Percutaneous Radiofrequency Ablation of Parietal Endometriosis : a Pilot Study (PRFA)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 11
- 试验地点
- 2
- 主要终点
- Feasibility of PRFA. Evaluation by composite criteria with the need to validate all the criteria for the procedure to be considered "feasible".
研究概览
简要总结
Parietal endometriosis is the implantation of endometrial tissue in abdominal structures more superficial than the peritoneum. It is a rare form of the disease (incidence estimated between 0.04 and 12% among women operated on for endometriosis depending on the series) but is classically resistant to medical treatment and can be disabling. Surgical resection is currently the reference treatment in the event of failure of hormonal treatment, despite the sometimes significant skin scars and the risk of parietal fragility that may require a cure of venting by parietal prosthesis. The recurrence rate after surgical resection is 4.3%. The use of radiofrequency for therapeutic purposes is nowadays described in multiple applications such as cardiac arrhythmia, neurological and spinal disorders, as well as for the treatment of liver, kidney, prostate, breast, lung or skin cancers. Its use has already been reported in the field of benign gynecology with, in particular, demonstrated efficacy in the treatment of uterine fibroids by laparoscopic, trans-vaginal or percutaneous means. There are also large published series on radiofrequency for the treatment of adenomyosis, by the transvaginal and laparoscopic route.
In the context of parietal endometriosis, this would be a minimally invasive, percutaneous treatment. Ultrasound guidance allowing good targeting of the lesions and the procedure would most often be carried out on an outpatient basis and under local anaesthesia. And in case of failure or partial effectiveness, the reference treatment would remain accessible for these patients.
There is only one published case of the use of radiofrequency in parietal endometriosis (case reports). Despite results that seem encouraging in terms of a rapid and prolonged therapeutic effect on symptoms, no further cases or series have been published since.
Our study aims to investigate the feasibility of percutaneous radiofrequency treatment for parietal endometriosis, with the secondary objective of evaluating the safety, efficacy and risk factors for failure of the technique.
10 patients will be treated. For follow-up all patients will have an ultrasound and MRI before treatment, then an ultrasound at 1 month, 3 months and 6 months post-treatment and a second MRI at 6 months post-treatment. The investigators will also evaluate pain and quality of life with specific questionnaires at each visit.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 25 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Patient over 25 years of age;
- •Presenting between 1 and 3 lesions of parietal endometriosis, all accessible to radiofrequency treatment, with a major axis less than 10cm;
- •Symptomatic (chronic and/or catamenial pain);
- •Histological diagnosis of endometriosis;
- •In failure of medical treatment;
- •Nodule visible on ultrasound;
- •Affiliated with or beneficiary of a social security or similar scheme.
- •Having signed an informed consent for participation in the study
排除标准
- •Presence of a parietal endometriosis lesion with superficial skin involvement (dermis);
- •Presence of other symptomatic extra-parietal endometriosis lesions for which surgical treatment is planned;
- •Uncontrolled diabetes, i.e. HbA1c >7% despite well-treated and well-controlled treatment;
- •Contraindication to the use of radiofrequency: implanted electronic device, such as a pacemaker or self-synchronizing defibrillator; weakened immune system; coagulation disorder;
- •Contraindication to the use of Sonovue
- •Contraindication to the use of gadolinium
- •Severe renal failure (glomerular filtration rate less than 30 ml / min / 1.73m²)
- •Pregnant patient or with a desire to become pregnant within 6 months after treatment;
- •Patient who is not fluent in the English language;
- •Patient over the age of majority protected by law, under curatorship or guardianship;
- •Person deprived of liberty by a judicial or administrative decision, person subject to psychiatric care and people admitted to a health or social establishment for purposes other than that of research.
- •Patient participating in other interventional research that may interfere with the present research (at the discretion of the investigator);
- •Patient who has participated in other research that includes an ongoing opt out period.
结局指标
主要结局
Feasibility of PRFA. Evaluation by composite criteria with the need to validate all the criteria for the procedure to be considered "feasible".
时间窗: The day of the treatment (Day 0) - no earlier than 7 days after the 1st visit
The treatment is considered "feasible" if it meets all of the following criteria: * Visualization of the lesion intraoperatively by percutaneous ultrasound (yes/no), * Visibility of the posterior aponeurosis/peritoneum interface behind the lesion (yes/no), * Placement of one or more radiofrequency (RF) needles within the target lesion (yes/no), * Procedure for firing without anomaly (yes/no) : * Performing one or more treatment zones until a drop in effective power is obtained, automatically interrupting needle activity and demonstrating the effectiveness of the treatment. * complete covering of the nodule by the CO bubbles released by the procedure.
次要结局
- Security and tolerance of PRFA(From the 1st visit (no later than 7 days before treatment (Day -7)) until the end of the study (Month 6))
- radiological effectiveness measured by ultrasonography with Sonovue (composite criteria)(6 month post therapeutic (Month 6))
- radiological effectiveness measured by MRI with Gadolinium (composite criteria)(6 month post therapeutic (Month 6))
- clinical efficiency (composite criteria)(6 month post therapeutic (Month 6))
- clinical efficiency measured by SF36(6 month post therapeutic (Month 6))
- clinical efficiency measured by EHP-5(6 month post therapeutic (Month 6))
- Feature of PRFA: total duration (min) of the procedure(The day of the treatment (Day 0) - no earlier than 7 days after the 1st visit)
- population characteristics (composite criteria)(At the 1st visit: up to 7 days before treatment (Day -7))
- Feature of PRFA: power of the shot(The day of the treatment (Day 0) no earlier than 7 days after the 1st visit)
- Feature of PRFA: duration of the shot(The day of the treatment (Day 0) no earlier than 7 days after the 1st visit)