High-grade gliomas (HGGs) have a poor prognosis and are difficult to treat. This review examines the evolving landscape of endovascular therapies for HGGs. Recent advances in endovascular catheter technology and delivery methods allow for super-selective intra-arterial cerebral infusion (SSIACI) with increasing precision. This treatment modality may offer the ability to deliver anti-tumoral therapies directly to tumor regions while minimizing systemic toxicity. However, challenges persist, including blood–brain barrier (BBB) penetration, hemodynamic complexities, and drug–tumor residence time. Innovative adjunct techniques, such as focused ultrasound (FUS) and hyperosmotic disruption, may facilitate BBB disruption and enhance drug penetration. However, hemodynamic factors that limit drug residence time remain a limitation. Expanding therapeutic options beyond chemotherapy, including radiotherapy and immunobiologics, may motivate future investigations. While preclinical and clinical studies demonstrate moderate efficacy, larger randomized trials are needed to validate the clinical benefits. Additionally, future directions may involve endovascular sampling for peri-tumoral surveillance; changes in drug formulations to prolong residence time; and the exploration of non-pharmaceutical therapies, like radioembolization and photodynamic therapy. Endovascular strategies hold immense potential in reshaping HGG treatment paradigms, offering targeted and minimally invasive approaches. However, overcoming technical challenges and validating clinical efficacy remain paramount for translating these advancements into clinical care.
高级别胶质瘤预后不良且治疗困难。本综述探讨了针对高级别胶质瘤血管内治疗领域的发展动态。血管内导管技术和输送方法的最新进展使得超选择性动脉内脑灌注能够实现更高的精准度。这种治疗方式可能具备将抗肿瘤疗法直接递送至肿瘤区域的能力，同时最大限度地降低全身毒性。然而，包括血脑屏障穿透、血流动力学复杂性以及药物-肿瘤驻留时间在内的挑战依然存在。聚焦超声和高渗破坏等创新辅助技术可能促进血脑屏障的破坏并增强药物渗透。然而，限制药物驻留时间的血流动力学因素仍是当前局限。将治疗选择扩展到化疗之外，包括放疗和免疫生物制剂，可能推动未来的研究。尽管临床前和临床研究显示出中等疗效，但仍需更大规模的随机试验来验证其临床获益。此外，未来发展方向可能涉及用于肿瘤周围监测的血管内采样；改变药物剂型以延长驻留时间；以及探索非药物治疗方法，如放射性栓塞和光动力疗法。血管内策略在重塑高级别胶质瘤治疗模式方面具有巨大潜力，提供了靶向和微创的治疗途径。然而，克服技术挑战并验证临床疗效，对于将这些进展转化为临床实践仍然至关重要。
Endovascular Applications for the Management of High-Grade Gliomas in the Modern Era
肿瘤(癌症)患者之家