Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era.

Autor: Kappel AD; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., Jha R; Harvard Medical School, Boston, MA 02115, USA., Guggilapu S; Harvard Medical School, Boston, MA 02115, USA., Smith WJ; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA., Feroze AH; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., Dmytriw AA; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA., Vicenty-Padilla J; Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico., Alcedo Guardia RE; Neurosurgery Section, School of Medicine University of Puerto Rico, Medical Sciences Campus, San Juan P.O. Box 365067, Puerto Rico., Gessler FA; Department of Neurosurgery, Rostock University Hospital, 18057 Rostock, Germany., Patel NJ; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., Du R; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., See AP; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Boston Children's Hospital, Boston, MA 02115, USA., Peruzzi PP; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., Aziz-Sultan MA; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA., Bernstock JD; Harvard Medical School, Boston, MA 02115, USA.; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2024 Apr 22; Vol. 16 (8). Date of Electronic Publication: 2024 Apr 22.
DOI: 10.3390/cancers16081594
Abstrakt: High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood-brain barrier (BBB) penetration, hemodynamic complexities, and drug-tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.
Databáze: MEDLINE
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