Modern possibilities of treating brain tumors: intraoperative technologies in neurooncology
- Authors: Nafikov A.I.1, Minnigaleev R.I.1, Yarullina E.R.1, Magomedova E.M.2, Soboleva K.G.3, Sobolev M.M.3, Egamova O.R.1, Kirillova Y.A.4, Arutyunyan A.A.4, Tokhova F.A.4, Abbasova N.A.5, Saadueva K.K.5, Yarmeev I.F.5
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Affiliations:
- Bashkir State Medical University
- Dagestan State Medical University
- Kuban State Medical University
- Rostov State Medical University
- Astrakhan State Medical University
- Issue: Vol 16, No 1 (2025)
- Pages: 64-75
- Section: Reviews
- URL: https://journals.rcsi.science/clinpractice/article/view/295971
- DOI: https://doi.org/10.17816/clinpract643543
- ID: 295971
Cite item
Abstract
The fundamental principle of neurooncology is the maximal removal of the tumor, simultaneously minimizing the effects on the healthy brain structures. In cases of malignant gliomas, the extent of resection still remains a critical parameter, which significantly affects the prognosis of the disease. The results from numerous trials show that the increase of the resected tumor volume correlates with improved survival rates. This review provides the data on the innovative intraoperative therapeutic technologies, developed for improving the treatment outcomes among the patients with brain tumors. It is important to note that each of these technologies has its benefits and limitations. For example, laser interstitial thermotherapy provides the ability of highly precise destruction of tumor cells with minimal damaging of the surrounding healthy tissues, however, it requires special equipment and qualified personnel. Photodynamic therapy is distinguished by selective affecting the tumor, but its efficiency depends on the type of photosensibilizing agent used and on the depth of light penetration. Brachytherapy, in turn, provides the possibility of local tumor irradiation, minimizing the effects on the surrounding structures, but it can require a long-term following up the patient after the procedure. Thus, the use of modern intraoperative methods gives access to new perspectives in neurooncology, providing a more precise and sparing destruction of tumors with preserving the functional activity of the healthy brain structures. However, the success of their use depends on further development of technologies, on increasing the qualification of specialists and on the close interactions of the scientific community with the industry and with the regulating authorities.
Full Text
##article.viewOnOriginalSite##About the authors
Arthur I. Nafikov
Bashkir State Medical University
Author for correspondence.
Email: doccomiss@rambler.ru
ORCID iD: 0009-0003-6288-7831
Russian Federation, 3 Lenin st, Ufa, 450008
Radmir I. Minnigaleev
Bashkir State Medical University
Email: mega.minnigaleev@mail.ru
ORCID iD: 0009-0006-3984-371X
Russian Federation, 3 Lenin st, Ufa, 450008
Elina R. Yarullina
Bashkir State Medical University
Email: yarullinaer02@gmail.com
ORCID iD: 0009-0003-3600-2163
Russian Federation, 3 Lenin st, Ufa, 450008
Eminat M. Magomedova
Dagestan State Medical University
Email: qweftyug@gmail.com
ORCID iD: 0009-0001-9366-3676
Russian Federation, Makhachkala
Karina G. Soboleva
Kuban State Medical University
Email: padeliya69@yandex.ru
ORCID iD: 0009-0006-8102-833X
Russian Federation, Krasnodar
Maksim M. Sobolev
