Oxytocin-Augmented and Non-Sedating High-Intensity–Focused Ultrasound (HIFU) for Uterine Fibroids Showed Promising Outcome As Compared To HIFU Alone or Uterine Artery Embolization

Yu, Simon C.H.; Cheung, Eva C. W.; Leung, Vivian; Fung, L.W. Eva

doi:10.1016/j.ultrasmedbio.2019.07.410

Cited by 18 publications

(14 citation statements)

References 12 publications

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“…Wang et al (34) compared the efficacy of HIFU and other uterine-sparing surgeries for the treatment of submucosal fibroids with an deep intramural extension, concluding that HIFU had lower re-intervention rates. Simon et al (35) implemented a novel HIFU treatment using a modified energy transmission and oxytocin augmentation, which resulted in lower re-intervention rates in comparison with UAE. Moreover, a few studies (36,37) pointed out that the ablation effect of HIFU could be enhanced by using a microbubble contrast agent, which could significantly increase the postoperative NPV ratio and reduce the incidence of recurrence of uterine fibroids.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Uterine fibroids are common benign tumors among premenopausal women. High- intensity focused ultrasound (HIFU) is an emerging non-invasive intervention which uses the high-intensity ultrasound waves from ultrasound probes to focus on the targeted fibroids. However, the efficacy of HIFU in comparison with that of other common treatment types in clinical procedure remains unclear.Objective: To investigate the comparative effectiveness and safety of HIFU with other techniques which have been widely used in clinical settings.Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing & Allied Health Literature, Web of Science, ProQuest Nursing & Allied Health Database, and three Chinese academic databases, including randomized controlled trials (RCTs), non-RCTs, and cohort studies. The primary outcome was the rate of re-intervention, and the GRADE approach was used to interpret the findings.Results: About 18 studies met the inclusion criteria. HIFU was associated with an increased risk of re-intervention rate in comparison with myomectomy (MYO) [pooled odds ratio (OR): 4.05, 95% confidence interval (CI): 1.82–8.9]. The results favored HIFU in comparison with hysterectomy (HYS) on the change of follicle-stimulating hormone [pooled mean difference (MD): −7.95, 95% CI: −8.92–6.98), luteinizing hormone (MD: −4.38, 95% CI: −5.17−3.59), and estradiol (pooled MD: 43.82, 95% CI: 36.92–50.72)]. HIFU had a shorter duration of hospital stay in comparison with MYO (pooled MD: −4.70, 95% CI: −7.46−1.94, p < 0.01). It had a lower incidence of fever (pooled OR: 0.15, 95% CI: 0.06–0.39, p < 0.01) and a lower incidence of major adverse events (pooled OR: 0.04, 95% CI: 0.00–0.30, p < 0.01) in comparison with HYS.Conclusions: High-intensity focused ultrasound may help maintain feminity and shorten the duration of hospital stay. High-quality clinical studies with a large sample size, a long-term follow-up, and the newest HIFU treatment protocol for evaluating the re-intervention rate are suggested to be carried out. Clinical decision should be based on the specific situation of the patients and individual values.

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

et al. 2021

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“…Therefore, T1-w contrast enhancement can reflect the blood perfusion status of uterine fibroids in predicting the effect of ablation [24]. As a practical consequence, studies have shown that for MRgHIFU [25] as well as USgHIFU [26], NPVR was larger after Representative MRI images (T2-w, sagittal plane) of large uterine fibroids show different signal intensities of the fibroids according to the Funaki classification scheme: Funaki type 1 (a) with very low T2-w intensity comparable to that of skeletal muscle, low vascularization; Funaki type 2 (b) with T2-w intensity between that of skeletal muscle and myometrium; Funaki type 3 (c, d) with heterogeneous T2-w intensity equal to or higher than that of the myometrium. additional intravenous oxytocin administration, which causes contraction of the fibroid leading to diminished vascularization.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study

