脑肿瘤声动力疗法综述

声动力疗法（SDT）作为一种有前景的非侵入性脑肿瘤治疗方法，逐渐受到关注，能够靶向并选择性杀死肿瘤细胞，副作用有限。本文综述了SDT的作用机制以及正在进行的临床试验，以优化声照射参数，旨在治疗胶质母细胞瘤（GBM）和弥漫性桥脑胶质瘤（DIPG）。简要讨论了在梅奥诊所首次治疗复发性GBM患者的初步结果。作者利用PubMed、EMBASE和OVID等电子数据库，检索涉及“声动力疗法”、“SDT”、“聚焦超声”、“5-ALA”、“脑肿瘤”、“弥漫性桥脑胶质瘤”、“胶质母细胞瘤”和“高等级胶质瘤”的相关预临床和临床试验文章。在高等级胶质瘤和GBM的预临床模型中，SDT显示通过产生活性氧种产生靶向肿瘤细胞死亡的证据。新兴的临床试验结果显示，复发性GBM和DIPG对SDT有良好的治疗反应，患者副作用少。目前，SDT被认为是一种有潜力的非侵入性癌症治疗方式，患者耐受性良好。初步数据显示，GBM对单次SDT的影像学反应良好，尚未观察到多次（月度）声照治疗后的非靶向副作用。SDT的临床试验旨在探讨其能否将致命性的GBM或DIPG诊断转变为一种慢性、可治疗的疾病。SDT安全、可重复、比化疗和放疗更易耐受，已在人体癌症治疗中显示出一定效果，但仍需更多临床试验以建立标准化的声敏剂递送、治疗参数和联合治疗方案。治疗的最佳时机尚待确定，是在术后预防复发，还是作为复发性GBM患者的救援治疗（当再次手术不适用）。未来，SDT有望在转移瘤、脑膜瘤和低级别胶质瘤等临床适应症中得到拓展，相关临床试验正在筹备中。

Sonodynamic therapy (SDT) is gaining attention as a promising new noninvasive brain tumor treatment that targets and selectively kills tumor cells, with limited side effects. This review examines the mechanisms of SDT and ongoing clinical trials looking at optimization of sonication parameters for potential treatment of glioblastoma (GBM) and diffuse intrinsic pontine glioma (DIPG). The results in the first patient with recurrent GBM treated at the Mayo Clinic are briefly discussed.The authors of this literature review used electronic databases including PubMed, EMBASE, and OVID. Articles reporting relevant preclinical and clinical trials were identified by searching for text words/phrases and MeSH terms, including the following: "sonodynamic therapy," "SDT," "focused ultrasound," "5-ALA," "ALA," "brain tumors," "diffuse pontine glioma," "glioblastoma," and "high grade glioma."Preclinical and clinical trials investigating the specific use of SDT in brain tumors were reviewed. In preclinical models of high-grade glioma and GBM, SDT has shown evidence of targeted tumor cell death via the production of reactive oxygen species. Emerging clinical trial results within recurrent GBM and DIPG show evidence of successful treatment response, with minimal side effects experienced by recruited patients. So far, SDT has been shown to be a promising noninvasive cancer treatment that is well tolerated by patients. The authors present pilot data suggesting good radiological response of GBM to a single SDT treatment, with unpublished observation of a lack of off-target effects even after multiple (monthly) sonication outpatient treatments. The scope of the clinical trials of SDT is to investigate whether it can be the means by which the fatal diagnosis of GBM or DIPG is converted into that of a chronic, treatable disease.SDT is safe, repeatable, and better tolerated than both chemotherapy and radiotherapy. It has been shown to have an effect in human cancer therapy, but more clinical trials are needed to establish standardized protocols for sonosensitizer delivery, treatment parameters, and combination therapies. The most appropriate timing of treatment also remains to be determined-whether to prevent recurrence in the postoperative period, or as a salvage option in patients with recurrent GBM for which redo surgery is inappropriate. It is hoped that SDT will also be developed for a wider spectrum of clinical indications, such as metastases, meningioma, and low-grade glioma. Further clinical trials are in preparation.