Ultrasound-Based Therapies in Primary Central Nervous System Tumors.

Primary central nervous system (CNS) tumors remain a major challenge in neuro-oncology due to their cellular heterogeneity, infiltrative growth, and the protective blood-brain barrier (BBB), which limits the effectiveness of systemic therapies. Despite aggressive multimodal treatments, patient survival remains poor, highlighting the urgent need for new therapeutic strategies. Ultrasound-based therapies, including focused ultrasound (FUS) and sonodynamic therapy (SDT), have emerged as promising approaches. FUS can transiently open the BBB and induce localized mechanical and thermal effects, enhancing drug delivery, while SDT activates tumor-specific sensitizers to generate reactive oxygen species that trigger cancer cell death. Preclinical and early clinical studies suggest that combining these modalities with chemotherapy, immunotherapy, or radiotherapy may improve treatment outcomes. Emerging tools such as AI-guided monitoring, theranostic platforms, and ultrasound-responsive nanoparticles could further enable personalized interventions. However, challenges remain, including protocol variability, tumor heterogeneity, and limited long-term safety data. Careful optimization and clinical validation are needed before these strategies can be widely adopted in the management of CNS tumors.