Histotripsy means "cell pulverizing". We know disruption (pulverization or otherwise) of a tumor bed tends to incite a local inflammatory reaction, and a brisk inflammatory reaction seems to correlate with survival. So the idea here seems to be an extension of high energy ultrasound methods developed for lithotripsy (breaking up kidney stones) to disrupt tumor beds. Not something I'd want for a pre-cancerous lesion, but if it's stage 4 liver mets ... sure. Have at it.
The machine has been available for a couple years to treat liver tumors. It’s available in several US cities but not widely available. It uses cavitation to destroy the tumor.
The advancements in imaging, cheap intelligence and non-invasive (mostly) tools like this are amazing. I can easily see a future where we can scan, and analyze, every cell in a body and then selectively manipulate them to achieve the desired effect. I doubt we are actually that far away actually.
As someone who was recently diagnosed and treated for Uveal Melanoma (get your annual eye exam and retinal scans!), and occasionally struggling with some intrusive thoughts about the potential for liver mets, reading about this treatment brought me so much joy. Bless Zhen Xu!
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? 2024 meta analysis of seeding I didn't see ultrasound in there: https://pubmed.ncbi.nlm.nih.gov/39605885/
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body?
Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer.
If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"
Metastasis is not just random tumor cell going for a hike, they are seeded with extracellular vesicles carrying particular mix of microRNAs, growth factors, vimentin and other stuff.
Due to some family stuff, this is something I've been investigating. My oncologist has said "this will probably be standard care in a few years". The results and studies around this have been excellent.
What this does better than pretty much anything else is it isolates the destruction of cells to just the target. The liver is a VERY "bleedy" organ. It has a ton of blood that flows through it which makes surgery extra hard. In fact, the not this surgery that's next best for our circumstances laparoscopic through the arteries to drop a radioactive pellet in the center of the cancer.
The non-invasive nature of this is going to be very good for the future of cancer treatment. Minimizing scaring and damage to tissue is the number 1 factor to better results.
The only reason my local oncologist does not have this machine is they are still pretty pricey.
When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.
Pretty pricey, yes. HistoSonics is a microcosm of the truth of healthcare spending: it is an amazing technology made by possible by deep and sophisticated capital markets. But, better health technology seems to explain more than 50% of the growth of healthcare spending since medicare (1965), meaning all of the faster-than-GDP growth people gripe about. When people talk about slowing health spending to something manageable, they are talking about not just govt not paying for things like histotrispy - not paying is a shell game, nobody chooses to not pay to save their life, and hence faster than GDP healthcare spending growth is observed everywhere in the West, not just the US. They are talking about somehow making the technology not happen altogether.
I'm unfortunately on the same situation. We made a consultation with people from Baptist Health Miami and it seems like there are several non trivial requirements for such treatment (histotripsy), like the number and location of mets. Hope that this improves in the mear future.
Per the article, this seems even better than the headline would suggest:
> Histotripsy generally seems to stimulate an immune response, helping the body attack cancer cells that weren’t targeted directly by ultrasound. The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood. Researchers are now exploring ways to pair histotripsy with immunotherapy to amplify that effect.
I had the opportunity to meet with folks from Histosonics at a Canopy Cancer Collective (pancreas cancer focused group - https://canopycancer.org/) annual meeting a couple of years ago. They had shown very promising results (and approval) with liver cancer, and the applicability to any soft-tissue openly-addressable masses (e.g., not brains in skulls, not lungs full of air) seemed very likely, based on the physics. (Note: I'm a consumer electronics and ML engineer, not a medical devices engineer).
I'm excited to see this option become more broadly available. The ability to precisely target and illicit an inflammatory response is impressive, and Whipples are no joke.
Probably not as lungs are behind the rib cage and filled with air, making two sources of spurious reflections that could be dangerous with high intensity ultrasounds.
Could this be applicable and available to the public within a reasonable time horizon? My mother is dealing with a brain tumor located in the pons, and no surgeons will operate because of its location, as the risk is too high. Radiation treatments have also been exhausted and have already caused some necrosis. There was another form of light-based therapy, but it is experimental and carries an incredibly high risk as well. The prognosis has never been good, but we’ve been holding out hope. At this point, treatment consists of nonstop chemotherapy.
Thanks for posting this. Sounds super promising, and the explanation of histotripsy's mechanism of action is compelling.
Given the 2023 approval (for liver tumors) and oversubscribed $250m funding round announced in October, it seems like there's a ton of momentum behind this. I also see that the treatment is available at my local hospital system (Inova), which is an encouraging sign of its general availability.
