Enhanced sonodynamic therapy and theranostic integration for breast cancer treatment: nanomaterial-driven...

Breast cancer is a common malignant tumour affecting women worldwide. Despite advances in various treatment areas, existing methods are still limited by the disease's high heterogeneity and complexity, which makes achieving ideal therapeutic effects difficult. Sonodynamic therapy (SDT), a novel non-invasive treatment modality, employs ultrasound to activate sonosensitizers, triggering chemical reactions that produce reactive oxygen species and other highly reactive free radicals. This approach offers excellent tissue penetration capabilities and precise controllability, thus opening new avenues for breast cancer treatment. However, the clinical translation of sonosensitizers faces various challenges, including limited targeting and treatment resistance mediated by the tumor microenvironment. The emergence of nanomedicine has introduced new strategies to address these issues. This review summarizes strategies for enhancing the efficacy of sonosensitizers based on nanotechnology, including improving the tumor microenvironment, enhancing targeting and penetration, and increasing biosafety and compatibility. It also explores the combined application of SDT with chemotherapy, radiotherapy, immunotherapy, chemodynamic therapy, and photothermal therapy, along with their synergistic mechanisms. The integration of SDT with ultrasound imaging technology, as well as its combined application with other imaging modalities (such as photoacoustic imaging and magnetic resonance imaging), offers potential for integrated diagnosis and treatment of breast cancer. Additionally, this review highlights the current challenges and future prospects for the clinical translation of SDT, providing insights into potential advancements that may enhance breast cancer treatment outcomes.