Therapeutic manipulation and bypass of the blood–brain barrier: powerful tools in glioma treatment
Alexandra Giantini-Larsen, Abhinav Pandey, Andrew Garton, Margherita Rampichini, Graham Winston, Jacob L. Goldberg, Rajiv Magge, Philip E. Stieg, Mark M. Souweidane, Rohan Ramakrishna
Abstract
The blood-brain barrier (BBB) remains an obstacle for delivery of chemotherapeutic agents to gliomas. High grade and recurrent gliomas continue to portend a poor prognosis. Multiple methods of bypassing or manipulating the BBB have been explored, including hyperosmolar therapy, convection-enhanced delivery (CED), laser-guided interstitial thermal therapy (LITT), and Magnetic Resonance Guided Focused Ultrasound (MRgFUS) to enhance delivery of chemotherapeutic agents to glial neoplasms. Here, we review these techniques, currently ongoing clinical trials to disrupt or bypass the BBB in gliomas, and the results of completed trials.