Kuban State Medical University
Email: Max.sobolev2033@yandex.ru
ORCID iD: 0009-0003-3690-5282
Russian Federation, Krasnodar
Oishakhon R. Egamova
Bashkir State Medical University
Email: oishaxon@inbox.ru
ORCID iD: 0009-0008-8215-2601
Russian Federation, 3 Lenin st, Ufa, 450008
Yulia A. Kirillova
Rostov State Medical University
Email: yula.a.k@list.ru
ORCID iD: 0009-0004-1822-0930
Russian Federation, Rostov-On-Don
Arut A. Arutyunyan
Rostov State Medical University
Email: arutik1803@yandex.ru
ORCID iD: 0009-0009-5164-7852
Russian Federation, Rostov-On-Don
Fatimat A. Tokhova
Rostov State Medical University
Email: tohovafatima289@gmail.ru
ORCID iD: 0009-0003-2317-7917
Russian Federation, Rostov-On-Don
Nurlana A. Abbasova
Astrakhan State Medical University
Email: nurlanaabbasova@yandex.ru
ORCID iD: 0009-0006-6985-8402
Russian Federation, Astrakhan
Khanipat Kh. Saadueva
Astrakhan State Medical University
Email: hanipatsaadueva@gmail.com
ORCID iD: 0009-0001-2079-8705
Russian Federation, Astrakhan
Ilshat F. Yarmeev
Astrakhan State Medical University
Email: yarmeev.ilshat@yandex.ru
ORCID iD: 0009-0007-7545-7514
Russian Federation, Astrakhan
References
- Сарычева М.М., Важенин А.В., Доможирова А.С. Результаты многокомпонентного лечения пациентов с прогрессированием первичных глиом головного мозга // Сибирский онкологический журнал. 2023. Т. 22, № 1. С. 110–118. [Sarycheva MM, Vazhenin AV, Domozhirova AS. Results of multicomponent treatment of patients with progression of primary brain glioma. Siberian journal of oncology. 2023;22(1):110–118]. doi: 10.21294/1814-4861-2023-22-1-110-118 EDN: LLBFWP
- Кузнецова Н.С., Гурова С.В., Гончарова A.С., и др. Современные подходы к терапии глиобластомы // Южно-Российский онкологический журнал. 2023. Т. 4, № 1. С. 52–64. [Kuznetsova NS, Gurova SV, Goncharova AS, et al. Modern approaches to glioblastoma therapy. South Russian Journal of Cancer. 2023;4(1):52–64]. doi: 10.37748/2686-9039-2023-4-1-6 EDN: IICMMC
- Brown TJ, Brennan MC, Li M, et al. Association of the extent of resection with survival in glioblastoma: A systematic review and meta-analysis. JAMA Oncol. 2016;2(11):1460–1469. doi: 10.1001/jamaoncol.2016.1373
- Габидуллин А.Ф., Данилов В.И., Алексеев А.Г. Неврологический дефицит у больных после удаления опухолей головного мозга с использованием высокотехнологичных нейрохирургических методов и оптимизация лечения больных этой группы // Неврологический вестник. 2015. Т. 47, № 2. C. 26–29. [Gabidullin AF, Danilov VI, Alekseev AG. Neurological deficit in patients after removal of brain tumors using high-tech methods and optimization of neurosurgical treatment of this group of patients. Neurological bulletin. 2015;(2):26–29.]. doi: 10.17816/nb13908 EDN: TUFSGL
- Острейко О.В., Черебилло В.Ю., Гусев А.А. Малоинвазивная лазерная гипертермия рецидивных супратенториальных глиобластом // Вопросы онкологии. 2022. Т. 68, № 35. С. 302–303. [Ostreiko OV, Cherebillo VYu, Gusev AA. Minimally invasive laser hyperthermia of recurrent supratentorial glioblastomas. Problems in oncology. 2022;68(35):302–303.]. EDN: HVNZFI
- Holste KG, Orringer DA. Laser interstitial thermal therapy. Neurooncol Adv. 2019;2(1):vdz035. doi: 10.1093/noajnl/vdz035
- Schupper AJ, Hadjipanayis CG. Novel approaches to targeting gliomas at the leading/cutting edge. J Neurosurg. 2023;139(3):760–768. doi: 10.3171/2023.1.JNS221798
