Laser Technique Shrinks Fibroids
|November 28, 2000
CHICAGO (AP) - Experimental technology that uses lasers to heat and shrink uterine fibroids is showing promise in helping women avoid hysterectomies or other surgery, doctors reported Monday.
About three out of four women of reproductive age will develop fibroids, which are non-cancerous tumors. They are among the most common reasons for hysterectomies, or surgical removal of the uterus. But surgeons sometimes try to remove just the fibroid and leave the uterus intact.
Laser ablation, which also is being tried in treating other tumors - including cancers of the liver, kidney and lung - is among the latest treatments that preserve the uterus.
"Basically, we're using laser fibers to heat up and liquefy the fibrous tissue," said radiologist Dr. Wladyslaw M. Gedroyc of St. Mary's Hospital in London, who studied the technique in 40 women and presented the findings Monday at a meeting of the Radiological Society of North America.
The technique successfully shrank fibroids in 35 of the women. At a six-month follow-up, fibroids had shrunk an average of 37 percent. All the women reported improvement in symptoms, including less abdominal pain and lighter menstrual periods.
Because the treatment targets only the fibroid, Gedroyc said it does not appear to affect fertility, but research is continuing to determine if patients can go on to have children.
Fibroids are bundles of muscle fiber and connective tissue that typically grow inside the uterus or uterine wall. Tiny ones generally cause no symptoms, but fibroids can become cantaloupe-sized and may cause severe abdominal and back pain, heavy menstrual bleeding, frequent urination and infertility. The female hormone estrogen promotes their growth; fibroids tend to shrink and disappear after menopause.
Gedroyc's patients had fibroids ranging from about 4 to 8 inches in diameter.
The technique involves inserting four skinny needles into the abdomen and guiding them to the fibroid with magnetic resonance imaging, which allows the doctor to pinpoint where to apply the heat. Laser fibers are then inserted through the needles into the fibroid, where they are heated to over 140 degrees to kill fibroid cells. Shrinkage continues until about six months after treatment, said co-researcher Dr. Penny Law.
The procedure, performed under light sedation, takes about two hours, and patients can go home four hours later, Gedroyc said.
The shrinkage Gedroyc found was less than others have reported with a technique called uterine artery embolization. That procedure, introduced in this country about three years ago, blocks off arteries feeding the uterus and has been performed in about 5,000 U.S. patients, though many insurance companies still consider it experimental and will not pay for it, said Dr. Adam Winick, a Johns Hopkins University radiologist.
Though even more experimental, the laser treatment is less painful and does not require an overnight stay, Gedroyc said.
Dr. Elizabeth Stewart, clinical director of the Center for Uterine Fibroids at Brigham and Women's Hospital in Boston, said the technique sounds promising but needs further study.
Using MRIs to guide the laser may give it an advantage over other treatments by providing doctors with more accuracy, Stewart said.
Gedroyc plans to start another phase of the study early next year using ultrasound to see if fibroids can be zapped without even breaking the skin. Other doctors are using the ultrasound technology in experiments on cancerous and non-cancerous breast tumors, an approach that promoters say could revolutionize tumor treatment.