• New possibilities in the treatment of uterine body myomas – HIFU-technology
To content

New possibilities in the treatment of uterine body myomas – HIFU-technology

HEALTH OF WOMAN. 2017.7(123):47–51; doi 10.15574/HW.2017.123.47

Kozarenko T. M., Karacharova I. Yu., Goncharenko V. N., Klyusov A. N., Govoruha Т. М.
SI «Institute of Nuclear Medicine and Radiation Diagnostics of NAMS of Ukraine», National Medical Academy of Postgraduate Education P.L. Shupika, Kyiv
Kyiv City Clinical Cancer Center, Center for Nuclear Medicine
KL «Feofaniya» DUS, Kiev

The technology of HIFU-ablation has a number of advantages in comparison with other methods of treatment of patients with uterine myoma, since it is non-invasive, organ-preserving, has no clinically significant general effect on the body, is not accompanied by a long period of rehabilitation and temporary disability.
The objective: was to increase the effectiveness of treatment of women with uterine myoma by optimizing the protocols of ultrasound ablation.
Patients and methods. The clinical material consisted of 90 remote ultrasound ablations for women diagnosed with «symptomatic myoma of the uterus body», which were performed at KMECC, the Center for Nuclear Medicine. The procedure was carried out on a JC apparatus (manufactured by: Chongqing Haifu (HIFU) Technology Co., Ltd., China).
Results. The power during treatment was 350±70 W, the total energy was 282 487±47 650 J, the average time of insonation was 765±137 s. With dynamic observation, the regression of the volume of myoma nodes on average averaged 25±14.6% after 1 month, 33±12.9% after 3 months, and 61±17.8% after 6 months. But 4 (9,7%) patients had an unsatisfactory effect after the procedure, and the treatment was continued. All patients recorded a decrease in clinical symptoms already in the first month after the procedure. When the procedure was performed, 5 (12.2%) patients had a first-degree skin burn, 14 (34.1%) women had a short-term increase in body temperature to 37.6°C on the day of the procedure, which stabilized independently in for 3 days, in 1 (2.4%) – cystitis.
The conclusion. The method is selective, does not damage surrounding tissues, thereby being safe for the endometrium, which is important for maintaining fertility. The area of fibrosis, which is formed after treatment and the regression process of the myoma node, is safe for further gestation. For the clinical evaluation of this method, its impact on the quality of life, immediate and long-term results, further accumulation and analysis of the clinical material is necessary.
Key words: uterine myoma, local adenomyosis, ultrasonic ablation, HIFU-technology, treatment.

REFERENCES

1. Burov AK, Andreevskaya GD. 1956. Vozdeystvie ultraakusticheskih kolebaniy vyisokoy intensivnosti na zlokachestvennyie opuholi u zhivotnyih i cheloveka. DAN SSSR. 106:445–448.

2. Gavrilov LR. 2010. Evolyutsiya moschnyih fokusiruyuschih sistem dlya primeneniya v razlichnyih oblastyah meditsinyi (obzor). Akust. zhurnal 6(56):844–861.

3. Gavrilov LR, Tsirulnikov EM. 1980. Fokusirovannyiy ultrazvuk v fiziologii i meditsine. L, Nauka:199.

4. Vishninskiy AA, Kurashvili YuB, Myishenkova SA. 2007. Tsvetovoe dopplerovskoe kartirovanie v otsenke effektivnosti lecheniya miomyi matki metodom FUZ-ablyatsii. Materialyi IX Vseros. nauch. foruma «Mat i ditya». M:696.

5. Kozarenko TM, Karacharova IIu, Honcharenko VM, Hovorukha TM, Kliusov OM. 2015. Optymizatsiia sonohrafichnykh kryteriiv vuzlovoi miomy matky dlia vyznachennia mozhlyvosti provedennia ultrazvukovoi abliatsii. Zdorove zhenshchynы 9(105):119–122.

6. Kozarenko TM, Karacharova IIu. 2016. Ultrazvukova abliatsiia (HIFU) – vysokotekhnolohichna alternatyva v likuvanni patsiientok iz miomoiu tila matky. Ukrainskyi Medychnyi Chasopys 5(115):58–59.

7. Lyadov KV, Sidorova IS, Kurashvili YuB i dr. 2008. Distantsionnaya neinvazivnaya ablyatsiya tkaney fokusirovannyim ultrazvukom pod kontrolem magnitno-rezonansnoy tomografii v lechenii miomyi matki (rukovodstvo dlya vrachey).

8. Clement GT. 2004. Perspectives in clinical uses of high-intensity focused ultrasound. Ultrasonics. 42(10):1087–1093. https://doi.org/10.1016/j.ultras.2004.04.003; PMid:15234170

9. Fruehauf JH, Back W, Eiermann A et al. 2008. High-intensity focused ultrasound for the targeted destruction of uterine tissues: experiences from a pilot study using a mobile HIFU unit. Archives of Gynecology and Obstetrics 277:143–50. https://doi.org/10.1007/s00404-007-0435-0; PMid:17823809

10. Gavrilov LR. 1984. Use of focused ultrasound for stimulation of nerve structures. Ultrasonics. 22;3:132–138. https://doi.org/10.1016/0041-624X(84)90008-8

11. Gavrilova-Jordan LP, Rose CH, Traynor KD et al. 2007. Successful term pregnancy following MR-guided focused ultrasound treatment of uterine leiomyoma. J. Perinatol. 27(1):59–61. https://doi.org/10.1038/sj.jp.7211624; PMid:17180132

12. Keshavarzi A, Vaezy S, Noble ML, Paun MK, Fujimoto VY. 2003. Treatment of uterine fibroid tumors in an in situ rat model using high-intensity focused ultrasound. Fertil. Steril. 80(2):761–767. https://doi.org/10.1016/S0015-0282(03)00783-0

13. Stewart E, Rabinovici J, Tempany C et al. 2006. Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids. Fertil Steril 85:22–29. https://doi.org/10.1016/j.fertnstert.2005.04.072; PMid:16412721

14. Theodore J. Dubinsky, Carlos Cuevas, Manjiri K. Dighe, Orpheus Kolokythas, Joo Ha Hwang. 2008. High-Intensity Focused Ultrasound: Current Potential and Oncologic Applications. AJR 190:191–199. https://doi.org/10.2214/AJR.07.2671; PMid:18094311