TMZ-assisted chemotherapy combined with MRgFUS destroys blood-brain barrier to treat PATIENTs after GBM

Backgroundthe main cause of death of glioblastoma (GBM) patients after treatment was the recurrence and progression of the tumorUsually the tumor recurrence is within 2 cm of the lesions to the edge of the lesions, the blood-brain barrier (BBB) in this area is basically intact, interfering with the delivery of chemotherapy drugsThere are several ways to destroy BBB, but their application is limited by a lack of specificity, safety, and insufficient concentration of medication for brain tissueIn recent years, MR-guided focused ultrasound (MRgFUS) has attracted widespread attention as a non-invasive means of temporary destruction of BBBMRgFUS transmits ultrasonic energy to the target area without craniofacial surgery through in-the-operative imaging guidance and real-time feedbackThe current MRgFUS device consists of a phased array sensor system of 1024 independent guide elements that targets the tumor area of the brain with submillimeter accuracyLow-intensity focused ultrasound (FUS) uses the cavitation effect to destroy BBB, and the addition of microbubbles (MBs) reduces the cavitation threshold, thereby reducing the sound power required to break the BBBSo Hee Park, of the Institute of Neurosurgery and Brain Research at Yonsei University School in Seoul, South Korea, and others studymed MRGFUS repeatedly undermined the safety and feasibility of the blood-brain barrier in GBM patients in TMZ-standard complementary chemotherapy, published online January 2020 in J Neurosurgresearch method
this forward-looking, single-center and single-arm study was designed to destroy the BBB in the high-signalwhite white matter region with MRgFUS on the first or second day of TMZ-assisted chemotherapyTo avoid overlap in the ultrasonic alignment area, the target spacing is greater than 1cmTargets are predetermined by neurosurgeons and neuroradiologists through MRI imagingRadiology, laboratory and clinical evaluation is carried out 2 days prior to each BBB destructionBBB destruction was performed on the same target during a single cycle of assisted chemotherapy; MrI-T1 weighted or MRI-T2 weighted/gradient echo (GRE) scans are performed immediately after each MRgFUS treatment;results
from September 2018, six postoperative GBM patients were treated with MRgFUS to destroy BBB at 145 targets at different sites of the tumor's edge, along with TMZ-assisted chemotherapy Results In 131 (90.3%) targets (90.3%) of MRI-T1 weighted images and 93 (64.1%) targets of MRI-T2/GRE weighted images, radon-enhanced lesions were observed, and a total of 134 (92.4%) targets were destroyed MrI during follow-up showed that the lesions of the agent were gradually disappeared During the 6-cycle TMZ-assisted chemotherapy combined with MRgFUS treatment, no associated clinical complications occurred conclusions
the study for the first time in the standard auxiliary chemotherapy process, the use of MRgFUS repeatedly destroyed GBM excision of the tumor limbic tissue BBB, showing that MRgFUS treatment can be accurate, repeated, no adverse reactions However, a longer follow-up period was required to observe the exact effect.