Fighting tumors with beams

Doctors at Brigham and Women's Hospital this week annihilated a benign tumor bigger than a softball in a woman's uterus -- but there was no cutting, no suturing, not even any bleeding involved.

They simply pointed a sharply focused beam of high-intensity ultrasound energy at the fibroid tumor and zapped it dead.

The procedure, which could gain approval for commercial use as early as next spring, is one of a whole new array of alternatives to hysterectomy for the millions of women who suffer from fibroids, benign growths in the uterus that lead to more surgery than any other tumor.

But it may be the most futuristic, relying on sound waves guided by magnetic resonance imaging to hit its target.

''People talk about minimally invasive surgical treatments,'' said Dr. Elizabeth Stewart, clinical director of the Center for Uterine Fibroids at the hospital. ''This is really non-invasive surgery.''

Newly published research indicates that the ultrasound procedure is safe, and it is already commercially available in Europe and Israel, but it still needs Food and Drug Administration approval in this country. For now, it is done only as part of research protocols at the Mayo Clinic in Minnesota, Johns Hopkins Medical School in Maryland, and at Brigham and Women's, which performs it on only two patients a week.

Wednesday's patient, Andrea Strathmeyer, said after the operation that ''If it works, I think it's great.'' Conscious during the procedure, she felt only some mild cramping, she said, and ''There was not a drop of blood. Nothing.''

Researchers at Brigham and Women's say the technology could eventually be applied to other types of tumors, even malignant brain tumors. Other investigators have begun trying ultrasound on prostate and breast tumors.

But for now, fibroid tumors are the first target at Brigham and Women's, where researchers pioneered much of the high technology involved in using ultrasound beams guided by MRI and were the first to use it on fibroids.

Though benign, fibroids can cause pain, fertility problems, and unusually heavy menstrual bleeding, and are the main reason for 200,000 of the 600,000 hysterectomies performed in the United States each year.

Strathmeyer, a 41-year-old computer consultant from Reading, started developing a fibroid late last year, and found out about the ultrasound treatment by doing her own reasearch on the Internet.

Strathmeyer said she had strong personal reasons to avoid major surgery: When she was 12, her father underwent surgery for a benign lung tumor, and developed such severe complications that his heart stopped for several minutes. He has never been the same since; he is barely able to walk and feed himself, and his short-term memory was obliterated.

''I wouldn't want my family to have to face that,'' she said.

Also, she said, ''I always thought surgery, where you have to cut open a human body and go in and move things around, was antiquated and even kind of barbaric. So this just seemed like the way to go.''

Her ultrasound procedure lasted less than three hours. Reached by phone on Wednesday afternoon, she said she had been able to walk a couple of blocks to a restaurant and have lunch immediately afterward -- quite a contrast to the weeks of recuperation that follow a typical hysterectomy.

''I'm not even tender or sore,'' she said.

The ultrasound works by sending in sound waves that vibrate the molecules, heating the tissue as the waves are absorbed. The heating coagulates the proteins in the tissue in a process reminiscent of what happens when an egg is cooked, except that the fibroid tissue does not harden like an egg. The beam also seals small blood vessels, so they do not bleed.

It is not clear what happens to the fibroid, but it appears that much of it is reabsorbed by the body, said Dr. Clare Tempany, clinical director of the Focused Ultrasound Program in the Radiology Department at the hospital.

Because the tumor is not malignant, the ultrasound does not need to kill every last cell; it is enough, she said, if it shrinks the tumor long enough for the woman to reach menopause, after which fibroid problems usually abate by themselves.

Tempany and Dr. Kullervo Hynynen, a physicist, oversaw the operation from their computer consoles on the other side of a window from where Strathmeyer lay in the car-sized, doughnut-shaped MRI machine.

The MRI let them monitor every second of the procedure, so they could be sure that the ultrasound beam reached a high enough temperature at each spot of the fibroid. With their computer mice, they manipulated the ultrasound transducer so that the beam was sure to hit only the fibroid and nothing else.

It is a bit like playing a video game, Hynynen said.

Each ''sonication,'' or burst of ultrasound energy, lasted 20 seconds, and they attacked more than 50 spots on the tumor, enough to shrink it significantly.

The team at Brigham and Women's has done nearly 50 such procedures, and has encountered no serious side effects. But Stewart, the clinical director, said it will take more time and follow-up to ascertain how effective the procedure really is. Ultrasound is not for everyone, however, Tempany said. Some people cannot undergo MRI scans. Also, the tumors must be between 3 and 10 centimeters.

Ultrasound has also been used very little on women who still hope to have children. Because it focuses so exactly on the fibroid and spares the healthy parts of the uterus, there is reason to believe it might be easier on fertility, said Tempany, but that has not been proven.

Good alternatives to hysterectomies have been increasing, and patients should be informed about each. Among those options, Stewart said, ultrasound ''is offering a new choice for treatment for certain patients.''

Carey Goldberg can be reached at goldberg@globe.com.