Histotripsy for Liver Tumors: Emerging Evidence in the Context of Established Locoregional Therapies.

Histotripsy is a nonthermal, nonionizing ultrasound-based technique that uses acoustic cavitation to mechanically ablate liver tumors which received U.S. Food and Drug Administration authorization for destruction of liver tumors in 2023. Early prospective studies demonstrate technical success and favorable short-term safety in selected patients with small tumors, but durable efficacy remains uncertain because of limited follow-up and evolving imaging response criteria. Emerging real-world data, however, raise additional questions regarding patient selection and short-term outcomes as histotripsy use expands. This discussion places histotripsy in the context of established liver-directed therapies, and highlights considerations relevant to radiation oncologists: anesthesia, ultrasound-guided treatment feasibility, tumor size and location, safety, sequencing, and systemic-therapy integration, and priorities for comparative trials.