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Updated: Sep 13, 2025
The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma
Published on: April 16, 2019
Invasive and non-invasive tumor-treating electric field (TTF) therapy: An exciting advance in oncologic
Thomas Eckert1, Rishishankar Suresh2, M S Zobaer3
1MUSC Institute for Neuroscience Discovery, Medical University of South Carolina, Charleston, SC, USA; School of Medicine, University of South Carolina, Columbia, SC, USA.
Background:
Tumor-treating fields (TTF) have been shown to slow glioblastoma (GBM) cell growth through mitotic arrest, increased membrane and blood-brain barrier permeability, and other cellular mechanisms. TTF as currently used prolongs GBM survival by 5 months, but there are areas of possible improvement. One of the interesting problems is optimization of TTF delivery to tumor cells, which is attenuated by intervening anatomy and shunting. Current research involving invasive approaches including cranial remodeling, intracortical TTF and intratumoral modulation therapy (IMT) may improve outcomes.
Objective:
Present the history of TTF and discuss current areas of research with a focus on invasive TTF.
Methods:
We obtained and analyzed studies referencing TTF, invasive TTF, and any of transcranial electrical stimulation (tES), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), vagus nerve stimulation (VNS), peripheral nervous system (PNS), focused ultrasound (FUS), and transcranial magnetic stimulation (TMS) with respect to mechanism of action or anti-cancer-related effects.
Results:
Invasive strategies including cranial remodeling and IMT, through stereotaxis like DBS, would help alleviate the current limitations of TTF. In addition, FUS and VNS induce similar blood brain barrier effects and immune modulation as TTF that may enhance and promote an insurmountable host immune response against the immunosuppressive tumor microenvironment.
Conclusions:
TTF as currently practiced is a remarkable advance in cancer treatment. Improvements which exploit the effects of TTF in combination with other neuromodulatory modalities or in immunotherapy promise to improve this even further.
Insights
Tumor-treating fields (TTFields) show promise for glioblastoma (GBM) treatment. Invasive TTFields and combination therapies may enhance delivery and efficacy against brain tumors.
Area of Science:
- Neuro-oncology
- Biophysics
- Cancer Therapy
Background:
- Tumor-treating fields (TTFields) slow glioblastoma (GBM) growth via mitotic arrest and increased permeability.
- Current TTFields therapy extends GBM survival by approximately 5 months.
- Optimizing TTFields delivery is crucial due to anatomical barriers and shunting.
Purpose of the Study:
- To review the history of TTFields.
- To explore current research in TTFields, emphasizing invasive approaches.
- To discuss potential improvements in TTFields delivery and efficacy.
Main Methods:
- Literature review of studies on TTFields, invasive TTFields, and related neuromodulatory techniques.
- Analysis of mechanisms of action and anti-cancer effects.
- Inclusion of transcranial electrical stimulation (tES), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), vagus nerve stimulation (VNS), peripheral nervous system (PNS), focused ultrasound (FUS), and transcranial magnetic stimulation (TMS).
Main Results:
- Invasive strategies like cranial remodeling and intratumoral modulation therapy (IMT) can overcome TTFields delivery limitations.
- Stereotactic approaches, similar to DBS, can enhance invasive TTFields application.
- Focused ultrasound (FUS) and vagus nerve stimulation (VNS) show potential for blood-brain barrier modulation and immune response enhancement.
Conclusions:
- TTFields represent a significant advancement in cancer treatment.
- Combining TTFields with other neuromodulatory techniques or immunotherapy can further improve outcomes.
- Future research should focus on optimizing TTFields delivery and exploring synergistic treatment strategies.
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