DURABILITY OF UTERINE FIBROID TREATMENTS UP TO 10 YEARS: ASCERTAINING LONG-TERM OUTCOMES OF FIBROID TREATMENTS (ALOFT) STUDY

Document Type

Conference Proceeding

Publication Date

12-1-2025

Publication Title

Fertil Steril

Keywords

adult, cohort analysis, conference abstract, endometrium ablation, female, fibroma, human, hysterectomy, leiomyoma, major clinical study, menopause, MR-guided focused ultrasound, myomectomy, radiofrequency ablation, retreatment, survival analysis, therapy, uterine artery embolization, uterus myoma

Abstract

OBJECTIVE: Most women develop fibroids before menopause. Uterine-sparing treatment options are available to manage fibroids and their symptoms. Evidence on durability of those treatments is limited. Our goal is to describe the duration after uterine-sparing fibroid treatment until a subsequent treatment occurs. MATERIALS AND METHODS: ALOFT participants (n=713) completed a survey about subsequent treatments up to 10 years post initial uterine-sparing fibroid treatment: hysterectomy and uterine-sparing fibroid treatment options such as myomectomy (MYO), endometrial ablation (EA), laparoscopic radiofrequency ablation (RFA), uterine artery embolization (UAE), and magnetic resonance guided focused ultrasound (MRgFUS). (R01HD109127, NCT06430320) Survival analyses performed using R v.4.4.1; statistical significance was pre-specified at p<0.05. Kaplan-Meier plots created to examine durability of initial treatment. RESULTS: Median age of ALOFT participants was 46.8 years. Initial treatment types included n=473 (66.3%) MYO, n=89 (12.4%) EA, n=95 (13.3%) RFA, and n=56 (7.8%) UAE. [Formula presented] 205 (28.7%) participants had a retreatment, the most common next treatment type was hysterectomy (n=94, 45.9%), followed by MYO (n=57, 27.8%), UAE (n=26, 12.7%), EA (n=12, 5.9%), MRgFUS (n=10, 4.9%), and RFA (n=6, 2.9%). As shown in Table 1, MYO at baseline was associated with the longest time until another fibroid treatment; at 2.5 years after baseline, 90.1% of those that had a MYO had not had another treatment. RFA was associated with the shortest time until retreatment; 2.5 years after baseline the probability of no retreatment 75.8% of those with an RFA had yet to have an additional treatment. When EA, RFA, and UAE were compared with MYO, RFA was found to have a statistically significantly higher rate of retreatment relative to MYO (HR (95% CI) = 1.74 (1.20, 2.52); p=0.004). No statistically significant differences found for EA or UAE versus MYO. CONCLUSIONS: Uterine-sparing fibroid treatments can provide many patients durable results. RFA may have less durability than MYO, EA and UAE. Further analysis adjusting for fibroid volume at time of treatment is needed. IMPACT STATEMENT: This research enables physicians and patients to develop a care plan informed by evidence on the durability of uterine-sparing fibroid treatments. SUPPORT: R01HD109127

Volume

124

Issue

6

First Page

e286

Last Page

e287

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