Articles
Register for OBGYN.net Conference Coverage
From the 35th Annual
Meeting - Las Vegas, Nevada- November 2006
Non-invasive Treatment for Fibroids
Richard Chudacoff, MD, FACOG &
Bernard Cantor, MD, FACOG
OBGYN.net Editorial Advisors
watch the video interview in Windows Media
Dr. Chudacoff: We are here with Dr. Bernie Cantor. He is from, is it Hollywood, Florida?
Dr. Cantor: Westin Florida.
Dr. Chudacoff:: Westin, Florida and he is actually a recently retired reproductive endocrinologist but I think we have actually got him out of retirement because he got involved with MR-guided focused ultrasound surgery with ExAblate of South Florida. How did that bring you out of retirement?
Dr. Cantor: I was fascinated by this technology for several years and when I saw that there was commercial applications for it, I decided to look into it and see how we could work to make this thing happen.
Dr. Chudacoff: I don’t know about you, but the first time I ever saw the technology, I was just enthralled. I was actually enrapt. I could not take my mind or my eyes off the monitor.
Dr. Cantor: I think when I first read about it, to me, this was Star Wars coming to life. Just a totally different approach with absolutely no invasion, no needles, no catheters and what seems to be excellent end results.
Dr. Chudacoff: Anyway, we have patients who are going to be treated for a very common disorder without any incisions, with really no recovery time. I think the recovery time is about an hour or however long it takes for them to metabolize the Fentanyl & Versed. Obviously, for big fibroids, it will be a certain gain for patients. Do you see any application in fertility?
Dr. Cantor: At this point, the technology is not approved by the FDA for use in women whose families are not complete, but I do think that when the ongoing studies that are now being carried out come to fruition, that they are going to find that those women who seem to have infertility due to their fibroids who are treated with ExAblate will end up more likely than not to have the same outcomes, the same good pregnancy rates as those women who undergo classical myomectomy. So I think it is definitely going to have the ability for that, but I do not think that we are ready to recommend it yet until we get more data.
Dr. Chudacoff: No, I was just wondering about maybe in the future.
Dr. Cantor: Yes.
Dr. Chudacoff: Of course, we need more data and, of course, those studies are currently being performed. This is certainly different than, say, uterine artery embolization where patients who’ve had laparoscopy after uterine artery embolization and they actually have adhesions because this is a global destruction of the uterus and it certainly goes to the serosa, whereas opposed to MR-guided focused ultrasound, which is limited to the fibroid itself.
Dr. Cantor: Right. Basically we are treating the center of the fibroid out, so there should not be any evidence of any damage to the serosal surface of the uterus. So we would not expect any adhesions or any other intraperitoneal adverse complications from this and, so far, there haven’t been any.
Dr. Chudacoff: Any time we change the peritoneum, any time we increase adhesions or even just change the milieu that is going to increase the risk of infertility.
Dr. Cantor: Correct, absolutely.
Dr. Chudacoff: One way that I see this application is those patients that probably we would not treat for small fibroids in their early 20s, who once we have proven or shown that this is effective treatment, we can treat the smaller fibroids sooner, they do not get to be big fibroids.
Dr. Cantor: I think that being proactive and trying to deal with these fibroids before they become significantly symptomatic is probably going to be a major benefit to many women. The only real concern is how to anticipate which of those women will ultimately become symptomatic, to look at this from a cost perspective and make sure that it makes sense to be proactive. But I think symptomatically, there is no question that it will make a difference.
Dr. Chudacoff: How do you think the gynecologist is accepting MR-guided focused ultrasound into a potential new practice?
Dr. Cantor: We are seeing more and more interest in this from the gynecologists here at the meeting and certainly the group of gynecologists who have come together in south Florida to establish our own center. Very enthusiastic, it did not take very much to get a lot of individuals very interested in this technology for most of the reasons we have been discussing.
Dr. Chudacoff: I think it is an awesome business opportunity, as well as a clinical opportunity. Last year, when I was at AAGL, there were probably about 14 or 15 gynecologists involved with MR-guided focused ultrasound. Now I think recent numbers are up to about 100, so it certainly is mushrooming in just one year.
Dr. Cantor: Yes, and I think it is going to be exponential once the word gets out about the ease of the therapy, the benefits, the end results, really lack of pain, lack of hospitalization, very minimal risks, lots of benefits, little downside and, as you said, from an economic perspective, it allows the gynecologist to take control of the procedure, to be able to not only perform the procedure and get reimbursement on the professional side which will be very similar to the reimbursement, say, for hysterectomy or myomectomy, but also to participate in ownership of the center and derive significant benefits from that, as well.
Dr. Chudacoff: I think we are going to laugh in five years. We will review this tape and talk about how it was just in its infancy and it will be such a ubiquitous treatment, not only for gynecologists, but probably all surgical specialties. In five years, we will toast a glass of champagne and watch this.
Dr. Cantor: I think just at this meeting, the keynote address yesterday on looking to the future for technology, this is one of those modalities which is going to be I think, ubiquitous within five years. I think fibroids are just one small, little piece in terms of the applications of this in terms of other areas in prostate, liver, bone metastases and pain relief, which the studies look very good for, brain possibly – a tremendous amount of applications. The FDA has approved this for fibroids, but there are other things that are going to make this mushroom in addition to just the gynecologic aspects.
Dr. Chudacoff:: Interestingly, the FDA just produced a list of their top 14 medical devices they approved in 2005, this was as of November 2 this month, and Exablate topped that list.
Dr. Cantor: Yes. It is phenomenal technology and having worked with it and seen how patients react to it, I think everybody is going to be very happy: the physicians and, particularly, the patients because of the limited amount of time lost from normal activities. They are basically back to work and normal activities in 24 hours.
Dr. Chudacoff: Well, I appreciate you sitting down with me and having this interview from the AAGL in Las Vegas.
