Malignant brain tumors including primary brain tumors (e.g., glioblastoma multiforme) and
metastases, are aggressive and lethal entities for the majority of affected patients. Current standard
treatments involving combinations of surgery, radiotherapy and systemic chemotherapy offer only
modest improvements in survival. Faced with dismal survival, great efforts are deployed to find
interesting treatment alternatives. However, the blood-brain barrier (BBB) and the blood-tumor
barrier (BTB) remain great obstacles to significant drug delivery to brain tumors. The need to
optimize delivery strategies for better patient outcome in the treatment of malignant brain tumors is
well acknowledged. Certain interesting strategies use surgical or physical techniques to enhance the distribution of
therapeutic agents to the central nervous system. The following strategies will be discussed in this review: intra-arterial
delivery, osmotic BBB disruption, intranasal delivery, convection-enhanced delivery and osmotic pumps, implanted
polymers, magnetic microspheres and ultrasound BBB disruption. The purpose of this paper is to review the importance
of the BBB and the BTB and to review the current status and future perspectives of these delivery procedures.
Keywords: Blood-brain barrier, blood-brain barrier disruption, brain tumor, chemotherapy, drug delivery, glioblastoma
multiforme, targeted delivery.
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