Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
J Neurooncol. 2024 Sep;169(3):507-516. doi: 10.1007/s11060-024-04772-6. Epub 2024 Jul 23.
Intra-axial brain tumors persist as significant clinical challenges. Aggressive surgical resection carries risk of morbidity, and the blood-brain barrier (BBB) prevents optimal pharmacological interventions. There is a clear clinical demand for innovative and less invasive therapeutic strategies for patients, especially those that can augment established treatment protocols. Focused ultrasound (FUS) has emerged as a promising approach to manage brain tumors. Sonodynamic therapy (SDT), a subset of FUS, utilizes sonosensitizers activated by ultrasound waves to generate reactive oxygen species (ROS) and induce tumor cell death.
This review explores the historical evolution and rationale behind SDT, focusing on its mechanisms of action and potential applications in brain tumor management.
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Preclinical studies have demonstrated the efficacy of various sonosensitizers, including 5-aminolevulinic acid (5-ALA), fluorescein, porphyrin derivatives, and nanoparticles, in conjunction with FUS for targeted tumor therapy and BBB disruption. Clinical trials have shown promising results in terms of safety and efficacy, although further research is needed to fully understand the potential adverse effects and optimize treatment protocols. Challenges such as skull thickness affecting FUS penetration, and the kinetics of BBB opening require careful consideration for the successful implementation of SDT in clinical practice. Future directions include comparative studies of different sonosensitizers, optimization of FUS parameters, and exploration of SDT's immunomodulatory effects.
SDT represents a promising frontier in the treatment of aggressive brain tumors, offering hope for improved patient outcomes.
脑内轴内肿瘤仍然是重大的临床挑战。积极的手术切除有产生发病率的风险，而血脑屏障 (BBB) 阻止了最佳的药物干预。患者需要创新和微创的治疗策略，特别是那些可以增强现有治疗方案的策略，这是明确的临床需求。聚焦超声 (FUS) 已成为治疗脑肿瘤的一种有前途的方法。声动力学疗法 (SDT) 是 FUS 的一个分支，利用超声激活的声敏剂产生活性氧 (ROS) 并诱导肿瘤细胞死亡。
本综述探讨了 SDT 的历史演变和基本原理，重点介绍了其作用机制及其在脑肿瘤管理中的潜在应用。
使用系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行了系统综述。
临床前研究已经证明了各种声敏剂的功效，包括 5-氨基酮戊酸 (5-ALA)、荧光素、卟啉衍生物和纳米颗粒，与 FUS 联合用于靶向肿瘤治疗和 BBB 破坏。临床试验在安全性和有效性方面显示出了有希望的结果，尽管需要进一步研究才能充分了解潜在的不良反应并优化治疗方案。FUS 穿透时颅骨厚度的影响和 BBB 开放的动力学等挑战需要仔细考虑，以确保 SDT 在临床实践中的成功实施。未来的方向包括不同声敏剂的比较研究、FUS 参数的优化以及 SDT 的免疫调节作用的探索。
SDT 代表了治疗侵袭性脑肿瘤的一个有前途的前沿领域，为改善患者预后带来了希望。
