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BJOG. 2018 Feb;125(3):354-364. doi: 10.1111/1471-0528.14689. Epub 2017 Jun 5.

Evaluation of high-intensity focused ultrasound ablation for uterine fibroids: an IDEAL prospective exploration study.

Author information

1
College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
2
The Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
3
Nuffield Department of Surgical Science, Oxford University, Oxford, UK.
4
Clinical Center for Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, Chongqing, China.
5
Department of Obstetrics and Gynaecology, Peking Union Medical College, Beijing, China.

Abstract

OBJECTIVE:

To evaluate the clinical outcomes of high-intensity focused ultrasound (HIFU) and surgery in treating uterine fibroids, and prepare for a definitive randomised trial.

DESIGN:

Prospective multicentre patient choice cohort study (IDEAL Exploratory study) of HIFU, myomectomy or hysterectomy for treating symptomatic uterine fibroids.

SETTING:

20 Chinese hospitals.

POPULATION OR SAMPLE:

2411 Chinese women with symptomatic fibroids.

METHODS:

Prospective non-randomised cohort study with learning curve analysis (IDEAL Stage 2b Prospective Exploration Study).

MAIN OUTCOME MEASURES:

Complications, hospital stay, return to normal activities, and quality of life (measured with UFS-Qol and SF-36 at baseline, 6 and 12 months), and need for further treatment. Quality-of-life outcomes were adjusted using regression modelling. HIFU treatment quality was evaluated using LC-CUSUM to identify operator learning curves. A health economic analysis of costs was performed.

RESULTS:

1353 women received HIFU, 472 hysterectomy and 586 myomectomy. HIFU patients were significantly younger (P < 0.001), slimmer (P < 0.001), better educated (P < 0.001), and wealthier (P = 0.002) than surgery patients. Both UFS and QoL improved more rapidly after HIFU than after surgery (P = 0.002 and P = 0.001, respectively at 6 months), but absolute differences were small. Major adverse events occurred in 3 (0.2%) of HIFU and in 133 (12.6%) of surgical cases (P < 0.001). Median time for hospital stay was 4 days (interquartile range, 0-5 days), 10 days (interquartile range, 8-12.5 days) and 8 days (interquartile range, 7-10 days).

CONCLUSIONS:

HIFU caused substantially less morbidity than surgery, with similar longer-term QoL. Despite group baseline differences and lack of blinding, these findings support the need for a randomised controlled trial (RCT) of HIFU treatment for fibroids. The IDEAL Exploratory design facilitated RCT protocol development.

TWEETABLE ABSTRACT:

HIFU had much better short-term outcomes than surgery for fibroids in 2411-patient Chinese IDEAL format study.

KEYWORDS:

Fibroid; learning curve; trial methodology; ultrasound

Comment in

PMID:
28421665
DOI:
10.1111/1471-0528.14689
[Indexed for MEDLINE]
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