Efficacy and safety of combined GnRH-a, hysteroscopic surgery, and LNG-IUS for adenomyosis with suboptimal HIFU ablation: a retrospective study.
This study suggests that a combination of GnRH-a, hysteroscopic surgery, and LNG-IUS may be a safe option for patients with adenomyosis who do not respond well to HIFU, but further research is needed to confirm these findings.
Where it sits
this study against the rest of the buserelin corpusSummary and findings
This study evaluated the safety and efficacy of a sequential combination therapy of gonadotropin-releasing hormone agonist (GnRH-a), hysteroscopic surgery, and levonorgestrel-releasing intrauterine system (LNG-IUS) in 71 patients with adenomyosis who had a suboptimal response to high-intensity focused ultrasound (HIFU) ablation. The median follow-up duration was 39 months, and significant reductions in dysmenorrhea and menstrual blood volume were observed at all post-treatment time points. No therapeutic claims are made.
Abstract
<h4>Objective</h4>To evaluate the safety and efficacy of sequential combination therapy comprising gonadotropin-releasing hormone agonist (GnRH-a), hysteroscopic surgery (residual lesion resection plus endometrial ablation), and levonorgestrel-releasing intrauterine system (LNG-IUS) insertion in patients with adenomyosis who exhibited suboptimal response to high-intensity focused ultrasound (HIFU) ablation (non-perfused volume (NPV) ratio < 50%).<h4>Methods</h4>This retrospective study enrolled 71 patients with adenomyosis who underwent HIFU ablation with an NPV ratio < 50% and subsequently received three doses of GnRH-a, followed by hysteroscopic surgery (residual lesion resection plus endometrial ablation) with concurrent LNG-IUS insertion (HIFU-GHL regimen). All patients completed a minimum follow-up of 24 months. Clinical efficacy was assessed using the visual analogue scale (VAS) for dysmenorrhea and the sensation quantity scale (SQS) for menstrual blood volume at baseline and at 6, 12, 18, and 24 months post-treatment.<h4>Results</h4>The median follow-up duration was 39 months (IQR: 29-53 months). The median NPV ratio following HIFU ablation was 22.2% (IQR: 12.0%-36.2%). Compared with baseline, significant reductions in both VAS and SQS scores were observed at all post-treatment time points (all <i>p</i> < 0.05), with no significant differences among the four follow-up intervals (<i>p</i> > 0.05). Only two patients (2.8%) required re-intervention for recurrent dysmenorrhea.<h4>Conclusions</h4>The sequential regimen of GnRH-a, hysteroscopic surgery (lesion resection plus endometrial ablation), and LNG-IUS insertion is a safe and effective uterine-preserving salvage strategy for adenomyosis patients with suboptimal HIFU ablation (NPV ratio < 50%). Prospective randomized trials with extended follow-up are warranted to validate these findings.
Background
This paper addresses the clinical question of how to manage adenomyosis in patients who do not respond adequately to high-intensity focused ultrasound (HIFU) ablation. Prior studies have indicated that HIFU can be effective for adenomyosis, but some patients exhibit suboptimal responses, necessitating alternative treatment strategies. This study is significant as it explores a combined therapeutic approach that may offer a uterine-preserving option for these patients.
Methods
This retrospective study included 71 patients diagnosed with adenomyosis who underwent HIFU ablation with a non-perfused volume (NPV) ratio of less than 50%. Participants received three doses of GnRH-a followed by hysteroscopic surgery (residual lesion resection plus endometrial ablation) and concurrent LNG-IUS insertion. The primary outcome measures included changes in dysmenorrhea assessed by the visual analogue scale (VAS) and menstrual blood volume assessed by the sensation quantity scale (SQS) at baseline and at 6, 12, 18, and 24 months post-treatment.
Results
The median follow-up duration was 39 months (IQR: 29-53 months). The median NPV ratio following HIFU ablation was 22.2% (IQR: 12.0%-36.2%). Significant reductions in VAS and SQS scores were observed at all post-treatment time points (all p < 0.05). However, no significant differences were noted among the four follow-up intervals (p > 0.05). Only two patients (2.8%) required re-intervention for recurrent dysmenorrhea.
Interpretation
The findings suggest that the sequential regimen of GnRH-a, hysteroscopic surgery, and LNG-IUS may provide a safe and effective option for managing adenomyosis in patients with suboptimal HIFU response. However, the effect sizes, while statistically significant, may not be clinically meaningful given the small sample size and the retrospective nature of the study. The lack of a control group and potential confounding factors limit the conclusions that can be drawn.
Key findings
- Median NPV ratio following HIFU ablation was 22.2% (IQR: 12.0%-36.2%)
- Significant reductions in VAS scores were observed at all post-treatment time points (all p < 0.05)
- Significant reductions in SQS scores were observed at all post-treatment time points (all p < 0.05)
- No significant differences among the four follow-up intervals (p > 0.05)
- Only two patients (2.8%) required re-intervention for recurrent dysmenorrhea
Limitations
- Retrospective study design
- Small sample size n=71
- Lacks a control group
- Short follow-up duration for some outcomes
- Potential confounding factors not controlled for