Safety and efficacy of selective and superselective intra-arterial cerebral infusion with blood-brain barrier disruption for glioma: a systematic review and meta-analysis.

IF 4.3 1区医学 Q1 NEUROIMAGING

Journal of NeuroInterventional Surgery Pub Date : 2025-10-02 DOI:10.1136/jnis-2025-024057

Christian Ferreira, Márcio Yuri Ferreira, Leonardo Januario Campos Cardoso, João Paulo Liute Scarramal, Alleh Nogueira, Tamika Wong, Sanskruti Bokil, Faith Singh, Sara Massimo, Olivia Albers, Netanel Ben-Shalom, Randy D'Amico, David Langer, John Boockvar, Yafell Serulle

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引用次数: 0

Abstract

Background: Selective and superselective intra-arterial cerebral infusion (SIACI/SSIACI) delivers chemotherapy directly to tumor-supplying arteries, achieving high local drug levels with reduced systemic toxicity. Often combined with blood-brain barrier disruption (BBBd) to enhance penetration, these methods have been widely studied, yet a comprehensive evidence synthesis is lacking. This study systematically assesses the safety and efficacy of intra-arterial chemotherapy with BBBd for glioma treatment.

Methods: We searched PubMed, Embase, and Web of Science for studies on SIACI with BBBd in glioma patients. Safety outcomes included rates of cases with complications, procedure-related complications (major/minor), stroke, intracranial and intratumoral hemorrhage, and mortality. Efficacy was based on tumor response (complete, partial, stable disease, progression). A subanalysis of SSIACI-only cases was also conducted.

Results: Nine studies with 230 glioma patients were included. The pooled rate of cases with complications was 27.1% (95% CI 19.8% to 35.7%), with procedure-related complications occurring in 15.4% (95% CI 6.1% to 24.6%). Major and minor complication rates were 4.3% (95% CI 0.9% to 7.7%) and 9.7% (95% CI 1.0% to 18.7%), respectively. Stroke, intracranial hemorrhage, and intratumoral hemorrhage occurred in 3.1% (95% CI 0% to 6.1%), 0.5% (95% CI 0% to 3.2%), and 0.04% (95% CI 0% to 3%), respectively, with no procedure-related deaths reported. Pooled response rates were 10.4% complete (95% CI 0% to 21.5%), 24.2% partial (95% CI 14.3% to 34.1%), 38.2% stable disease (95% CI 21.5% to 54.9%), and 39.3% progression (95% CI 14.8% to 63.8%). Subanalysis of superselective infusions yielded comparable outcomes to the overall cohort.

Conclusion: The findings indicate that SIACI/SSIACI chemotherapy following BBBd is a feasible and safe approach for glioma treatment, demonstrating a favorable procedural risk profile and preliminary signs of efficacy. Further studies are warranted to validate these results and refine procedural protocols.

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选择性和超选择性脑动脉输注破坏血脑屏障治疗胶质瘤的安全性和有效性：一项系统综述和荟萃分析。

背景：选择性和超选择性脑动脉输注（SIACI/SSIACI）将化疗直接输送到肿瘤供应动脉，实现高局部药物水平和降低全身毒性。这些方法通常与血脑屏障破坏（BBBd）联合使用以增强穿透性，已被广泛研究，但缺乏全面的证据合成。本研究系统评估了动脉内化疗BBBd治疗胶质瘤的安全性和有效性。方法：我们检索了PubMed， Embase和Web of Science关于脑胶质瘤患者SIACI与BBBd的研究。安全性结局包括并发症发生率、手术相关并发症（主要/次要）、中风、颅内和肿瘤内出血以及死亡率。疗效基于肿瘤反应（完全、部分、疾病稳定、进展）。还对仅ssiaci病例进行了亚分析。结果：9项研究纳入230例胶质瘤患者。合并并发症发生率为27.1% (95% CI 19.8% ~ 35.7%)，手术相关并发症发生率为15.4% （95% CI 6.1% ~ 24.6%）。主要和次要并发症发生率分别为4.3% （95% CI 0.9% ~ 7.7%）和9.7% （95% CI 1.0% ~ 18.7%）。卒中、颅内出血和肿瘤内出血发生率分别为3.1% （95% CI 0% ~ 6.1%）、0.5% （95% CI 0% ~ 3.2%）和0.04% (95% CI 0% ~ 3%)，无手术相关死亡报告。合并缓解率为完全缓解率10.4% (95% CI 0% ~ 21.5%)，部分缓解率24.2% (95% CI 14.3% ~ 34.1%)，稳定缓解率38.2% (95% CI 21.5% ~ 54.9%)，进展缓解率39.3% （95% CI 14.8% ~ 63.8%）。超选择性输注的亚分析结果与整个队列相当。结论：研究结果表明，BBBd后SIACI/SSIACI化疗是一种可行且安全的胶质瘤治疗方法，具有良好的程序风险特征和初步疗效迹象。需要进一步的研究来验证这些结果并完善程序协议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.