UFE Supported in Journal Articles
August 17, 2009—Uterine fibroid embolization (UFE) was supported by articles published in the New England Journal of Medicine and the American Journal of Obstetrics and Gynecology.
On August 13, the Society of Interventional Radiology announced that a New England Journal of Medicine "Clinical Therapeutics" article by Scott C. Goodwin, MD, and James B. Spies, MD, highlighted UFE as an appropriate treatment (2009;361:690–697). The authors are fellows of the Society of Interventional Radiology.
"UFE is a safe, effective, and minimally invasive option for women to consider," commented Dr. Goodwin. "This is especially significant news for the more than 300,000 women who have hysterectomies performed annually in the United States to treat symptomatic uterine fibroids. Many of these women can confidently choose UFE, and this could significantly decrease the hysterectomy rate in the United States."
The article noted that the American College of Obstetricians and Gynecologists (ACOG) considers UFE a "safe and effective option for appropriately selected women." An ACOG practice bulletin noted that women who want to choose UFE "should have a thorough evaluation with an obstetrician-gynecologist to help facilitate optimal collaboration with the interventional radiologist and to ensure the appropriateness of therapy, taking into account the reproductive wishes of the patient." Dr. Goodwin added that women can be confident about UFE as a treatment option and that interventional radiologists can provide a second opinion and assess whether they are appropriate candidates for UFE.
The article includes a case review with treatment recommendations. It proceeds with a review of treatment benefits, major clinical studies, the clinical use of this treatment, and potential adverse effects—ending with the coauthors' clinical recommendations. In this case, a gynecologist had recommended a hysterectomy for a 45-year-old African American woman who had had an abnormally heavy and prolonged menstrual period and severe uterine pain during menstruation over the past 10 years. The woman did not want a hysterectomy and sought alternatives. She was referred to an interventional radiologist who ordered an MRI exam. Women typically undergo an ultrasound at their gynecologist's office as part of the evaluation process to determine the presence of uterine fibroids. An MRI has additional benefits, explained Dr. Goodwin. The Society of Interventional Radiology noted that 20% to 40% of women age 35 and older have uterine fibroids of a significant size and African American women are at a higher risk for fibroids.
"Publishing this information in the New England Journal of Medicine will further prompt physicians to discuss all treatment options, including UFE, for symptomatic uterine fibroids if they are not already doing so," said Dr. Goodwin. "A woman seeking treatment for her fibroids should be aware of all of her treatment options. UFE may be one of those options, and the best way to determine this is for the patient and gynecologist or primary care provider to consult with an interventional radiologist."
In an article published in the August issue of the American Journal of Obstetrics & Gynecology, Linda D. Bradley, MD, concluded that UFE is a safe, effective, and durable nonsurgical alternative to a hysterectomy (2009;201:127–135). The author noted that benign uterine fibroids, or leiomyomas, are the most common tumors found in gynecologic practice. Symptomatic fibroids present with menorrhagia, pelvic pain, leukorrhea, pressure and bloating, increased abdominal girth, and severe dysmenorrhea. Traditional treatment has relied on surgery, because long-term medical therapies have demonstrated only minimal response. Using particulate emboli to occlude the uterine arteries, UFE disrupts the blood supply to fibroids, leading to devascularization and infarction, which has been reported to be effective in alleviating fibroid-related symptoms, stated Dr. Bradley.
The article reviews the clinical research, discusses benefits and drawbacks, and presents recommendations for patient triage before UFE. Dr. Bradley also noted, "A collaborative and multidisciplinary practice between gynecologists and interventional radiologists represents state-of-the-art care for women with fibroids. With such an approach, our patients can give a truly informed consent."
This study was supported in part by BioSphere Medical, Inc. (Rockland, MA), which develops embolotherapy devices using bioengineered microspheres to treat uterine fibroids, hypervascularized tumors, and vascular malformations. Biosphere stated that Dr. Bradley's article is an excellent primer about UFE for gynecologists and primary care physicians and advocates the best practice of cross-specialty consultation and collaboration. UFE provides safe and effective clinical outcomes, low relative complications, a quick return to the activities of daily living, and favorable costs for the patients, providers, and payers, the company noted.