Marinova

Ghaei

Recker

et al. 2021

International Journal of Hyperthermia

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Introduction: To evaluate treatment response of uterine fibroids after ultrasound guided high-intensity focused ultrasound (USgHIFU) with a special focus on fibroid size and characterization based on Funaki classification scheme, as well as clinical response to treatment of leading fibroid-associated symptoms. Materials and methods: Uterine fibroids treated by USgHIFU were assigned to Funaki type 1-3 based on T2-w-MRI. Differences in size, non-perfused volume ratio (NPVR) and volume reduction over time were determined using T1-/T2-w MRI sequences and contrast-enhanced sonography. Treatment effects on three leading fibroid-associated symptoms were also evaluated. Measurements were compared by mixed model, Bland-Altman's plot and Spearman's correlation. Results: In this prospective single-center study, 35 patients with 44 symptomatic uterine fibroids were treated by USgHIFU (n ¼ 22, n ¼ 12 and n ¼ 10 assigned to Funaki type 1, 2 and 3, respectively). NPVRs of Funaki type 1 and 2 fibroids were significantly higher compared to type 3 (p ¼ .0023). A significant fibroid shrinkage was observed independent of Funaki type compared to baseline: 38.8 ± 26.9%, 46.7 ± 30.3% and 54.5 ± 29.3% at 3, 6 and 12 months, respectively (each p < .05). Moreover, patients experienced a significant improvement of fibroid-associated hypermenorrhea (3.9 ± 1.3 vs. 2.3 ± 1.3), pressure in the pelvic area (3.5 ± 1.3 vs. 2.1 ± 0.9) and frequent urination (2.8 ± 1.5 vs. 1.9 ± 0.8) one year post-procedure (each p < .05), regardless of fibroid Funaki type. Conclusion: Following USgHIFU, a significant shrinkage of uterine fibroids and improvement of leading fibroid-associated symptoms were demonstrated regardless of the Funaki type.

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“…With the discovery of OTR in the non-gestational uterusOT has been used to promote uterine contraction of women with menorrhagia to reduce the amount of bleeding .OT has also been used to promote uterine contractions and reduce bleeding in laparoscopic or open myomectomy. In recent years, OT has also been used in HIFU ablation for uterine broids and adenomyosis to reduce the blood perfusion in the target area in real time and improve the acoustic environment to make ultrasonic energy deposition more effective [13][14][15] .Zhang Xin et al 16 compared the effect of intravenous infusion of OT and glucose on ultrasonic ablation for adenomyosis and the results showed that intravenous infusion of OT could effectively improve the non-perfused volume (NPV) rate and shorten the treatment time, but the ablation e ciency could not be improved with the increase of intravenous drip dose of OT (0.32U/min or 0.48U/min) 17 , and there is a lack of research comparison in lower dose group. With the saturation of OTR, stepping up the dose of OT may increase the adverse drug reactions.…”

Section: Introductionmentioning

confidence: 99%

Vascular effects and dose-effect relationship of higher-dose oxytocin on adenomyosis: a randomized controlled trial

Li¹,

Wang²,

Hu³

et al. 2021

Preprint

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Objective To assess the changes of blood flow in adenomyosis after higher-dose oxytocin(OT) in different doses,and to evaluate the safety for patients. Methods A total of 124 patients with adenomyosis were randomly divided into four groups with continuous intravenous infusion of oxytocin as 0.06U/min, 0.12U/min, 0.24U/min and 0.36U/min, respectively. The changes of arteries of adenomyosis before and after intravenous infusion of OT were observed by color Doppler ultrasound. The changes of blood flow volume of artery of adenomyosis before and after intravenous infusion of OT were compared among the four groups, and the vital signs and adverse drug reactions were monitored during intravenous drip. Results During the trial, no severe adverse reactions occurred and the vital signs of all the patients were stable. In the four groups of patients, compared with those before intravenous infusion of OT, except that there was no significant difference in the diameter of vessels around the lesion and the peak blood flow velocity within the lesion in the 0.06 U/min OT intravenous drip group (P༞0.05), the peak blood flow velocity, mean blood flow velocity, vascular diameter and blood flow volume decreased after intravenous drip of OT, while the resistance index increased, and the difference was statistically significant (P༜0.05). Among the four groups, it was found that there was significant difference in the change of blood flow volume of blood artery in adenomyosis lesions between 0.06 U/min OT group and the other three groups after intravenous drip of OT(P༜0.05), but there were no significant difference in blood flow volume among the three groups(P༞0.05), and the difference of adverse drug reactions was statistically significant with the increase of OT dose (P༜0.05). Conclusion Oxytocin can effectively reduce the blood flow volume of adenomyosis lesions, and continuous intravenous infusion of 0.12 U/min OT is an appropriate dose that can not only minimize the blood flow volume but also reduce the incidence of adverse drugreactions. Trial registration : Chinese Clinical Trial Registry (NO.ChiCTR1800017048).

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Oxytocin-Augmented and Non-Sedating High-Intensity–Focused Ultrasound (HIFU) for Uterine Fibroids Showed Promising Outcome As Compared To HIFU Alone or Uterine Artery Embolization

Cited by 18 publications

References 12 publications

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

Comparative Effectiveness and Safety of High-Intensity Focused Ultrasound for Uterine Fibroids: A Systematic Review and Meta-Analysis

Efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for uterine fibroids: an observational single-center study

Vascular effects and dose-effect relationship of higher-dose oxytocin on adenomyosis: a randomized controlled trial

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