Histotripsy is a novel, noninvasive, non-thermal technology invented in 2004 for the precise destruction of biologic tissue. It offers a powerful alternative to more conventional thermal or surgical interventions. Using short-pulse, low-duty cycle ultrasonic waves, histotripsy creates cavitation bubble clouds that selectively and precisely destroy targeted tissue in a predefined volume while sparing critical structures like bile ducts, ureters, and blood vessels. Such precision is of value when treating tumors near vital structures. The FDA has cleared histotripsy for the treatment of all liver tumors. Major medical centers are currently spearheading clinical trials, and some institutions have already integrated the technology into patient care. Histotripsy is now being studied for a host of other cancers, including primary kidney and pancreatic tumors. Preclinical murine and porcine models have already revealed promising outcomes. One of histotripsy’s primary advantages is its non-thermal mechanical actuation. This feature allows it to circumvent the limitations of heat-based techniques, including the heat sink effect and unpredictable treatment margins near sensitive tissues. In addition to its non-invasive ablative capacities, it is being preliminarily explored for its potential to induce immunomodulation and promote abscopal inhibition of distant, untreated tumors through CD8+ T cell responses. Thus, it may provide a multilayered therapeutic effect in the treatment of cancer. Histotripsy has the potential to improve precision and outcomes across a multitude of specialties, from oncology to cardiovascular medicine. Continued trials are crucial to further expand its applications and validate its long-term efficacy. Due to the speed of recent developments, the goal of this review is to provide a comprehensive and updated overview of histotripsy. It will explore its physics-based mechanisms, differentiating it from similar technologies, discuss its clinical applications, and examine its advantages, limitations, and future.
组织裂解术是一种于2004年发明的创新型非侵入性非热消融技术，可实现生物组织的精准破坏。该技术为传统热消融或外科手术提供了强有力的替代方案。通过短脉冲、低占空比的超声波，组织裂解术产生空化气泡云，在预设范围内选择性地精确破坏目标组织，同时保护胆管、输尿管及血管等重要结构。这种精准性对于邻近重要结构的肿瘤治疗具有重要价值。美国食品药品监督管理局已批准组织裂解术用于所有肝脏肿瘤的治疗。目前主要医疗中心正牵头开展临床试验，部分机构已将该技术整合至临床诊疗体系。组织裂解术现正被研究应用于多种其他癌症的治疗，包括原发性肾脏及胰腺肿瘤。临床前小鼠和猪模型已显示出令人鼓舞的结果。 组织裂解术的主要优势之一在于其非热机械作用机制。这一特性使其能够规避热消融技术的局限性，包括热沉效应及邻近敏感组织治疗边界不可预测等问题。除其非侵入性消融能力外，该技术通过CD8+ T细胞反应诱导免疫调节、促进远端未治疗肿瘤旁观抑制的潜力正在被初步探索。因此，它可能在癌症治疗中提供多层次的治疗效果。从肿瘤学到心血管医学等多个专科领域，组织裂解术都有望提升治疗精准度并改善临床结局。持续开展临床试验对于进一步拓展其应用范围和验证长期疗效至关重要。 鉴于该领域的快速发展，本综述旨在提供组织裂解术全面且最新的概述。文章将探讨其基于物理的作用机制，区分其与相似技术的差异，讨论其临床应用，并分析其优势、局限性与未来发展方向。
Breaking Barriers with Sound: The Implementation of Histotripsy in Cancer
肿瘤(癌症)患者之家