Читать книгу Intracranial Gliomas Part III - Innovative Treatment Modalities - Группа авторов - Страница 62

Ultrasound is widely used as a clinical diagnostic tool in medicine, but the adoption of its therapeutic applications, particularly in the brain, has only recently begun to develop momentum. Extracranially, therapeutic ultrasound has cemented itself as a treatment for uterine fibroids and the palliation of bone metastasis. It is in the brain though, where therapeutic ultrasound arguably holds the most promising possibilities, including neuromodulation, focused ultrasound surgery, and blood–brain barrier (BBB) disruption. Recent clinical trials of MRI-guided high-intensity focused ultrasound (HIFU) for essential tremor have had optimistic results and provided reassurance that such therapy in the brain can be performed safely [1, 2]. The first attempt at thermal ablation of human glioblastoma multiforme (GBM) was, unfortunately, tainted by a serious adverse event that not unexpectedly had a deleterious effect on the initiation of further clinical trials [3]. However, gliomas portend a dismal prognosis, and patients harboring these challenging tumors are in dire need of new treatment options. Beyond the addition of fractionated radiotherapy (FRT) in the 1970s, arguably the only significant advance in the treatment of GBM has been the combination of the alkylating chemotherapeutic agent temozolomide (TMZ) with irradiation. Thermal ablation of brain tumors with HIFU might soon become another tool in the armamentarium of neurosurgeons and neuro-oncologists, and combined with other modalities, ultrasound and its unique biological effects, in particular BBB disruption, may one day dramatically change the way that gliomas are treated.