- Shin DH, Melnick KF, Tran DD, Ghiaseddin AP. In situ vaccination with laser interstitial thermal therapy augments immunotherapy in malignant gliomas. J Neurooncol. 2021;151(1):85–92. doi: 10.1007/s11060-020-03557-x EDN: SRTTGJ
- Chiu D, Qi J, Thin TH, et al. A phase I trial of VEGF-A inhibition combined with PD-L1 blockade for recurrent glioblastoma. Cancer Res Commun. 2023;3(1):130–139. doi: 10.1158/2767-9764.CRC-22-0420 EDN: QCYBNZ
- Hormigo A, Mandeli J, Hadjipanayis C, et al. Phase I study of PD-L1 inhibition with avelumab and laser interstitial thermal therapy in patients with recurrent glioblastoma. J Clin Oncol. 2019;37(15 Suppl):TPS2074–TPS2074. doi: 10.1200/JCO.2019.37.15_suppl.TPS2074
- Rennert RC, Khan U, Tatter SB, et al. Patterns of clinical use of stereotactic laser ablation: Analysis of a multicenter prospective registry. World Neurosurg. 2018;116:e566–e570. doi: 10.1016/j.wneu.2018.05.039
- Anderson BM, Padilla L, Ryckman JM, et al. Open RT structures: A solution for TG-263 accessibility. Int J Radiat Oncol Biol Phys. 2024;118(3):859–863. doi: 10.1016/j.ijrobp.2023.09.041 EDN: ZDAJRT
- Pepper NB, Eich HT, Müther M, et al. ALA-RDT in GBM: Protocol of the phase I/II dose escalation trial of radiodynamic therapy with 5-Aminolevulinic acid in patients with recurrent glioblastoma. Radiat Oncol. 2024;19(1):11. doi: 10.1186/s13014-024-02408-7 EDN: YYIUIG
- Mohammadi AM, Schroeder JL. Laser interstitial thermal therapy in treatment of brain tumors: The NeuroBlate System. Expert Rev Med Devices. 2014;11(2):109–119. doi: 10.1586/17434440.2014.882225 EDN: SSPBCP
- Sloan AE, Ahluwalia MS, Valerio-Pascua J, et al. Results of the NeuroBlate system first-in-humans phase I clinical trial for recurrent glioblastoma: Clinical article. J Neurosurg. 2013;118(6):1202–1219. doi: 10.3171/2013.1.JNS1291
- De Groot JF, Kim AH, Prabhu S, et al. Efficacy of laser interstitial thermal therapy (LITT) for newly diagnosed and recurrent IDH wild-type glioblastoma. Neurooncol Adv. 2022;4(1):vdac040. doi: 10.1093/noajnl/vdac040 EDN: XLTSVK
- Chan M, Tatter S, Chiang V, et al. Efficacy of laser interstitial thermal therapy for biopsy-proven radiation necrosis in radiographically recurrent brain metastases. Neurooncol Adv. 2023;5(1):vdad031. doi: 10.1093/noajnl/vdad031 EDN: HBZQQU
- Landazuri P, Shih J, Leuthardt E, et al. A prospective multicenter study of laser ablation for drug resistant epilepsy: One year outcomes. Epilepsy Res. 2020;167:106473. doi: 10.1016/j.eplepsyres.2020.106473
- Калинин В.А., Повереннова И.Е., Якунина А.В., Бекетова Е.М. Инновационные методы диагностики и лечения эпилепсии (обзор) // Саратовский научно-медицинский журнал. 2017. Т. 13, № 1. С. 143–147. [Kalinin VA, Poverennova IE, Yakunina AV, Beketova EM. Innovation in diagnostics and treatment of epilepsy. Saratov journal of medical scientific research. 2017;13(1):143–147]. EDN: YPYFZB
- Kang JY, Wu C, Tracy J, et al. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia. 2016;57(2):325–334. doi: 10.1111/epi.13284
- Sperling MR, Gross RE, Alvarez GE, et al. Stereotactic laser ablation for mesial temporal lobe epilepsy: A prospective, multicenter, single-arm study. Epilepsia. 2020;61(6):1183–1189. doi: 10.1111/epi.16529
- Jethwa PR, Barrese JC, Gowda A, et al. Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: Initial experience. Neurosurgery. 2012;71(1 Suppl Operative):133–144; 144–145. doi: 10.1227/NEU.0b013e31826101d4
