Fibroid embolization fails in many patients

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Embolization, a relatively new therapy for fibroid tumors that cuts off their blood supply, leads to quicker and less painful recoveries than hysterectomy. But the tumors often return.

A team of researchers in Scotland studied 157 fibroid patients in 27 hospitals in the United Kingdom. Two thirds of the women were randomly assigned to uterine-artery embolization. The rest underwent either myomectomies to remove the fibroids or hysterectomies to remove the entire uterus.

Women in the embolization group were released from the hospital in a mean average of one day vs. five days for the surgery group. They also experienced much less postoperative pain and were able to drive after about a week instead of a month.

But the treatment failed in 21% of cases. Within a year, 10 of the patients suffered a recurrence of symptoms that required either another embolization or a hysterectomy; 11 others required additional procedures later. “The results make clear that the choice between surgery and uterine-artery embolization…involves tradeoffs,” the researchers said (N Engl J Med. 2007; 356:360-370).

In an accompanying editorial, Togas Tulandi, MD, of McGill University in Montreal, noted that the study did not compare embolization to newer, less invasive procedures—vaginal or laparoscopic hysterectomies. These patients presumably would also have quicker and easier recoveries than from abdominal surgery.

Noting that the effect of embolization on child-bearing is unclear, Dr. Tulandi suggested these guidelines: Myomectomy for women planning to conceive in the future; hysterectomy for women who do not plan to have children and who want to be certain the tumors will not recur, and embolization for women with a history of multiple laparotomies or women with “diffuse uterine fibroids in whom myomectomy might not be technically feasible.”

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