Histotripsy

Histotripsy is a non-invasive and precise treatment for cancer in the liver that targets and destroys tumors using high-frequency sound waves. Unlike traditional cancer treatments, histotripsy does not involve incisions, radiation, or needles. Patients experience few, if any, side effects. Most people go home on the day of their procedure and quickly resume their normal activities.

Histotripsy can alleviate symptoms, slow tumor growth, and extend life for patients who are not candidates for surgery or are waiting for a liver transplant. The treatment can be used in conjunction with chemotherapy or immunotherapy. If you are a candidate, our physicians will work with your oncologist or surgeon to add histotripsy to your overall treatment plan.   

Histotripsy at Columbia Interventional Radiology

Columbia’s interventional radiologists are among the first to offer histotripsy to patients with primary liver cancer (hepatocellular carcinoma) or other cancers that have metastasized (spread) to the liver. Our interventional radiologists have extensive experience with image-guided procedures. A consultation with a Columbia interventional radiologist can help you determine if histotripsy can help you.

Am I a candidate for histotripsy?

Histotripsy is recommended for patients with three or fewer tumors that are less than four centimeters in size and in treatable locations.

How does histotripsy work?

Histotripsy uses focused sound waves, delivered through a robotic-assisted ultrasound machine, to destroy tumor cells without damaging surrounding healthy tissue. Your doctor will use ultrasound to see and map out the coordinates of the tumor they want to destroy. Then, sound wave energy is turned on and focused on the targeted tissue. The sound waves create microbubbles within the tumor. As bubbles form and collapse, they cause the mass to break apart, killing tumor cells. Over time, the destroyed tissue is gradually replaced with healthy liver tissue.

Doctors and researchers have studied histotripsy for more than 20 years, including in clinical trials. The #HOPE4LIVER trials demonstrated successful use of histotripsy in patients with primary and metastatic tumors in the liver in the US and EU.

What can I expect from the procedure?

• You will receive detailed instructions before your appointment about eating, drinking, and taking medications. Please arrange for someone to accompany you home after the procedure.
• On the day of the procedure, you will arrive at the hospital and a healthcare provider will escort to the interventional radiology suite.
• You will be given general anesthesia to minimize movement during the procedure.
• During the procedure, a treatment head (the source that sends out the sound waves) is placed on your abdomen. The treatment head is encased in a soft membrane filled with water.

• Your interventional radiologist will look at your liver on ultrasound and identify the area to be treated.
• Soundwaves are then directed at the targeted area, creating small bubbles that destroy the tissue as they expand and collapse.
• Throughout the procedure, your interventional radiologist will monitor the treatment in real time using ultrasound.
• The procedure time will vary depending on the number of histotripsy treatments delivered in one session. One histotripsy treatment can take between five and 30 minutes.

Are there any risks?

The procedure is safe when performed by an experienced interventional radiologist. Complications such as bleeding and infection are possible, but the risk is low compared to more invasive treatments. There is a small risk of rare complications from general anesthesia, which we are well-equipped to deal with.

After the procedure

Most patients are scheduled for their procedure early in the day, with time to recover and go home in the afternoon. You may feel some pain or discomfort after treatment, which can be treated with oral pain medication.

Follow Up

We will schedule a follow up appointment with you about two weeks after the procedure. Chemotherapy does not typically need to be stopped. Follow up imaging, such as CT, MRI, or PET CT, is usually performed approximately two weeks after the procedure.