Histotripsy Outcomes for Primary and Metastatic Hepatic Disease

Histotripsy is an emerging nonthermal, nonionizing, and noninvasive focused ultrasound therapy that uses acoustic cavitation to mechanically disrupt targeted tissue. In the liver, histotripsy may offer several advantages over conventional locoregional therapies, including treatment without percutaneous probes, treatment of select tumors near vascular or biliary structures, and potential proposed preclinical immunomodulatory effects. Early clinical studies, such as the THERESA and #HOPE4LIVER trials, have demonstrated high technical success rates and relatively low rates of major complications; however, expanding real-world evidence has identified clinically important complications including vascular injury, portal vein thrombosis, and acute kidney injury. Additional prospective studies are needed to determine long-term local tumor control, survival benefits, optimal patient selection, and the role of histotripsy in combination with systemic therapies and other locoregional treatments. This narrative review summarizes the possible mechanism of action, clinical outcomes, safety profile, patient selection considerations, and future directions of histotripsy for the treatment of primary and metastatic liver tumors.