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聚焦超声在胶质母细胞瘤治疗中的应用:一个新领域。

Applications of Focused Ultrasound for the Treatment of Glioblastoma: A New Frontier.

作者信息

Hersh Andrew M, Bhimreddy Meghana, Weber-Levine Carly, Jiang Kelly, Alomari Safwan, Theodore Nicholas, Manbachi Amir, Tyler Betty M

机构信息

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.

出版信息

Cancers (Basel). 2022 Oct 8;14(19):4920. doi: 10.3390/cancers14194920.

Abstract

Glioblastoma (GBM) is an aggressive primary astrocytoma associated with short overall survival. Treatment for GBM primarily consists of maximal safe surgical resection, radiation therapy, and chemotherapy using temozolomide. Nonetheless, recurrence and tumor progression is the norm, driven by tumor stem cell activity and a high mutational burden. Focused ultrasound (FUS) has shown promising results in preclinical and clinical trials for treatment of GBM and has received regulatory approval for the treatment of other neoplasms. Here, we review the range of applications for FUS in the treatment of GBM, which depend on parameters, including frequency, power, pulse duration, and duty cycle. Low-intensity FUS can be used to transiently open the blood-brain barrier (BBB), which restricts diffusion of most macromolecules and therapeutic agents into the brain. Under guidance from magnetic resonance imaging, the BBB can be targeted in a precise location to permit diffusion of molecules only at the vicinity of the tumor, preventing side effects to healthy tissue. BBB opening can also be used to improve detection of cell-free tumor DNA with liquid biopsies, allowing non-invasive diagnosis and identification of molecular mutations. High-intensity FUS can cause tumor ablation via a hyperthermic effect. Additionally, FUS can stimulate immunological attack of tumor cells, can activate sonosensitizers to exert cytotoxic effects on tumor tissue, and can sensitize tumors to radiation therapy. Finally, another mechanism under investigation, known as histotripsy, produces tumor ablation via acoustic cavitation rather than thermal effects.

摘要

胶质母细胞瘤(GBM)是一种侵袭性原发性星形细胞瘤,总体生存期较短。GBM的治疗主要包括最大程度的安全手术切除、放射治疗以及使用替莫唑胺的化疗。尽管如此,复发和肿瘤进展仍是常态,这是由肿瘤干细胞活性和高突变负荷驱动的。聚焦超声(FUS)在GBM治疗的临床前和临床试验中已显示出有前景的结果,并且已获得治疗其他肿瘤的监管批准。在此,我们回顾FUS在GBM治疗中的应用范围,其取决于频率、功率、脉冲持续时间和占空比等参数。低强度FUS可用于短暂打开血脑屏障(BBB),血脑屏障会限制大多数大分子和治疗剂扩散进入大脑。在磁共振成像的引导下,可将血脑屏障靶向定位在精确位置,仅允许分子在肿瘤附近扩散,从而防止对健康组织产生副作用。打开血脑屏障还可用于通过液体活检改善对游离肿瘤DNA的检测,实现非侵入性诊断和分子突变鉴定。高强度FUS可通过热效应导致肿瘤消融。此外,FUS可刺激对肿瘤细胞的免疫攻击,可激活声敏剂对肿瘤组织发挥细胞毒性作用,还可使肿瘤对放射治疗敏感。最后,正在研究的另一种机制,即组织粉碎术,通过声空化而非热效应产生肿瘤消融。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c542/9563027/2d660d98fc7b/cancers-14-04920-g001.jpg

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