Precisely Focused Ultrasound Destroys Liver Tumors Without Surgery
Imran Siddiqui, MD, FACS
Cancer
Orlando Health Cancer Institute has introduced histotripsy to its portfolio of treatment options for patients with primary and metastatic liver tumors. A nonthermal and incisionless technology, histotripsy depends on a sonic beam therapy platform that directs focused ultrasound waves to target and destroy liver tumors through cavitation.
“While ultrasound itself is not new, the physics of this unique technology has appropriately identified and harnessed the exact waveform, wavelength, and more importantly, precision of delivery, necessary to cavitate tumors,” says Imran Siddiqui, MD, a board-certified hepatopancreaticobiliary surgeon and chief of hepatopancreaticobiliary surgery at Orlando Health Cancer Institute.
Histotripsy uses select frequency, high-amplitude pulses to create microbubble clouds from gases naturally present in targeted tissue. These bubble clouds activate a cavitation event — forming and collapsing in microseconds to create strong, rapid pressure change explosions that destroy and liquify specific selected tissue.
This novel approach targets only the designated tumor without damaging nearby blood vessels or bile ducts, enabling physicians to safely work close to critical anatomical structures.
“We can now destroy liver tumors at a sub-cellular level under precise ultrasound guidance,” says Dr. Siddiqui. “ This process doesn't damage a patient’s DNA like radiation or thermally destroy cells like microwave ablation. Instead, it enables me to liquefy the tumor into lysate at a very microscopic level — without ever making an incision.”
Most patients with liver tumors can be considered for histotripsy. The procedure ranges in time from one to three hours and is done under general anesthesia to control patient movement rather than for pain management. Following observation, most patients go home the same evening or next morning. The technology also can be used before, after or in combination with other procedures. “This is especially exciting for our patients who are not candidates for traditional lines of therapy like surgery, ablation or transplant,”says Dr. Siddiqui. “And unlike other treatments which are delivered over several weeks, histotripsy is ‘one-and-done.”
Dr. Siddiqui, who has published and presented research extensively internationally, sees potential in this revolutionary technology. “I believe we are at the beginning of what could become the future of surgery,” he says, noting several prospective trials currently studying histotripsy for liver, pancreas and kidney tumors, and benign indications in prostate enlargement.
