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Ultrasound-Based Therapies in Primary Central Nervous System Tumors
Giovanni Dima1,2, Alessandro Olivari1,3, Vincenzo Di Nunno1
1Nervous System Medical Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy.
Abstract:
Primary central nervous system (CNS) tumors remain a major challenge in neuro-oncology due to their cellular heterogeneity, infiltrative growth, and the protective blood-brain barrier (BBB), which limits the effectiveness of systemic therapies. Despite aggressive multimodal treatments, patient survival remains poor, highlighting the urgent need for new therapeutic strategies. Ultrasound-based therapies, including focused ultrasound (FUS) and sonodynamic therapy (SDT), have emerged as promising approaches. FUS can transiently open the BBB and induce localized mechanical and thermal effects, enhancing drug delivery, while SDT activates tumor-specific sensitizers to generate reactive oxygen species that trigger cancer cell death. Preclinical and early clinical studies suggest that combining these modalities with chemotherapy, immunotherapy, or radiotherapy may improve treatment outcomes. Emerging tools such as AI-guided monitoring, theranostic platforms, and ultrasound-responsive nanoparticles could further enable personalized interventions. However, challenges remain, including protocol variability, tumor heterogeneity, and limited long-term safety data. Careful optimization and clinical validation are needed before these strategies can be widely adopted in the management of CNS tumors.
Insights
Focused ultrasound (FUS) and sonodynamic therapy (SDT) show promise for treating brain tumors by enhancing drug delivery and targeting cancer cells. Combining these ultrasound therapies with other treatments may improve outcomes for central nervous system (CNS) tumors.
Area of Science:
- Neuro-oncology
- Medical Physics
- Biotechnology
Background:
- Primary central nervous system (CNS) tumors present significant challenges due to heterogeneity, infiltrative growth, and the blood-brain barrier (BBB).
- Current treatments offer limited efficacy, necessitating novel therapeutic strategies for improved patient survival.
Purpose of the Study:
- To explore the potential of ultrasound-based therapies, specifically focused ultrasound (FUS) and sonodynamic therapy (SDT), for managing CNS tumors.
- To evaluate the synergistic effects of combining FUS and SDT with conventional treatments like chemotherapy, immunotherapy, and radiotherapy.
Main Methods:
- Focused ultrasound (FUS) to transiently open the BBB and induce mechanical/thermal effects.
- Sonodynamic therapy (SDT) to activate tumor-specific sensitizers and generate cytotoxic reactive oxygen species.
- Review of preclinical and early clinical studies investigating these ultrasound modalities.
Main Results:
- FUS enhances drug delivery across the BBB.
- SDT induces cancer cell death through reactive oxygen species.
- Combination therapies show potential for improved treatment outcomes in CNS tumors.
Conclusions:
- Ultrasound-based therapies (FUS and SDT) offer promising avenues for CNS tumor treatment.
- Integration with AI, theranostics, and nanoparticles may enable personalized interventions.
- Further optimization and clinical validation are crucial to overcome challenges like protocol variability and tumor heterogeneity.
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