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Histotripsy is a cancer treatment that uses targeted ultrasound waves to destroy tumors in a non-invasive way. The Edison system, made by Histosonics, is currently the only commercially available histotripsy machine for humans on the market.
During treatment, the patient lies on a table and a device called the water bath sits on top of the patient, positioned over the tumor to prepare for therapy. The water bath serves the same purpose as gel in ultrasound imaging, preventing air pockets that would diffuse the ultrasound waves; the water is regular tap water run through a special filter to remove air bubbles. The procedure is performed in an operating room but is not sterile; no incisions are made. The most invasive part is obtaining IV access for sedation and typically anesthesia so the patient remains completely asleep and motionless during therapy.
Histotripsy destroys tumor cells by rapidly expanding and contracting the gases inside them, producing a mechanical destruction of tissue rather than a thermal or radiation-based effect. The tissue is liquefied immediately as histotripsy is delivered; there is no waiting period. Dr. Burns showed before-and-after images indicating how the liver tissue healed after histotripsy. Currently, histotripsy is primarily used to destroy liver tumors, but there is potential for application to other body areas.
An example patient received histotripsy to a single liver tumor; four months later MRI showed the entire lesion essentially resolved, with only a very small defect remaining and the liver having repaired and reabsorbed the area. Trials mentioned include a primary kidney tumor trial that has just closed, with results awaited, and a pancreatic trial underway in Barcelona, Spain, expected to be available in the US in 2026. Histotripsy is described as a technology platform with potential to expand to every organ, including possible future applications such as prostate (BPH or cancer), uterine fibroids, breast tumors, thyroid nodules, and brain tumors.
Air-filled organs pose a challenge because ultrasound waves dissipate in air (lungs, stomach, and intestines). A histotripsy session can take about one to three hours, depending on how many tumors are targeted. Most patients go home a few hours after the procedure; some experience pain or discomfort at the treatment site, and some have no symptoms. Afterward, patients may have systemic inflammatory symptoms (fever, flu-like malaise) starting the day after — considered normal as the body reacts. Histotripsy does not replace all surgeries but may benefit patients who might otherwise require surgery, and the procedure can be repeated multiple times as long as liver function is normal.
Histotripsy received FDA approval in October 2023 and is expanding availability as more machines are produced. There are centers near many patients, with expansion planned to the UK and other parts of Asia, as the technology becomes more globally available.