Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era.
Ari D KappelRohan JhaSaibaba GuggilapuWilliam J SmithAbdullah H FerozeAdam A DmytriwJuan Vicenty-PadillaRodolfo E Alcedo GuardiaFlorian A GesslerNirav J PatelRose DuAlfred Pokmeng SeePier Paolo PeruzziMohammad A Aziz-SultanJoshua D BernstockPublished in: Cancers (2024)
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.
Keyphrases
- high grade
- blood brain barrier
- poor prognosis
- low grade
- photodynamic therapy
- minimally invasive
- cerebral ischemia
- aortic dissection
- long non coding rna
- current status
- public health
- drug induced
- adverse drug
- subarachnoid hemorrhage
- low dose
- locally advanced
- stem cells
- high intensity
- radiation therapy
- palliative care
- oxidative stress
- brain injury
- combination therapy
- ultrasound guided
- single cell
- climate change
- radiation induced
- chemotherapy induced
- fluorescence imaging
- robot assisted