Endovascular superselective treatment of brain tumors: a new endovascular era? A quick review

Peschillo, Simone; Miscusi, Massimo; Missori, Paolo

doi:10.1136/neurintsurg-2013-011095

Cited by 8 publications

(10 citation statements)

References 31 publications

(40 reference statements)

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“…Prior reviews of the topic were included and references therein also searched,8–10 including the last review in Journal of Neurointerventional Surgery. 11 Manuscripts and studies focusing on non-IA infusions (ie, IV infusion) were excluded.…”

Section: Methodsmentioning

confidence: 99%

Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors

Srinivasan

Lang

Chen

et al. 2019

J NeuroIntervent Surg

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BackgroundMalignant gliomas continue to have a poor clinical outcome with available therapies. In the past few years, new targeted biologic therapies have been studied, with promising results. However, owing to problems with ineffective IV delivery of these newer agents, an alternative, more direct delivery mechanism is needed. Simultaneously, advancements in neuroendovascular technology have allowed endovascular selective intra-arterial approaches to delivery. This method has the potential to increase drug delivery and selectively target tumor vasculature.ObjectiveTo review the history of IA therapy for brain tumors, prior failures and successes, the emergence of new technologies and therapies, and the future direction of this young field.MethodsA comprehensive literature search of two databases (PubMed, Ovid Medline) was performed for several terms including ‘brain tumor’, ‘glioma’, and ‘endovascular intra-arterial’. Forty-five relevant articles were identified via a systematic review following PRISMA guidelines. Additional relevant articles were selected for further in-depth review. Emphasis was given to articles discussing selective intra-arterial intracranial delivery using microcatheters.ResultsEndovascular intra-arterial therapy with chemotherapy has had mixed results, with currently active trials using temozolomide, cetuximab, and bevacizumab. Prior attempts at IA chemotherapy with older-generation medications did not surpass the efficacy of IV administration. Advances in neuro-oncology have brought to the forefront new targeted biologic therapies.ConclusionsIn this review, we discuss the emerging field of endovascular neuro-oncology, a field that applies modern neuroendovascular techniques to the delivery of new therapeutic agents to brain tumors. The development of targeted therapies for brain tumors has been concurrent with the development of microcatheter technology, which has made superselective distal intracranial arterial access feasible and safe.

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Section: Methodsmentioning

confidence: 99%

Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors

Srinivasan

Lang

Chen

et al. 2019

J NeuroIntervent Surg

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“…These last two alterations (hypoxia and the reflux phenomenon) are targeted in GBM therapy through the use of an anti-angiogenic antibody (bevacizumab) that binds to vascular endothelial growth factor A, preventing interaction of the factor with its receptor expressed by endothelial cells which would lead to angiogenesis,18 and the administration of chemotherapeutics including paclitaxel, docetaxel, imatinib, topotecan, and temozolomide 13…”

Section: The Blood–brain Barrier (Bbb)mentioning

confidence: 99%

“…Combinations of superselective intra-arterial cerebral infusion (SIACI; achieved by catheterization of the intracranial arteries directly supplying tumors) or intra-arterial infusion (achieved by catheterization of the internal carotid artery or vertebral artery) of mannitol with intra-arterial bevacizumab or intravenous etoposide and intra-arterial melphalan and carboplatin have been described in three different clinical trials 18 22–24. Mannitol produces non-selective disruption of the BBB (unlike the abovementioned RMP-7), explaining the need for endovascular procedures to obtain adequate control over the diffusion of chemotherapeutic drugs.…”

Section: Well-known Strategies To Circumvent the Bbbmentioning

confidence: 99%

“…Despite these very encouraging observations, further research is still required, particularly since improvements in survival are not yet clear 18 57. The ability to modify the BBB probably needs to be improved and MRI-FUS is likely to play a major role in this goal, given its potential to selectively alter target tissue and the immediate quantitative control with MRI.…”

Section: Future Scenariosmentioning

confidence: 99%

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New therapeutic strategies regarding endovascular treatment of glioblastoma, the role of the blood–brain barrier and new ways to bypass it

Peschillo

Caporlingua

Diana

et al. 2015

J NeuroIntervent Surg

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The treatment protocols for glioblastoma multiforme (GBM) involve a combination of surgery, radiotherapy and adjuvant chemotherapy. Despite this multimodal approach, the prognosis of patients with GBM remains poor and there is an urgent need to develop novel strategies to improve quality of life and survival in this population. In an effort to improve outcomes, intra-arterial drug delivery has been used in many recent clinical trials; however, their results have been conflicting. The blood-brain barrier (BBB) is the major obstacle preventing adequate concentrations of chemotherapy agents being reached in tumor tissue, regardless of the method of delivering the drugs. Therapeutic failures have often been attributed to an inability of drugs to cross the BBB. However, during the last decade, a better understanding of BBB physiology along with the development of new technologies has led to innovative methods to circumvent this barrier. This paper focuses on strategies and techniques used to bypass the BBB already tested in clinical trials in humans and also those in their preclinical stage. We also discuss future therapeutic scenarios, including endovascular treatment combined with BBB disruption techniques, for patients with GBM.

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“…2 Interventional neuroradiology techniques are minimally invasive and allow for superselective delivery of therapeutic agents to specific CNS targets. 3 In the presence of an intact BBB, safe, effective, and most importantly predictable opening of the BBB is a critical element to increase therapeutic efficacy for multiple CNS pathologies, including tumors and neurodegenerative disorders. 4 Osmotic BBB opening (BBBO) is a proven method that results in increased BBB permeability; however, this technique remains controversial due to its variability and the lack of non-invasive methods for real-time intra-procedural validation.…”

Section: Introductionmentioning

confidence: 99%

Predicting and optimizing the territory of blood–brain barrier opening by superselective intra-arterial cerebral infusion under dynamic susceptibility contrast MRI guidance

Janowski

Walczak

Pearl

2015

J Cereb Blood Flow Metab

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Interventional neuroradiology techniques are minimally invasive and allow for superselective drug delivery to specific brain regions. The passage of most agents, however, is impaired by the blood-brain barrier (BBB). Despite its discovery over 40 years ago, hyperosmotic BBB opening (BBBO) remains highly variable, preventing its widespread implementation. Here, we report on a technique that enables the prediction and optimization of the BBBO territory. We found that the microcatheter tip position and the speed of hyperosmolar mannitol injection, both major determinants of the targeted territory, can be modulated in real-time as guided by trans-catheter perfusion MRI.

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Endovascular superselective treatment of brain tumors: a new endovascular era? A quick review

Cited by 8 publications

References 31 publications

Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors

Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors

New therapeutic strategies regarding endovascular treatment of glioblastoma, the role of the blood–brain barrier and new ways to bypass it

Predicting and optimizing the territory of blood–brain barrier opening by superselective intra-arterial cerebral infusion under dynamic susceptibility contrast MRI guidance

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