Focused Ultrasound Therapy
Focused ultrasound is an early stage, noninvasive therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with brain tumors. This novel technology focuses beams of ultrasonic energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.
How it Works
Where the beams converge, the ultrasound produces a variety of therapeutic effects enabling treatment without incisions or radiation.
Current treatments for brain tumors include surgery, radiation therapy, and chemotherapy, all of which have limitations and side effects.
Focused ultrasound has the potential to provide an alternative to invasive surgery or to replace or augment radiosurgery for treatment of tumors in the brain. Focused ultrasound is noninvasive – no incisions, holes in the skull, electrodes in the brain – and therefore has reduced risk for infection, blood clots, and mechanical tissue damage associated with surgery. There is no ionizing radiation and, due to precise targeting, no damage to surrounding healthy tissue.
Focused ultrasound may also be a complement to drug therapy, enabling enhanced delivery of chemotherapy or immunotherapy into the brain via temporary opening of the blood-brain barrier and/or enhanced permeability of the blood-tumor barrier. It may also induce an anti-tumor immune response.
The following studies are recruiting patients with brain tumors for focused ultrasound treatment:
Exablate Blood-Brain Barrier Disruption With Carboplatin for the Treatment of rGBM
A new pair of clinical trials has opened in the United States and Canada that use focused ultrasound to open the blood brain barrier (BBB) prior to carboplatin therapy for patients with recurrent glioblastoma.
Safety and efficacy of opening the BBB with the SonoCloud-9 in patients with Glioblastoma
This clinical trial is opening the BBB in patients with recurrent glioblastoma and is designed to help enhance the penetration of chemotherapy. This study began in France and has extended to include US sites.
Exablate Blood Brain Barrier Disruption (BBBD) for Planned Surgery in Glioblastoma
This clinical trial is a feasibility study that will open blood brain barrier prior to surgery in patients with glioblastoma.
A Feasibility Safety Study of Benign Centrally-Located Intracranial Tumors in Pediatric and Young Adult Subjects
Centrally located intracranial benign tumors that require intervention in pediatric and young adult patients. Click here for a list of tumors treated in this study.
Exablate Blood-Brain Barrier Disruption for Glioblastoma in Patients Undergoing Standard Chemotherapy
A clinical trial at Severance Hospital, a part of Yonsei University Health System, in Seoul, Korea, is investigating the use of focused ultrasound to open the blood-brain barrier (BBB) and allow chemotherapeutic agents to more efficiently reach the tumors of patients with glioblastoma.
Exablate Blood-Brain Barrier Disruption for Patients with Glioblastoma Undergoing Standard Chemotherapy
This US clinical trial is investigating the use of focused ultrasound to open the BBB to allow chemotherapeutic agents to more efficiently reach the tumors of patients with glioblastoma.
The following studies concern treatment of tumors from the body that have metastasized to the brain.
A clinical trial for patients with breast cancer that has metastasized to their brain is enrolling patients in Canada. The team will us focused ultrasound to open the blood-brain barrier to allow therapeutic medications to more effectively reach the tumor in their brain. This study is only open to Canadian citizens.
For a full list of known brain tumor clinical trials, please see here.
Regulatory Approval and Reimbursement
Focused ultrasound is not approved by any regulatory bodies worldwide as a treatment for brain tumors, nor is the treatment reimbursed by medical insurance providers.
Preclinical Laboratory Studies
Preclinical studies are underway to investigate the use of various mechanisms of focused ultrasound in the treatment of brain tumors. Examples of these studies include:
- Focused ultrasound to temporarily disrupt the BBB and deliver a variety of chemotherapy or immunotherapy drugs, including the dosing and timing (e.g. frequency) of drug administration.
- Focused ultrasound to induce an immune response, including a multi-site study investigating the type of immune response elicited by different “modes” of energy delivery.
- Focused ultrasound to enable targeted delivery and/or activation of drugs via carrier vehicles (e.g. microbubbles, nanoparticles, liposomes) to enable delivery of high concentrations in the tumor with minimal systemic side effects.
- Non-thermal mechanical destruction of tumor using a type of focused ultrasound called histotripsy.
There are many government bodies and patient groups dedicated to brain tumors, including the following:
- Medline Plus: A service of the U.S. National Library of Medicine and NIH
- National Cancer Institute's Brain Tumor Page
- American Brain Tumor Association
- National Brain Tumor Society
Suggested Reading: Focused Ultrasound for Glioblastoma (PDF), June 2019.
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Daniel Y. Zhang, Crismita Dmello, Li Chen, Victor A. Arrieta, Edgar Gonzalez-Buendia, J. Robert Kane, Lisa P. Magnusson, Aneta Baran, C. David James, Craig Horbinski, Alexandre Carpentier, Carole Desseaux, Michael Canney, Miguel Muzzio, Roger Stupp and Adam M. Sonabend Ultrasound-mediated Delivery of Paclitaxel for Glioma: A Comparative Study of Distribution, Toxicity, and Efficacy of Albumin-bound Versus Cremophor Formulations. Clin Cancer Res 2019. DOI: 10.1158/1078-0432.CCR-19-2182 Published January 2020
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McDannold N, Zhang Y, Supko JG, Power C, Sun T, Peng C, Vykhodtseva N, Golby AJ, Reardon DA. Acoustic feedback enables safe and reliable carboplatin delivery across the blood-brain barrier with a clinical focused ultrasound system and improves survival in a rat glioma model. Theranostics. 2019 Aug 14;9(21):6284-6299. doi: 10.7150/thno.35892. eCollection 2019.
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Wu SK, Santos MA, Marcus SL, Hynynen K. Brain Tumor GLioma MR-guided Focused Ultrasound Facilitates Sonodynamic Therapy with 5-Aminolevulinic Acid in a Rat Glioma Model. Sci Rep. 2019 Jul 18;9(1):10465. doi: 10.1038/s41598-019-46832-2.
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Goutal S, Gerstenmayer M, Auvity S, Caillé F, Mériaux S, Buvat I, Larrat B, Tournier N. Physical blood-brain barrier disruption induced by focused ultrasound does not overcome the transporter-mediated efflux of erlotinib. J Control Release. 2018 Nov 8;292:210-220. doi: 10.1016/j.jconrel.2018.11.009.
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Click here for additional references from PubMed.
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