- Wilfong AA, Curry DJ. Hypothalamic hamartomas: Optimal approach to clinical evaluation and diagnosis. Epilepsia. 2013;54(Suppl 9):109–114. doi: 10.1111/epi.12454
- Абдуллаев О.А., Гайтан А.С., Салим Н., и др. Начальные результаты лечения рецидивных глиобластом головного мозга с применением резекции в сочетании с интраоперационной баллонной электронной брахитерапией // Сибирский научный медицинский журнал. 2019. Т. 39, № 4. С. 99–109. [Abdullaev OA, Gaytan AS, Salim N, et al. Initial results in recurrent brain glioblastomas management with maximal safe resection followed by intaoperative balloon electronic brachyterapy. Siberian scientific medical journal. 2019;39(4):99–109]. doi: 10.15372/SSMJ20190413 EDN: YPGRUQ
- Абдуллаев О.А., Гайтан А.С., Салим Н., и др. Повторная резекция и интраоперационная лучевая терапия злокачественных глиом головного мозга: исторический экскурс и современное состояние проблемы // Вопросы нейрохирургии имени Н.Н. Бурденко. 2019. Т. 83, № 5. С. 101–108. [Abdullaev OA, Gaitan AS, Salim N, et al. Repetitive resection and intrasurgery radiation therapy of brain malignant gliomas: History of question and modern state of problem. Burdenko’s journal of neurosurgery. 2019;83(5):101–108]. doi: 10.17116/neiro201983051101 EDN: ZLTBWN
- Киприянов Е.А., Карнаух П.А., Важенин И.А., и др. Брахитерапия I-125 и роботизированная радиотерапия — методы лечения пациентов с локализованным раком предстательной железы // Вестник урологии. 2021. Т. 9, № 4. С. 40–50. [Kiprijanov EA, Karnaukh PA, Vazhenin IA, et al. Iodine-125 brachytherapy and robotic stereotactic radiotherapy: Treatment options for patients with localized prostate cancer. Vestnik Urologii = Urology Herald. 2021;9(4):40–50]. doi: 10.21886/2308-6424-2021-9-4-40-50 EDN: YJWMIP
- Брянцева Ж.В., Акулова И.А., Новиков С.Н., и др. Внутритканевая брахитерапия источниками высокой мощности дозы в лечении больных раком молочной железы // Онкологический журнал: лучевая диагностика, лучевая терапия. 2019. Т. 2, № 4. С. 26–34. [Bryantseva ZV, Akulova IA, Novikov SN, et al. High dose rate brachytherapy in treatment of breast cancer patients. Journal of oncology: diagnostic radiology and radiotherapy. 2019;2(4):26–34]. doi: 10.37174/2587-7593-2019-2-4-26-34 EDN: QOWQFC
- Jiang P, Geenen M, Siebert FA, et al. Efficacy and the toxicity of the interstitial high-dose-rate brachytherapy in the management of recurrent keloids: 5-Year outcomes. Brachytherapy. 2018;17(3):597–600. doi: 10.1016/j.brachy.2017.12.002
- Pilar A, Gupta M, Ghosh Laskar S, Laskar S. Intraoperative radiotherapy: Review of techniques and results. Ecancermedicalscience. 2017;11:750. doi: 10.3332/ecancer.2017.750 EDN: YFJHMF
- Woodhouse KD, Devlin PM, Kollmeier M, et al. ACR-ABS-ASTRO Practice parameter for the performance of low-dose-rate brachytherapy. Am J Clin Oncol. 2022;45(6):243–248. doi: 10.1097/COC.0000000000000912 EDN: RKTOLC
- Brachman DG, Youssef E, Dardis CJ, et al. Resection and permanent intracranial brachytherapy using modular, biocompatible Cesium-131 implants: Results in 20 recurrent, previously irradiated meningiomas. J Neurosurg. 2018;131(6):1819–1828. doi: 10.3171/2018.7.JNS18656
- Magill ST, Lau D, Raleigh DR, et al. Surgical resection and interstitial Iodine-125 brachytherapy for high-grade meningiomas: A 25-year series. Neurosurgery. 2017;80(3):409–416. doi: 10.1227/NEU.0000000000001262
