Fig. 5: Tumor growth was slower in patients receiving carboplatin before sonication.

The evolution of the tumor-related hyperintense T1w volume in the region targeted by the implant (shown in green in Fig. 4) was evaluated and is shown in A for both cohorts treated with 9 emitters active. A significantly higher growth rate over the study duration was found in cohort C (median = 2.31 mL/month) than in cohort D (median = 0.54 mL/month), as shown in B (Two-sided Wilcoxon–Mann–Whitney test: p = 0.04). The violin plots indicate the median (withe dot), first and third quartiles (gray line), and min and max (colored contour). When the region targeted by the implant was excluded from the analysis, there was no significant difference between the evolution of the T1 enhancement (p = 0.55). The local probability of tumor control was evaluated using T1w images at progression. A visualization of this analysis is shown in C in which each of the circles depicts an emitter axis from a real SonoCloud-9 implant in a patient. D The percentage of ring-shaped ROIs surrounding emitter axes covered with hyperintense tumor at the end of the study were compared between Cohorts C and D. The probability of T1w enhancement was lower in Cohort D than in Cohort C (two-sided Mann–Whitney U test, N = 26, p < 0.05 for radiuses up to 7.5 mm). The sonicated zone with BBB disruption corresponds to the 0–5 mm bin (10-mm cylinders), and effect on local tumor progression is observed up to 10-mm from the emitter axes (statistically significant up to 7.5 mm). Source data are provided as a Source Data file.