Clinical outcomes of histotripsy for liver malignancies: a systematic review of early clinical evidence.

BACKGROUND

Histotripsy is an emerging non-thermal, non-invasive focused ultrasound technology. This systematic review aims to evaluate the early clinical safety and efficacy of histotripsy in the treatment of liver malignancies.

METHODS

A systematic search was conducted across Web of Science, Medline, Scopus, and Cochrane CENTRAL up to February 2026. The search strings combined terms for "histotripsy" and "liver tumor/cancer/metastasis". Studies reporting technical success rate or complications of histotripsy for liver tumors were included.

RESULTS

Six studies involving 414 patients and 679 treated tumors were included. The majority of patients had colorectal liver metastases or hepatocellular carcinoma. Technical success rates ranged from 97.0% to 100%. Major complications (Clavien-Dindo classification ≥ III) were rare, though portal vein thrombosis was observed in some cases (up to 8.0%). Data on survival and quality of life were unavailable. Only one study specified the trial was for bridging therapy prior to liver transplantation. Ongoing trials are expanding the evidence base for the use of multidisciplinary approaches and immune modulation.

CONCLUSION

Early clinical evidence indicates that histotripsy is a feasible and safe non-thermal ablative technique for liver malignancies. However, it also identified urgent need for long-term efficacy data. Ongoing research into its biological effects and integration with systemic therapies suggests significant future potential. Furthermore, the significance of histotripsy as a bridging therapy to liver transplantation should be clarified in future studies.