Focused ultrasound for treatment of peripheral brain tumors

Abstract

Malignant brain tumors are the leading cause of cancer-related death in children and remain a significant cause of morbidity and mortality throughout all demographics. Central nervous system (CNS) tumors are classically treated with surgical resection and radiotherapy in addition to adjuvant chemotherapy. However, the therapeutic efficacy of chemotherapeutic agents is limited due to the blood-brain barrier (BBB). Magnetic resonance guided focused ultrasound (MRgFUS) is a new and promising intervention for CNS tumors, which has shown success in preclinical trials. High-intensity focused ultrasound (HIFU) has the capacity to serve as a direct therapeutic agent in the form of thermoablation and mechanical destruction of the tumor. Low-intensity focused ultrasound (LIFU) has been shown to disrupt the BBB and enhance the uptake of therapeutic agents in the brain and CNS. The authors present a review of MRgFUS in the treatment of CNS tumors. This treatment method has shown promising results in preclinical trials including minimal adverse effects, increased infiltration of the therapeutic agents into the CNS, decreased tumor progression, and improved survival rates.

Glioblastoma Therapy: Past, Present and Future

“…HIFU can cause thermoablation and mechanical destruction of the tumor. Both can be combined with radiotherapy [ 997 , 998 ].…”

“…The advantages of focused ultrasounds over current brain tumor treatments are considerable: (1) eliminating concerns related to surgical wound healing and the risk of infection, making it a safer option for patients; (2) precise targeting; (3) avoiding ionizing radiation exposure; (4) enhancing chemotherapy delivery by temporarily opening the BBB; and (5) their non-invasive nature allows for repeat treatments [ 854 , 997 ].…”

“…The absorbed energy can quickly elevate the temperature to over 55 °C, which causes protein denaturation, DNA fragmentation and coagulative necrosis when maintained for just a few seconds [ 999 , 1000 ]. This thermoablative process further increases tumor sensitivity to radiation by damaging DNA repair enzymes [ 997 ]. To date, clinical data are limited to case reports such as those first reported by Coluccia et al using MRI-guided HIFUs to achieve tumor ablation without inducing neurological deficits or other adverse effects in a patient with rGB [ 1001 ].…”

Overcoming challenges in glioblastoma treatment: targeting infiltrating cancer cells and harnessing the tumor microenvironment

“…Traditionally, the possibility of overcoming the BBB to concentrate systemically administered treatments (Thombre et al, 2023) and diagnostic tracers into the brain (Bae et al, 2023; Figure 1A) is achieved through temporary opening and partial disruption of tight junctions by physical interaction of focused high/low-frequency ultrasound (FUS) (Johansen et al, 2023;Mehta et al, 2023) as well as by using osmotic gradients (Cosolo et al, 1989; Figure 1B). Less conventional methods also include the use of isoflurane (Noorani et al, 2023) to increase the permeability of the brain to small hydrophilic molecules.…”

Advances in Brain Tumor Therapy Based on the Magnetic Nanoparticles

“… 209 HIFU beam can pass through soft tissues and reach the desired target without influencing normal tissues. 210 , 211 MRgFUS is a safe medical technology that has been used to treat many diseases, 153 including Parkinson’s disease, 212 obsessive-compulsive disorder, 213 and chronic pain. 214 One promising avenue for enhancing the efficacy of ultrasound thermoablation in tumor therapy involves the delivery of MNPs using focused magnetic targeting.…”