Journal Article Review Epublish
PubMed: 42281803 DOI: 10.1093/noajnl/vdaf131
Focused ultrasound for brain metastases.
Neurooncol Adv 8(Suppl 4):iv40-iv59
Authors: Ahmad Ozair, Bilal Moiz, Pavlos Anastasiadis, Dheeraj Gandhi, Bibhas Amatya, Michael W McDermott, Graeme F Woodworth, Manmeet S Ahluwalia
Affiliations
- Brain Tumor Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA.
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
Abstract
Brain metastases (BMs) increasingly represent a significant cause of morbidity and mortality in cancer patients. The efficacy of systemic therapies for BMs, in contrast to extracranial metastases (EMs), remains limited secondary to a host of challenges. These include insufficient drug delivery due to the blood-brain barrier and blood-tumor barrier, the unique immunological milieu in the tumor microenvironment and cerebrospinal fluid, the diversity of immunogenomic landscapes in BMs across genetically distinct malignancies, the branching evolution of BM from EMs, and the challenges in longitudinally obtaining information regarding clinically actionable genetic alterations in BMs for precision oncology. These complex, long-standing challenges require treatment strategies that address multiple problems concurrently, as represented by the potential of focused ultrasound (FUS) for enhancing effectiveness of several existing BM-specific management strategies. Beyond historically investigated applications of FUS for BMs, including thermoablation and histotripsy, new frontiers include enhanced drug delivery of systemic therapies, plasma sono-liquid biopsy of BM-derived factors, radiosensitization, and immunomodulation. These applications, as discussed here, enable multiple combinatorial opportunities of FUS with targeted- and/or immunotherapies for BMs. With multiple ultrasound delivery platforms (including MR-guided, neuro-navigation-guided, and implantable devices) being investigated in neuro-oncology trials worldwide, this review provides strategies for designing and optimizing future research efforts.
MeSH
Blood, Pharmaceutical Preparations, Acoustics, Microbubbles, Brain, Neoplasms, Neoplasm Metastasis, Therapeutics