New Laser Technique Shrinks Uterine Fibroids

C H I C A G O, Nov. 28, 2000 -- Experimental technology that uses lasers to heat

and shrink uterine fibroids is showing promise in helping women

avoid hysterectomies or other surgery, doctors reported.

About three out of four women of reproductive age will developfibroids, which are non-cancerous tumors. They are among the mostcommon reasons for hysterectomies, or surgical removal of theuterus. But surgeons sometimes try to remove just the fibroid andleave the uterus intact.

Laser ablation, which also is being tried in treating othertumors — including cancers of the liver, kidney and lung — is amongthe latest treatments that preserve the uterus.

“Basically, we’re using laser fibers to heat up and liquefy thefibrous tissue,” said radiologist Dr. Wladyslaw M. Gedroyc of St.Mary’s Hospital in London, who studied the technique in 40 womenand presented the findings Monday at a meeting of the RadiologicalSociety of North America.

Technique Seems Successful

The technique successfully shrank fibroids in 35 of the women.At a six-month follow-up, fibroids had shrunk an average of 37percent. All the women reported improvement in symptoms, includingless abdominal pain and lighter menstrual periods.

Because the treatment targets only the fibroid, Gedroyc said itdoes not appear to affect fertility, but research is continuing todetermine if patients can go on to have children.

Fibroids are bundles of muscle fiber and connective tissue thattypically grow inside the uterus or uterine wall. Tiny onesgenerally cause no symptoms, but fibroids can becomecantaloupe-sized and may cause severe abdominal and back pain,heavy menstrual bleeding, frequent urination and infertility. Thefemale hormone estrogen promotes their growth; fibroids tend toshrink and disappear after menopause.

Gedroyc’s patients had fibroids ranging from about 4 to 8 inchesin diameter.

The technique involves inserting four skinny needles into theabdomen and guiding them to the fibroid with magnetic resonanceimaging, which allows the doctor to pinpoint where to apply theheat. Laser fibers are then inserted through the needles into thefibroid, where they are heated to over 140 degrees to kill fibroidcells. Shrinkage continues until about six months after treatment,said co-researcher Dr. Penny Law.

The procedure, performed under light sedation, takes about twohours, and patients can go home four hours later, Gedroyc said.

The shrinkage Gedroyc found was less than others have reportedwith a technique called uterine artery embolization. Thatprocedure, introduced in this country about three years ago, blocksoff arteries feeding the uterus and has been performed in about5,000 U.S. patients, though many insurance companies still considerit experimental and will not pay for it, said Dr. Adam Winick, aJohns Hopkins University radiologist.

Though even more experimental, the laser treatment is lesspainful and does not require an overnight stay, Gedroyc said.

Dr. Elizabeth Stewart, clinical director of the Center forUterine Fibroids at Brigham and Women’s Hospital in Boston, saidthe technique sounds promising but needs further study.

Using MRIs to guide the laser may give it an advantage overother treatments by providing doctors with more accuracy, Stewartsaid.

Gedroyc plans to start another phase of the study early nextyear using ultrasound to see if fibroids can be zapped without evenbreaking the skin. Other doctors are using the ultrasoundtechnology in experiments on cancerous and non-cancerous breasttumors, an approach that promoters say could revolutionize tumortreatment.

“It’s fantastically exciting,” Gedroyc said.