Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran.
Neurosurgical Research Network (NRN), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
J Clin Neurosci. 2024 Oct;128:110786. doi: 10.1016/j.jocn.2024.110786. Epub 2024 Aug 14.
This scoping review aims to comprehensively review the available literature on the safety and efficacy of focused ultrasound (FUS) for blood-brain barrier disruption (BBBD) in patients with high-grade gliomas, including glioblastoma (GBM). High-grade gliomas pose significant challenges in neuro-oncology due to their aggressiveness and intricate location, often limiting the efficacy of traditional treatments. FUS offers a promising approach by transiently disrupting the blood-brain barrier, thereby facilitating enhanced drug delivery to tumor cells while minimizing systemic side effects.
A scoping review adhering to PRISMA guidelines was conducted to explore the literature on FUS-induced BBBD in glioma patients. PubMed and Embase databases were searched from inception to April 2024 using defined keywords. Original clinical studies focusing on FUS for BBBD in gliomas were included. Two reviewers independently screened records, with conflicts resolved by a third reviewer. Data extraction and quality assessment were performed accordingly.
A total of 1,310 studies were initially identified, resulting in nine eligible studies after screening and selection. These studies, published between 2016 and 2024, included 106 patients (39.6 % female) with ages ranging from 29 to 80 years. Recurrent GBM was the most common diagnosis (100 patients), with other diagnoses including anaplastic astrocytoma, diffuse infiltrating glioma, and oligodendroglioma. Various FUS devices and microbubble contrast agents were employed across the studies. Safety and efficacy were assessed in both experimental and clinical settings, with no significant adverse events reported during BBBD procedures. Notably, BBBD facilitated enhanced drug delivery to tumor tissue, demonstrating potential therapeutic benefits.
Studies investigating BBBD using FUS demonstrate promising outcomes in experimental and clinical settings. BBBD procedures in patients with malignant gliomas and recurrent GBM show safety and successful enhancement of drug delivery potential. Overall, FUS-mediated BBBD emerges as a safe and feasible approach for improving therapeutic outcomes in brain tumor patients, warranting further clinical exploration and optimization.
本范围综述旨在全面回顾关于高强度聚焦超声（FUS）用于破坏血脑屏障（BBBD）以治疗高级别脑胶质瘤患者（包括胶质母细胞瘤（GBM））的安全性和有效性的现有文献。高级别脑胶质瘤由于其侵袭性和复杂位置，给神经肿瘤学带来了重大挑战，往往限制了传统治疗的效果。FUS 提供了一种有前途的方法，通过短暂破坏血脑屏障，从而促进药物向肿瘤细胞的输送增强，同时最大限度地减少全身副作用。
按照 PRISMA 指南进行了范围综述，以探讨 FUS 诱导脑胶质瘤患者 BBBD 的文献。从成立到 2024 年 4 月，使用定义明确的关键字在 PubMed 和 Embase 数据库中进行了搜索。纳入了专注于 FUS 治疗脑胶质瘤 BBBD 的原始临床研究。两名评审员独立筛选记录，如果存在分歧，则由第三名评审员解决。相应地进行了数据提取和质量评估。
最初确定了 1310 项研究，经过筛选和选择后，有 9 项符合条件的研究入选。这些研究发表于 2016 年至 2024 年之间，共纳入 106 名患者（39.6%为女性），年龄在 29 岁至 80 岁之间。复发性 GBM 是最常见的诊断（100 名患者），其他诊断包括间变性星形细胞瘤、弥漫性浸润性胶质瘤和少突胶质细胞瘤。各项研究中使用了各种 FUS 设备和微泡造影剂。在实验和临床环境中评估了安全性和有效性，在 BBBD 过程中未报告任何重大不良事件。值得注意的是，BBBD 促进了药物向肿瘤组织的输送增强，显示出潜在的治疗益处。
使用 FUS 进行的 BBBD 研究在实验和临床环境中显示出有希望的结果。在恶性脑胶质瘤和复发性 GBM 患者中进行的 BBBD 程序显示出安全性和成功增强药物输送的潜力。总的来说，FUS 介导的 BBBD 作为一种提高脑肿瘤患者治疗效果的安全且可行的方法，值得进一步的临床探索和优化。
