HIFU: Therapeutic MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids

Sponsor

Philips Healthcare (Industry)

Overall Status

Completed

CT.gov ID

NCT01141062

Collaborator

(none)

Enrollment

Locations

Arm

Duration (Months)

7.5

Patients Per Site

0.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study is to collect supplementary safety and technical effectiveness data of Philips MRI guided High Intensity Focused Ultrasound (HIFU) in ablating uterine tissue associated with symptomatic fibroids in a 3T MRI scanner. The importance of this therapy is that it offers a non-invasive, uterine sparing procedure for the treatment of uterine fibroids in pre- and peri- menopausal women. MRI guided high intensity focused ultrasound uses ultrasound to heat and thermally ablate fibroid tissue. The MRI system identifies the ultrasound path and monitors heat rise in the fibroid tissue. The goal of the study is to collect supplementary 3T treatment safety and technical effectiveness data in a 1 month follow-up study. MRguided HIFU will be performed in patients who pass inclusion/exclusion criteria. Safety, quality of life, and imaging endpoints will be evaluated in all study patients.

Condition or Disease	Intervention/Treatment	Phase
Uterine Leiomyomas	Device: Philips MR-guided HIFU	Phase 3

Detailed Description

Fibroids occur in 20-50% of women over 30 years of age, and with increasing size produce pain, menorrhagia, pressure, bloating and urinary and bowel compression symptoms. Fibroids may also cause infertility. Uterine leiomyomas are benign tumors originating from smooth muscle cells of the uterus and occasionally the smooth muscle of uterine blood vessels. Fibroids are estrogen dependent tumors ranging in size and number and can be found within the myometrium(intramural), at the uterine periphery extending to the serosa (subserosal), or pushing into the uterine cavity (submucosal). Symptomatic fibroids impact health and well-being of the female including lost work hours and reduced quality of life.

Current medical treatments include invasive removal of the fibroid (hysterectomy, myomectomy), drug therapy (GnRH analogues or progestin compounds) or treatments causing necrosis of the fibroid tissue such as ablation (freezing or heating) or embolization. For the relief of symptoms, women wishing to preserve the uterus may choose between invasive procedures of myomectomy, Uterine Artery Embolization (UAE), ablation or cryotherapy. The surgically invasive procedures require anesthesia, hospital stays, and long recovery periods. HIFU may offer an alternative to the above mentioned surgically invasive procedures.

In MRI-guided High Intensity Focused Ultrasound (HIFU), the ultrasound generated by the transducer is focused into a small focal tissue volume at specific target locations. During treatment, the beam of focused ultrasound energy penetrates through soft tissue and causes localized high temperatures (55°C to 70°C) for a few seconds within the target producing well defined regions of protein denaturation, irreversible cell damage, and coagulative necrosis. The MRI system allows 3D planning, means of measuring the temperature increase generated by HIFU, and the capability to quantifying the energy/dose delivered to the treatment zone.

This study is a single-center, single arm, non-randomized trial evaluating the safety, technical effectiveness and volume treatment capabilities of the Philips MR-guided HIFU system in the treatment of symptomatic uterine fibroid patients. Patients who have symptomatic uterine fibroids, who are eligible according to the inclusion and exclusion criteria and provide informed consent will be enrolled in this study. It is anticipated that women will participate in the study for a 2month period to include the screening, HIFU treatment and post treatment follow-up.

This clinical study is designed to confirm safety and demonstrate technical effectiveness of the Philips HIFU system for Uterine Fibroid treatment. Safety will be primarily assessed by evaluating minor complications and adverse events, and technical effectiveness will primarily be assessed with MRI measurements. Specific primary and secondary endpoints are detailed below.

The study will use a combination of three primary endpoints: MR imaging of ablated volumes and minor complications/adverse events analysis to establish the safety and technical effectiveness of the Philips MR-HIFU system. These endpoints will determine the trial success.

