As the most common of gynecological tumours, uterine fibroids
have long been a thorn in the side of women — and
their doctors, who are keen to find an alternative to
surgical intervention. Though they often remain asymptomatic,
many women experience very heavy menstrual bleeding leading
to anemia, clots and debilitating pelvic pain.
The cost and side effects of other
therapies traditionally left surgery as the only longterm
solution. But an Israeli- pioneered combo technology
called ExAblate 2000 promises a noninvasive solution
for the roughly 30% of reproductive age Canadian women
affected by fibroids.
ExAblate 2000 uses magnetic resonance
imaging (MRI) to direct focused heat energy generated
by ultrasound to destroy the tumour. The patient lies
in the MRI machine while the fibroids are heated. Real
time thermal imaging allows the physician to ensure
that the targeted fibroid is fully treated while avoiding
all other tissue. ExAblate therapy can be done on an
outpatient basis without a need for incisions or anesthesia
(treatments last up to three hours) and recovery to
normal activity is one to two days.
SAFEGUARDING
THE WOMB
Of the 50,000 hysterectomies performed yearly in Canada
one-third are due to fibroids. Current Society of Obstetricians
and Gynaecologists of Canada (SOGC) guidelines suggest
that hysterectomy is still the best uterine fibroid
treatment for women not planning to conceive. But the
fact remains that hysterectomy is major surgery. Less
radical procedures include abdominal or laparoscopic
myomectomy; unfortunately fibroids have been found to
recur in 10 to 30% of myomectomy patients. Uterine artery
embolization as an option carries significant risks
without longterm data regarding efficacy, pregnancy
outcomes and patient satisfaction.
ExAblate 2000 has a number of other
applications and is already in use in Canada for some
of these. "We've been using ExAblate for about five
years in trials involving breast carcinomas," explains
Martin Ruel of University of Montreal's H�pital Saint-Luc.
"With recent FDA approval of this technology for uterine
fibroids, we have more and more patients inquiring about
this new technique."
ExAblate has been given the green
light in Europe and the US, but regulatory approval
is still pending from Health Canada. Even though ExAblate
preserves the uterus, the device is intended only to
treat women who don't plan to become pregnant, as it's
yet to be determined whether treatment impairs the ability
of the uterus to carry a healthy fetus to term. With
respect to the recurrence of fibroids after treatment
(71% success rate), ExAblate appears to be comparable
to traditional myomectomy.
"The machine is not technically
difficult to operate. One can be completely at ease
with ExAblate after three or four surgeries," says Mr
Ruel. ExAblate eliminates hospitalization, carries no
intraoperative or anesthetic risks, and is well received
by patients. "It's been a good investment both in cutting
down on healthcare costs and reducing patient morbidity."
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