Oxytocin and Misoprostol With Diclofenac in the Preparation for Magnetic Resonance–Guided High-Intensity Ultrasound Treatment of Symptomatic Uterine Fibroids: A Prospective Cohort Study

• Main Authors: Ciebiera, M. (Author), Filipowska, J. (Author), Kluz, T. (Author), Łoziński, T. (Author), Ludwin, A. (Author), Węgrzyn, P. (Author), Zgliczyńska, M. (Author)
• Format: Article
• Language: English
• Published: Elsevier Inc. 2021
• Subjects: adult; Adult; Article; clinical effectiveness; clinical outcome; cohort analysis; Cohort Studies; Combined Modality Therapy; computer assisted surgery; controlled study; diclofenac; Diclofenac; drug combination; Drug Combinations; drug effect; drug efficacy; female; Female; gynecological examination; HIFU; high intensity focused ultrasound; High intensity ultrasounds; High-Intensity Focused Ultrasound Ablation; human; Humans; interventional magnetic resonance imaging; leiomyoma; Leiomyoma; magnetic resonance guided high intensity focused ultrasound; Magnetic resonance imaging; Magnetic Resonance Imaging, Interventional; Magnetic resonance–guided focused ultrasound; Magnetic resonance–guided focused ultrasound (MRgFUS); Magnetic resonance–guided high-intensity ultrasound (MR-HIFU); Magnetism; major clinical study; medical parameters; misoprostol; Misoprostol; multimodality cancer therapy; non perfused volume; oxytocin; Oxytocin; Patient treatment; preoperative period; Preoperative Period; priority journal; procedures; Prospective Studies; prospective study; Sonication; Surgery, Computer-Assisted; Ultrasonics; Ultrasound; Uterine fibroid; Uterine fibroids; Uterine Neoplasms; uterus cancer; uterus myoma; Volume change; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 Uterine fibroids (UFs) are very common benign tumors of the female reproductive tract. According to recent reports, magnetic resonance–guided high-intensity ultrasound (MR-HIFU) appears to be a well-tolerated and efficient treatment option for UFs. However, MR-HIFU still presents several limitations. The treatment is rarely associated with achieving complete non-perfused volume (NPV). Not all patients are qualified for a final procedure, and selected women obtain very good results in such treatment. The primary objective of this experimental study was to assess the effect of transvaginal misoprostol and intravenous oxytocin preparation on UF volume change, sonication time and NPV after MR-HIFU procedure in women of reproductive age with symptomatic UFs. Secondary outcomes included the effect on the peri-procedural effectiveness of misoprostol and oxytocin. This study enrolled 247 women with symptomatic UFs; based on gynecologic examinations and magnetic resonance imaging (MRI) scans, 128 women qualified for MR-HIFU without pharmacologic treatment, 57 women qualified for the misoprostol/diclofenac group and 62 women qualified for the oxytocin group. Pharmacologic pre-treatment improved NPV compared with non-pharmacologic treatment (average NPV: controls 61.9% ± 25.8%; oxytocin 76.8% ± 20.7%; misoprostol/diclofenac 85.2% ± 15.1%; average sonication time: controls 120 min ± 56.4%; oxytocin 111 min ± 45.4%; misoprostol/diclofenac 80 min ± 47.7%). Statistical analysis did not reveal significant intergroup differences in UF volume changes after 6 mo (controls: n = 40, 37.4% ± 27.5%; oxytocin n = 25, 45.8% ± 31%; misoprostol/diclofenac n = 19, 33.4% ± 23.2%). The misoprostol/diclofenac group, which achieved the highest NPV immediately after the MR-HIFU procedure, was characterized by the lowest UF volume change percentages 6 mo later. The administration of vasoconstrictor drugs (oxytocin and misoprostol/diclofenac) to support MR-HIFU in UF treatment is a new issue that may improve the total effectiveness of this method. Randomized controlled trials are necessary to estimate the real effect of vasoconstrictors on MR-HIFU. © 2021 The Authors