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Focused ultrasound for brain metastases: an update on global clinical trials

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Abstract

Background

Despite advances in immunotherapy and targeted treatments for malignancies of the central nervous system (CNS), the treatment of brain metastases (BMs) remains a formidable challenge, due largely to difficulties in crossing the blood-brain barrier (BBB), drug resistance, and molecular discrepancies. Focused ultrasound (FUS) is a non-invasive tool for BBB breaching, tumor ablation, enhancing drug delivery, promoting the release of tumor biomarkers for liquid biopsy, or the tumor microenvironment disruption. This paper presents a comprehensive review of the current literature related to FUS and its application in the treatment of brain metastasis.

Methods

This review of the current literature via PubMed, Google Scholar, and Clincaltrials.gov focused on clinical trials in which FUS is used in the intracranial treatment of metastatic tumor, glioma, or GBM.

Results

FUS is safe and effective for treatment of primary or metastatic brain tumors. FUS-augmented drug delivery can open BBB to facilitate the transport of chemotherapeutic agents, immunotherapies, and targeted treatments. The integration of FUS with liquid biopsy has considerable potential for early tumor detection, precise gene profiling, and personalized therapy. Sonodynamic therapy can induce tumor cell apoptosis and could potentially be used to enhance the outcomes of other tumor treatments, such as surgery and chemotherapy.

Conclusion

Further work is required to establish FUS as a standard therapy for BMs. FUS has the potential to transform brain tumor treatment, particularly when combined with immunotherapy and targeted therapy as a non-invasive alternative to surgery and radiation therapy.

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Funding

This study was supported by Taipei Veterans General Hospital (VGHUST112-G1-3-1 and V112C-105). The sponsor had no role in the design of the study; the collection, analysis, or interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

    Yi-Hsiu Chen, Cheng-Chia Lee & Yan-Hua Su

  2. Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Yi-Hsiu Chen & Yan-Hua Su

  3. Focused Ultrasound Foundation, 1230 Cedars Court, Suite 206, Charlottesville, VA, 22903, USA

    David Moore

  4. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cheng-Chia Lee

  5. Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Cheng-Chia Lee

  6. Department of Neurosurgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan

    Yan-Hua Su

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  1. Yi-Hsiu Chen
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  2. David Moore
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Contributions

The study conception and design were done by YHS and CCL. Data acquisition and analysis were done by YHC, CCL and DM. The manuscript writing was done by YHC and YHS. Critical revision and final approval of the manuscript were done by all authors. All authors read and approved the final manuscript.

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Correspondence to Yan-Hua Su.

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Chen, YH., Moore, D., Lee, CC. et al. Focused ultrasound for brain metastases: an update on global clinical trials. J Neurooncol 165, 53–62 (2023). https://doi.org/10.1007/s11060-023-04492-3

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