目的:声动力疗法(SDT)作为一种有前途的新型非侵入性脑肿瘤治疗方法,正在引起人们的关注,靶向并选择性地杀死肿瘤细胞。副作用有限。这篇综述研究了SDT的机制和正在进行的临床试验,这些试验旨在优化成胶质细胞瘤(GBM)和弥漫性内在脑桥胶质瘤(DIPG)的潜在治疗方法的超声参数。简要讨论了在梅奥诊所治疗的首例复发性GBM患者的结果。
■这篇文献综述的作者使用了包括PubMed在内的电子数据库,EMBASE,和OVID。通过搜索文本单词/短语和MeSH术语来识别报告相关临床前和临床试验的文章。包括以下内容:“声动力疗法,\"\"SDT,\"\"聚焦超声,\"\"5-ALA,\"\"ALA,“”脑肿瘤,弥漫性脑桥胶质瘤,胶质母细胞瘤,“和”高级别神经胶质瘤。\"
结果:综述了研究SDT在脑肿瘤中的具体应用的临床前和临床试验。在高级别胶质瘤和GBM的临床前模型中,SDT已经显示了通过产生活性氧的靶向肿瘤细胞死亡的证据。复发性GBM和DIPG中的新兴临床试验结果显示了成功治疗反应的证据,招募患者的副作用最小。到目前为止,SDT已被证明是一种有希望的非侵入性癌症治疗方法,患者耐受性良好。作者提供的试验数据表明,GBM对单一SDT治疗的放射学反应良好,未发表的观察到即使在多次(每月)超声处理门诊治疗后也缺乏脱靶效应。SDT临床试验的范围是研究是否可以将GBM或DIPG的致命诊断转化为慢性,可治疗的疾病。
结论:SDT是安全的,可重复,耐受性优于化疗和放疗。它已被证明对人类癌症治疗有影响,但是需要更多的临床试验来建立标准化的超声增敏剂输送方案,处理参数,和组合疗法。最合适的治疗时机也有待确定-是否防止术后复发,或作为复发性GBM患者的抢救选择,其中重做手术是不合适的。希望还将针对更广泛的临床适应症开发SDT,如转移,脑膜瘤,和低级别的神经胶质瘤.进一步的临床试验正在准备中。
Sonodynamic therapy (SDT) is gaining attention as a promising new noninvasive brain tumor treatment that targets and selectively kills tumor cells, with limited side effects. This review examines the mechanisms of SDT and ongoing clinical trials looking at optimization of sonication parameters for potential treatment of glioblastoma (GBM) and diffuse intrinsic pontine glioma (DIPG). The results in the first patient with recurrent GBM treated at the Mayo Clinic are briefly discussed.
The authors of this literature review used electronic databases including PubMed, EMBASE, and OVID. Articles reporting relevant preclinical and clinical trials were identified by searching for text words/phrases and MeSH terms, including the following: \"sonodynamic therapy,\" \"SDT,\" \"focused ultrasound,\" \"5-ALA,\" \"ALA,\" \"brain tumors,\" \"diffuse pontine glioma,\" \"glioblastoma,\" and \"high grade glioma.\"
Preclinical and clinical trials investigating the specific use of SDT in brain tumors were reviewed. In preclinical models of high-grade glioma and GBM, SDT has shown evidence of targeted tumor cell death via the production of reactive oxygen species. Emerging clinical trial results within recurrent GBM and DIPG show evidence of successful treatment response, with minimal side effects experienced by recruited patients. So far, SDT has been shown to be a promising noninvasive cancer treatment that is well tolerated by patients. The authors present pilot data suggesting good radiological response of GBM to a single SDT treatment, with unpublished observation of a lack of off-target effects even after multiple (monthly) sonication outpatient treatments. The scope of the clinical trials of SDT is to investigate whether it can be the means by which the fatal diagnosis of GBM or DIPG is converted into that of a chronic, treatable disease.
SDT is safe, repeatable, and better tolerated than both chemotherapy and radiotherapy. It has been shown to have an effect in human cancer therapy, but more clinical trials are needed to establish standardized protocols for sonosensitizer delivery, treatment parameters, and combination therapies. The most appropriate timing of treatment also remains to be determined-whether to prevent recurrence in the postoperative period, or as a salvage option in patients with recurrent GBM for which redo surgery is inappropriate. It is hoped that SDT will also be developed for a wider spectrum of clinical indications, such as metastases, meningioma, and low-grade glioma. Further clinical trials are in preparation.