiologist who has
performed over 200 embolizations.
Since the safety of embolization and pregnancy is
still unknown, the first "line of treatment" for women who plan to have children
should be myomectomy, Dr. Togas Tulandi, a professor of obstetrics and
gynecology at McGill University in Canada, wrote in an editorial accompanying
the study.
(Agencies)