The Cryo-immunologic effect: A therapeutic advance in the treatment of glioblastomas?

Cébula, H.; Noël, Georges; Garnon, Julien; Todeschi, Julien; Burckel, Hélène; Mathelin, Michel de; Gangi, Afshin; Proust, F.

doi:10.1016/j.neuchi.2020.06.135

Cited by 5 publications

(7 citation statements)

References 36 publications

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“…MR-guided tar- get ultrasound (MRgFUS) with intravenous injection of microbubbles seems to be able to disrupt the BBB temporarily and repeatedly without needing open surgery [23] that might constitute a valuable option. IMRgC is finally in line with other reports of BBB disruption adding also very likely a cryo-immunologic effect [17]. IMRgC is probably able to activate dendritic cells with an antigen-presenting function.…”

Section: Perspectives Of Brain Cryotherapysupporting

confidence: 89%

“…After the procedure, each patient was admitted to our neurosurgical high dependency unit where a rigorous neurological monitoring was carried out for a mean of 6 days (5)(6)(7)(8). Afterwards, the patient was transferred to the standard ward with a mean in-hospital stay of 13.6 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Upon discharge, the patient underwent clinical and radiological follow-up at 6 weeks and thereafter every 3 months for the first 2 years (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Pertinent literature has already reported the role of the IMRgC [19] in managing brain metastases; the latter could likely represent an alternative treatment for gliomas [16]. MR guidance enables precise lesion targeting, facilitating optimal treatment margins while avoiding inadvertent parenchymal damage [17]. The advocated mechanism of brain cryotherapy was the direct cellular injury, causing induction of apoptosis, micro-circulatory ischemia, and cryo-immunologic effect [17].…”

Section: Cryotherapy and Blood-brain Barrier Disruptionmentioning

confidence: 99%

“…MR guidance enables precise lesion targeting, facilitating optimal treatment margins while avoiding inadvertent parenchymal damage [17]. The advocated mechanism of brain cryotherapy was the direct cellular injury, causing induction of apoptosis, micro-circulatory ischemia, and cryo-immunologic effect [17]. A previous animal study has suggested the BBB disruption mechanism of brain cryotherapy [18].…”

Section: Cryotherapy and Blood-brain Barrier Disruptionmentioning

confidence: 99%

“…This imaging-guided tool, thanking to a cine MRI technique, is able to create a tissue lesion by severe targeted hypothermia. Cryoablation through the use of argon/helium gas generates extreme cold temperature that destroys tumors via a direct cellular injury, inducing apoptosis, micro-vessel ischemia, and/or cryo-immunologic effect [17]. A disruptive effect of cryotherapy on the BBB has been suggested in an animal model demonstrating necrosis foci surrounded by a transition zone of edema and disrupted BBB on histological analysis [18].…”

Section: Introductionmentioning

confidence: 99%

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Does interventional MRI-guided brain cryotherapy cause a blood–brain barrier disruption? Radiological analysis and perspectives

et al. 2021

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Glioblastoma is the most common primary malignant brain tumor with an incidence of 5/100,000 inhabitants/year and a 5-year survival rate of 6.8%. Despite recent advances in the molecular biology understanding of glioblastoma, CNS chemotherapy remains challenging because of the impermeable blood-brain barrier (BBB). Interventional MRI-guided brain cryotherapy (IMRgC) is technique that creates a tissue lesion by making a severe targeted hypothermia and possibly a BBB disruption. This study goal was to analyze the effect of IMRgC on human BBB glioblastoma through its gadolinium enhancing features. All patients harboring a local glioblastoma recurrence and meeting all the inclusion criteria were consecutively included into this retrospective study during a 2-year period. The primary endpoint was to analyze the modification of the gadolinium enhancement on MRI T1 sequences using MR perfusion weighted images during follow-up. The secondary endpoint was to assess any ischemic/hemorrhagic complication following cryotherapy procedure using diffusion weighted imaging (DWI), susceptibility weighted imaging (SWI), or fluid-attenuated inversion recovery (FLAIR). Among the 6 patients studied, all (100%) showed a BBB disruption on the cryotherapy site through the analysis of the perfusion weighted images with an average delay of 2.83 months following the procedure. The gadolinium enhancement located around the cavity then spontaneously decreased in 4/6 patients (67%). No ischemic or hemorrhagic complication was recorded. This study confirms the IMRgC capacity to disrupt BBB as already suggested by the literature. IMRgC might represent a new option in the management of GBM allowing the combined effect of direct cryoablation and enhanced chemotherapy.

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Section: Perspectives Of Brain Cryotherapysupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Cryotherapy and Blood-brain Barrier Disruptionmentioning

confidence: 99%

Section: Cryotherapy and Blood-brain Barrier Disruptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does interventional MRI-guided brain cryotherapy cause a blood–brain barrier disruption? Radiological analysis and perspectives

et al. 2021

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Advancements and challenges in brain cancer therapeutics

Bai,

Deng,

et al. 2024

Exploration

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Treating brain tumors requires a nuanced understanding of the brain, a vital and delicate organ. Location, size, tumor type, and surrounding tissue health are crucial in developing treatment plans. This review comprehensively summarizes various treatment options that are available or could be potentially available for brain tumors, including physical therapies (radiotherapy, ablation therapy, photodynamic therapy, tumor‐treating field therapy, and cold atmospheric plasma therapy) and non‐physical therapies (surgical resection, chemotherapy, targeted therapy, and immunotherapy). Mechanisms of action, potential side effects, indications, and latest developments, as well as their limitations, are highlighted. Furthermore, the requirements for personalized, multi‐modal treatment approaches in this rapidly evolving field are discussed, emphasizing the balance between efficacy and patient safety.

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