The treatment capabilities and technical effectiveness of the Philips MR-guided HIFU system will be assessed by (measurement type is noted in parentheses)

Comparing the actual MR-measured ablated volumes to MR thermal dose predicted volumes Safety of the Philips MR-guided HIFU system will be demonstrated by Evaluating any minor complications or adverse events that result from the MR-guided HIFU treatment Verifying with MR imaging that no unintended lesions are formed as a result of the Treatment

In addition, the following endpoints will be collected to supplement the primary outcomes:

Pain and discomfort scores before, during and after treatment: These endpoints will be recorded using a 10-point visual analog scale for pain 4-point scale for discomfort.

Return to Activity: This duration in days will be determined by the time after which the patients return to work (i.e. days after leaving the hospital) or to the usual activities for those not employed.

Length of Hospital Stay (LOS): This duration in hours will be measured from the time the patient will arrive to the hospital until she will leave the hospital.

Quality of Life questionnaires: the SF-36(http://www.sf36.org/tools/SF36.shtml) and UFS-QoL (which includes SSS)

Study Design

Study Type:

Interventional

Actual Enrollment :

15 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Therapeutic MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids

Study Start Date :

Jun 1, 2010

Actual Primary Completion Date :

Oct 1, 2011

Actual Study Completion Date :

Oct 1, 2011

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Treated leiomyomas Philips MR-guided HIFU	Device: Philips MR-guided HIFU HIFU is the use of focused ultrasound energy to penetrate through soft tissue and causes localized high temperatures (55°C to 70°C) for a few seconds within the target producing well defined regions of protein denaturation, irreversible cell damage, and coagulative necrosis. Other Names: Sonalleve Uterine Leiomyomas Fibroids HIFU Ablation High Intensity Focused Ultrasound

Arm

Intervention/Treatment

Experimental: Treated leiomyomas

Philips MR-guided HIFU

Device: Philips MR-guided HIFU

HIFU is the use of focused ultrasound energy to penetrate through soft tissue and causes localized high temperatures (55°C to 70°C) for a few seconds within the target producing well defined regions of protein denaturation, irreversible cell damage, and coagulative necrosis.

Other Names:

Sonalleve

Uterine Leiomyomas

Fibroids

HIFU

Ablation

High Intensity Focused Ultrasound

Outcome Measures

Primary Outcome Measures

Safety of HIFU for treatment of the uterine fibroids as determined by adverse event reporting. [Day of treatment, 24, 48, 72 hrs, 1 and 2 wks and 30 days after treatment]
Safety of HIFU for treatment of the uterine fibroids as determined by adverse event reporting.
Technical efficacy of HIFU for treatment of uterine fibroids as assessed by a change in the Symptom Severity Score [Day of treatment, 30 days after treatment]
Technical efficacy of HIFU for treatment of uterine fibroids as assessed by a change in the Symptom Severity Score

Secondary Outcome Measures

Change in Quality of Life Scores [0, 30 days]
Change in Quality of Life Scores
Pain score [0, 24, 48, 72 hours and 1 and 2 weeks, and 30 days]
Pain scores before, during and after treatment: This endpoints will be recorded using a 10-point visual analog scale for pain 4-point scale for discomfort.
Timeframe before returning to daily activities [0, 24, 48, 72 hours and 1 and 2 weeks, and 30 days]
Timeframe before returning to daily activities

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 59 Years

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

Women, age between 18 and 59 years
Weight < 140kg
Pre- or peri-menopausal
Uterine size < 24 weeks
Transformed SSS score > 40
Normal Cervical cell assessment by PAP
Symptomatic Fibroid disease
Dominant fibroid greater than or equal to 3cm and less than or equal to 12 cm

Exclusion Criteria:

Other Pelvic Disease
Desire for future pregnancy
Significant systemic disease even if controlled
Positive pregnancy test
Hematocrit < 25%
Scarring or other interference of the HIFU beam
MRI or contrast contraindicated
Fibroids not quantifiable on MRI
Calcifications around or throughout uterine tissues
Communication barrier

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Thunder Bay Regional Health Sciences Centre	Thunder Bay	Ontario	Canada	P7B 6V4
2	Sunnybrook Health Sciences Centre, University of Toronto	Toronto	Ontario	Canada	M4N 3M5

Sponsors and Collaborators

Philips Healthcare

Investigators

Principal Investigator: Elizabeth David, MD, Sunnybrook Health Sciences Centre
Principal Investigator: Neety Panu, MD, Thunder Bay Regional Health Sciences Centre