- Dagnew E, Kanski J, McDermott MW, et al. Management of newly diagnosed single brain metastasis using resection and permanent Iodine-125 seeds without initial whole-brain radiotherapy: A two institution experience. Neurosurg Focus. 2007;22(3):E3. doi: 10.3171/foc.2007.22.3.4
- Wernicke AG, Yondorf MZ, Peng L, et al. Phase I/II study of resection and intraoperative Cesium-131 radioisotope brachytherapy in patients with newly diagnosed brain metastases. J Neurosurg. 2014;121(2):338–348. doi: 10.3171/2014.3.JNS131140
- Giordano FA, Brehmer S, Mürle B, et al. Intraoperative Radiotherapy in Newly Diagnosed Glioblastoma (INTRAGO): An open-label, dose-escalation phase I/II trial. Neurosurgery. 2019;84(1):41–49. doi: 10.1093/neuros/nyy018
- Nakaji P, Smith K, Youssef E, et al. Resection and surgically targeted radiation therapy for the treatment of larger recurrent or newly diagnosed brain metastasis: Results from a prospective trial. Cureus. 2020;12(11):e11570. doi: 10.7759/cureus.11570
- Weinberg J. Clinical trials in progress: ROADS trial. Oncology (Williston Park). 2021;35(8):495. doi: 10.46883/ONC.2021.3508.0495 EDN: RRXOAS
- Huss M, Barsoum P, Dodoo E, et al. Fractionated SRT using VMAT and Gamma Knife for brain metastases and gliomas: A planning study. J Appl Clin Med Phys. 2015;16(6):3–16. doi: 10.1120/jacmp.v16i6.5255
- Ramachandran P. New era of electronic brachytherapy. World J Radiol. 2017;9(4):148–154. doi: 10.4329/wjr.v9.i4.148
- Olyushin VE, Kukanov KK, Nechaeva AS, et al. Photodynamic therapy in neurooncology. Biomedical Photonics. 2023;12(3):25–35. doi: 10.24931/2413-9432-2023-12-3-25-35 EDN: LENXOF
- Куканов К.К., Нечаева А.С., Улитин А.Ю., и др. Достижения и перспективы дальнейшего развития технологии фотодинамической терапии в лечении церебральных опухолей // Российский журнал персонализированной медицины. 2024. Т. 4, № 1. С. 44–57. [Kukanov KK, Nechaeva AS, Ulitin AYu, et al. Achievements and prospects for further development of photodynamic therapy technology in the treatment of cerebral tumors. Russian Journal for Personalized Medicine. 2024;4(1):44–57]. doi: 10.18705/2782-3806-2024-4-1-44-57 EDN: ZPQYNN
- Kwiatkowski S, Knap B, Przystupski D, et al. Photodynamic therapy: Mechanisms, photosensitizers and combinations. Biomed Pharmacother. 2018;106:1098–1107. doi: 10.1016/j.biopha.2018.07.049
- Mahmoudi K, Garvey KL, Bouras A, et al. 5-Aminolevulinic acid photodynamic therapy for the treatment of high-grade gliomas. J Neurooncol. 2019;141(3):595–607. doi: 10.1007/s11060-019-03103-4 EDN: KFIEFI
- Cruz PM, Mo H, McConathy WJ, et al. The role of cholesterol metabolism and cholesterol transport in carcinogenesis: A review of scientific findings, relevant to future cancer therapeutics. Front Pharmacol. 2013;4:119. doi: 10.3389/fphar.2013.00119
- Tan L, Shen X, He Z, Lu Y. The role of photodynamic therapy in triggering cell death and facilitating antitumor immunology. Front Oncol. 2022;12:863107. doi: 10.3389/fonc.2022.863107 EDN: SPYAZX
- Rivera D, Schupper AJ, Bouras A, et al. Neurosurgical applications of magnetic hyperthermia therapy. Neurosurg Clin N Am. 2023;34(2):269–283. doi: 10.1016/j.nec.2022.11.004 EDN: YWPOOU
- Dupont C, Vermandel M, Leroy HA, et al. INtraoperative photoDYnamic Therapy for GliOblastomas (INDYGO): Study protocol for a phase I clinical trial. Neurosurgery. 2019;84(6):E414–E419. doi: 10.1093/neuros/nyy324
