Histotripsy For Liver Tumors: A Comprehensive Review

Abstract

Purpose: Histotripsy is a non-thermal, non-invasive, focused ultrasound method that uses controlled acoustic cavitation to mechanically destroy tissues. With FDA approval in October 2023 for the treatment of liver tumors, histotripsy is rapidly being adopted as the first completely non invasive method of liver ablation. This review summarizes the evidence for histotripsy in liver tumors and highlights the knowledge gaps that require further investigation.

Methods : A non-systematic search of PubMed and Google Scholar was conducted in June 2026 using keywords including histotripsy, acoustic cavitation ablation, hepatocellular carcinoma, liver metastases and HistoSonics Edison. Original peer-reviewed studies, clinical trials, systematic reviews and preclinical investigations relevant to histotripsy were included in this review.

Conclusion: The #HOPE4LIVER pivotal trials found a 95% technical success rate with a 7% major complication rate at 30 days. At one year, local tumor control was 63.4% by the primary assessment method and 90% by a post hoc reassessment. Remaining knowledge gaps include a lack of long-term (>1 year) and comparative effectiveness data, a tumor size limit of <3 cm, non-standardized imaging response criteria, unknown human immunological mechanisms, unclear dosing regimens, insufficient data from cirrhotic/high-risk patients, and undefined learning curves.

While histotripsy represents a well-founded scientific approach and a clinically promising technique for ablating liver tumors, there is still an immature body of literature lacking research integrity. There is a need for large prospective studies comparing various ablation techniques with long-term follow-up before histotripsy could be incorporated into clinical guidelines.