Liver malignancies, both primary and metastatic tumors, are a major cause of cancer-related mortality. Colorectal cancer alone results in liver metastases in nearly 50% of patients, with approximately 85% presenting with unresectable disease. Similarly, hepatocellular carcinoma and intrahepatic cholangiocarcinoma frequently present at advanced stages, limiting curative options. Systemic therapies provide modest survival benefits, underscoring the need for alternative treatments. Locoregional approaches, such as thermal ablation and chemoembolization, while effective, have notable limitations, including invasiveness, peri-procedural risks, and the requirement to interrupt systemic treatments. Histotripsy is a novel, non-invasive method that uses focused ultrasound-induced cavitation to enable precise tumor ablation without heat or radiation. Our institution utilizes a multidisciplinary tumor board approach to evaluate patients for histotripsy, particularly in cases involving unresectable disease, complex surgical candidacy, palliative intent related to disease control and symptom management, or as bridging therapy for transplantation. Early results, including preclinical data and the THERESA and #HOPE4LIVER trials, highlight its efficacy in treating liver tumors with minimal complications. This review outlines institutional protocols for histotripsy, covering pre- and post-procedural management, along with ethical considerations of current treatment paradigms. As a patient-centered approach, histotripsy offers a novel treatment option with a favorable safety profile and compatibility with systemic therapies.
肝脏恶性肿瘤，包括原发性和转移性肿瘤，是癌症相关死亡的主要原因。仅结直肠癌就有近50%的患者发生肝转移，其中约85%表现为不可切除的疾病。同样，肝细胞癌和肝内胆管癌也常在晚期才被发现，限制了根治性治疗的选择。全身性治疗虽能带来有限的生存获益，但凸显了对替代疗法的需求。局部区域治疗方法，如热消融和化疗栓塞，虽然有效，但存在显著局限性，包括侵入性、围手术期风险以及需要中断全身治疗。组织粉碎术是一种新型无创方法，利用聚焦超声诱导的空化效应实现精确的肿瘤消融，无需加热或辐射。我院采用多学科肿瘤委员会的方法来评估患者是否适合接受组织粉碎术，特别是在涉及不可切除疾病、手术条件复杂、以疾病控制和症状管理为目的的姑息治疗，或作为移植的桥接治疗等情况下。包括临床前数据以及THERESA和#HOPE4LIVER试验在内的早期结果，突显了其在治疗肝脏肿瘤方面的有效性，且并发症极少。本综述概述了组织粉碎术的机构方案，涵盖术前和术后管理，以及当前治疗模式的伦理考量。作为一种以患者为中心的方法，组织粉碎术提供了一种新的治疗选择，具有良好的安全性，并能与全身性治疗兼容。
Histotripsy of Liver Tumors: Patient Selection, Ethical Discussions, and How We Do It
肿瘤(癌症)患者之家