- Vermandel M, Dupont C, Lecomte F, et al. Standardized intraoperative 5-ALA photodynamic therapy for newly diagnosed glioblastoma patients: A preliminary analysis of the INDYGO clinical trial. J Neurooncol. 2021;152(3):501–514. doi: 10.1007/s11060-021-03718-6 EDN: XHZZDC
- Bhanja D, Wilding H, Baroz A, et al. Photodynamic therapy for glioblastoma: Illuminating the path toward clinical applicability. Cancers (Basel). 2023;15(13):3427. doi: 10.3390/cancers15133427 EDN: IBCCAQ
- Рында А.Ю., Олюшин В.Е., Ростовцев Д.М., и др. Применение интраоперационной фотодинамической терапии в структуре комплексного лечения злокачественных глиом // Вопросы нейрохирургии имени Н.Н. Бурденко. 2023. Т. 87, № 1. С. 25–34. [Rynda AYu, Olyushin VE, Rostovtsev DM, et al. Intraoperative photodynamic therapy in complex treatment of malignant gliomas. Burdenko’s journal of neurosurgery. 2023;87(1):25–34]. doi: 10.17116/neiro20238701125 EDN: ZTSNFF
- Yamaguchi T, Kitahara S, Kusuda K, et al. Current landscape of sonodynamic therapy for treating cancer. Cancers (Basel). 2021;13(24):6184. doi: 10.3390/cancers13246184 EDN: OGKBCY
- Rao R, Patel A, Hanchate K, et al. Advances in focused ultrasound for the treatment of brain tumors. Tomography. 2023;9(3):1094–1109. doi: 10.3390/tomography9030090 EDN: IHDQAU
- Sonabend AM, Gould A, Amidei C, et al. Repeated blood-brain barrier opening with an implantable ultrasound device for delivery of albumin-bound paclitaxel in patients with recurrent glioblastoma: A phase 1 trial. Lancet Oncol. 2023;24(5):509–522. doi: 10.1016/S1470-2045(23)00112-2 EDN: TTALYD
- Xiao R, Miller JA, Sabharwal NC, et al. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system. J Neurosurg Spine. 2017;26(5):628–637. doi: 10.3171/2016.10.SPINE16373
- Zhao L, Yang B, Wang Y, et al. Thermochemotherapy mediated by novel solar-planet structured magnetic nanocomposites for glioma treatment. J Nanosci Nanotechnol. 2012;12(2):1024–1031. doi: 10.1166/jnn.2012.4270
- Bregy A, Shah AH, Diaz MV, et al. The role of Gliadel wafers in the treatment of high-grade gliomas. Expert Rev Anticancer Ther. 2013;13(12):1453–1461. doi: 10.1586/14737140.2013.840090
- Wu W, Klockow JL, Zhang M, et al. Glioblastoma multiforme (GBM): An overview of current therapies and mechanisms of resistance. Pharmacol Res. 2021;171:105780. doi: 10.1016/j.phrs.2021.105780
- Khalafallah AM, Huq S, Jimenez AE, et al. “Zooming in” on glioblastoma: Understanding tumor heterogeneity and its clinical implications in the era of single-cell ribonucleic acid sequencing. Neurosurgery. 2021;88(3):477–486. doi: 10.1093/neuros/nyaa305
- Aldape K, Brindle KM, Chesler L, et al. Challenges to curing primary brain tumours. Nat Rev Clin Oncol. 2019;16(8):509–520. doi: 10.1038/s41571-019-0177-5 EDN: JYSKTZ
- Rominiyi O, Al-Tamimi Y, Collis SJ. The ‘Ins and outs’ of early preclinical models for brain tumor research: Are they valuable and have we been doing it wrong? Cancers (Basel). 2019;11(3):426. doi: 10.3390/cancers11030426
- Stummer W, Koch R, Valle RD, et al. Intraoperative fluorescence diagnosis in the brain: A systematic review and suggestions for future standards on reporting diagnostic accuracy and clinical utility. Acta Neurochir (Wien). 2019;161(10):2083–2098. doi: 10.1007/s00701-019-04007-y
- Hadjipanayis CG, Stummer W. 5-ALA and FDA approval for glioma surgery. J Neurooncol. 2019;141(3):479–486. doi: 10.1007/s11060-019-03098-y EDN: MXJFNW
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