Fibroid treatment outcomes vary with embolic agent

The message of a Monday morning interventional session at the RSNA meeting was clear: When it comes to embolization of uterine fibroids, all embolic agents are not created equal.

The success of uterine artery embolization (UAE), a minimally invasive treatment for fibroids, can be related to the type of embolic agent used, according to research conducted at Yale University Medical Center. Some agents show better results than others, said presenter Jorge Galvez.

The finding has important implications for women. Uterine fibroids are the most common type of tumor in the female reproductive system. Treatment options include hysterectomy and myomectomy, which removes the fibroids while sparing the uterus. Interest is growing in alternatives such as UAE, however, provided that treatment proves to be effective in the long term.

The Yale researchers compared long-term results, including recurrence of fibroids and fibroid-related symptoms, for UAE performed with three different agents:

• polyvinyl alcohol particles (PVA)

• gelatin microspheres (GM)

• polyvinyl alcohol spheres (sPVA)

sPVA has a smaller particle size than PVA.

The Yale study involved 247 women treated for UAE between 1999 and 2004. Of these, 101 patients met the inclusion criteria.

The researchers examined gadolinium-enhanced MR studies to assess fibroid volume six months (on average) after the UAE procedure. Residual enhancement on MRI indicated incomplete infarction of fibroids. They also surveyed patients about recurrence of symptoms and quality of life 27 months (on average) after the UAE.

With PVA, there was residual enhancement in 41% of cases and complete infarction in 59%. When sPVA was used, residual enhancement occurred in 75% of cases and complete infarction in 25%. With GM, residual enhancement was evident in 22% of cases and complete infarction in 78%.

The differences between sPVA and PVA, as well as between SPVA and GM, were statistically significant, Galvez said.

"Patients with sPVA were at higher risk of residual enhancement than those with PVA or GM," he said.

The patient survey also showed differences in recurrence of symptoms, but these differences were not statistically significant.

During the session, Galvez was presented with the Trainee Research Prize - Medical Student for his work on this study.