The blood–brain barrier (BBB) poses a significant challenge to drug delivery for brain tumors, with most chemotherapeutics having limited permeability into non-malignant brain tissue and only restricted access to primary and metastatic brain cancers. Consequently, due to the drug’s inability to effectively penetrate the BBB, outcomes following brain chemotherapy continue to be suboptimal. Several methods to open the BBB and obtain higher drug concentrations in tumors have been proposed, with the selection of the optimal method depending on the size of the targeted tumor volume, the chosen therapeutic agent, and individual patient characteristics. Herein, we aim to comprehensively describe osmotic disruption with intra-arterial drug administration, intrathecal/intraventricular administration, laser interstitial thermal therapy, convection-enhanced delivery, and ultrasound methods, including high-intensity focused and low-intensity ultrasound as well as tumor-treating fields. We explain the scientific concept behind each method, preclinical/clinical research, advantages and disadvantages, indications, and potential avenues for improvement. Given that each method has its limitations, it is unlikely that the future of BBB disruption will rely on a single method but rather on a synergistic effect of a combined approach. Disruption of the BBB with osmotic infusion or high-intensity focused ultrasound, followed by the intra-arterial delivery of drugs, is a promising approach. Real-time monitoring of drug delivery will be necessary for optimal results.
血脑屏障（BBB）对脑肿瘤的药物递送构成重大挑战，大多数化疗药物对非恶性脑组织的渗透性有限，仅能有限地进入原发性和转移性脑癌。因此，由于药物无法有效穿透血脑屏障，脑部化疗后的疗效仍不理想。目前已有多种方法被提出用于开放血脑屏障并在肿瘤内获得更高的药物浓度，最佳方法的选择取决于目标肿瘤体积的大小、所选治疗药物以及个体患者特征。本文旨在全面阐述动脉内给药联合渗透性开放、鞘内/脑室内给药、激光间质热疗、对流增强递送以及超声方法（包括高强度聚焦超声和低强度超声）以及肿瘤治疗电场。我们解释了每种方法背后的科学原理、临床前/临床研究、优缺点、适应症以及潜在的改进方向。鉴于每种方法都有其局限性，未来血脑屏障的开放不太可能依赖于单一方法，而是依赖于联合方法的协同效应。通过渗透性输注或高强度聚焦超声破坏血脑屏障，随后进行动脉内药物递送，是一种有前景的方法。为实现最佳疗效，实时监测药物递送将是必要的。
肿瘤(癌症)患者之家