Cerebral microcirculation in glioblastoma: A major determinant of diagnosis, resection, and drug delivery

Abstract

High-grade gliomas (HGGs), including Glioblastoma (GBM), are the most common primary malignant brain tumor in adults. 1 Despite intense research over the last 50 years, the survival of patients with HGG, a group comprising WHO grade III and IV malignant glioma tumors, continues to be poor. 2,3 The current standard of care consists of surgery followed by external beam radiotherapy (EBRT) and temozolomide (TMZ). 4 For GBM, the most common malignant glioma, the median survival is 14-16 months with a 2-year survival rate of about 30% following standard of care treatment. 5,6 With maximal cytoreductive surgery consisting of resection of the contrast-enhancing lesion up to 98%, survival can

Optical blood-brain-tumor barrier modulation expands therapeutic options for glioblastoma treatment

“…Formed by a tight-junction (TJ) protein complex and adherens junctions between the brain microvascular endothelial cells and modulated by surrounding stromal cells (pericytes and astrocytes), the BBB excludes or limits the delivery of 98% of conventional chemotherapies to subtherapeutic levels 5 . Although GBM can disrupt the integrity of the BBB in the hypoxic and angiogenic core, the magnitude of this local disruption is nonuniform or insufficient to allow drug penetration in meaningful quantities [6][7][8][9][10] . Moreover, evidence suggests that GBM has tumor cells infiltrating into the neighboring tissue without disrupting the BBB, which subsequently drives the inevitable fatal recurrence 11 .…”