Anyone who's commenting to ask whether it's an option for you or a loved one, check your state's right-to-try laws. Virginia and various other states do apparently have right-to-try laws that cover medical devices: https://triagecancer.org/state-laws/righttotry.
Being non-invasive and incredibly precise, this could be a fantastic therapy for brain cancer treatment.
Assuming the costs of the precise powerful machines needed are not too high (this isn't anything like MRI), it could be a therapy for almost any kind of cancer tumor, and even small potential/pre-cancer tumors that are safe to remove without bothering to do a diagnosis.
I wish there was a way todo chemo locally only. Like a body part has cancer, you add a bypass to that part and put that bodypart on a eccmo chemo poisoning only the affected system part. After that flush out and reconnect.
We are more than a decade away from knowing if Histosonics technology will actually be a meaningful treatment modality. It definitely is 'cool' in that there is no incision. However, whenever you deliver ultrasound energy from outside of the body, accuracy goes down; you are also limited by anatomy in the path of the ultrasound (e.g. going through the rib cage with ultrasound is not trivial). Folks I have spoken to who have bought these units say they are only allowed to use them if the tumor is superficial (i.e. near the skin). On top of that patient motion due to breathing definitely causes inaccuracies and complications. One doctor said it's an expensive paperweight (but it does bring patients in who ask for it).
Also, the clinical efficacy is not fully understood. Researchers are most excited by an enhanced abscopal effect (i.e. natural immune response), but that's not a proven phenomenon. Finally, it is really expensive (~$1.5M) so it will be difficult to scale outside of research hospitals and cancer centers. Of course, I don't want to be too negative. It's a win for patients when they have more options.
Full disclosure: I am co-founder of Current Surgical, where we are developing a minimally invasive system based on miniaturized focused ultrasound to achieve precise thermal ablation (not cavitation). Our device can both see and destroy tissue from the same sensors, we can achieve millimeter accuracy. And because the technology can be integrated into any number of surgical tools (needle, catheter, etc) we can potentially reach any anatomy.
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[ 93.6 ms ] story [ 1839 ms ] threadhttps://www.mdanderson.org/cancerwise/histotripsy-for-liver-...
Here is a study on AEs specifically from this type of ultrasound: https://journals.plos.org/plosone/article?id=10.1371/journal...
Quote: "Cavitation detaches cancer cells/emboli from the primary site and thereby releases them into the circulation, leading to metastasis"
Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer.
If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"
What this does better than pretty much anything else is it isolates the destruction of cells to just the target. The liver is a VERY "bleedy" organ. It has a ton of blood that flows through it which makes surgery extra hard. In fact, the not this surgery that's next best for our circumstances laparoscopic through the arteries to drop a radioactive pellet in the center of the cancer.
The non-invasive nature of this is going to be very good for the future of cancer treatment. Minimizing scaring and damage to tissue is the number 1 factor to better results.
The only reason my local oncologist does not have this machine is they are still pretty pricey.
When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.
I think we were all thinking that. Acoustic Cavitation has also been proposed as a mechanism for enabling cold fusion. https://www.science.org/doi/10.1126/science.1067589
> Histotripsy generally seems to stimulate an immune response, helping the body attack cancer cells that weren’t targeted directly by ultrasound. The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood. Researchers are now exploring ways to pair histotripsy with immunotherapy to amplify that effect.
I'm excited to see this option become more broadly available. The ability to precisely target and illicit an inflammatory response is impressive, and Whipples are no joke.
https://www.nature.com/articles/s41467-025-65080-9
which could imaginably lead to wireheading or something like Niven's "tasp".
https://news.ycombinator.com/item?id=46008332
Are these guys losers,clueless, or born psychopaths?
I hope for another category :)
Given the 2023 approval (for liver tumors) and oversubscribed $250m funding round announced in October, it seems like there's a ton of momentum behind this. I also see that the treatment is available at my local hospital system (Inova), which is an encouraging sign of its general availability.
Anyone who's commenting to ask whether it's an option for you or a loved one, check your state's right-to-try laws. Virginia and various other states do apparently have right-to-try laws that cover medical devices: https://triagecancer.org/state-laws/righttotry.
Fuck cancer.
Assuming the costs of the precise powerful machines needed are not too high (this isn't anything like MRI), it could be a therapy for almost any kind of cancer tumor, and even small potential/pre-cancer tumors that are safe to remove without bothering to do a diagnosis.
Click bait is click bait but reliably reels in the gullible.
Also, the clinical efficacy is not fully understood. Researchers are most excited by an enhanced abscopal effect (i.e. natural immune response), but that's not a proven phenomenon. Finally, it is really expensive (~$1.5M) so it will be difficult to scale outside of research hospitals and cancer centers. Of course, I don't want to be too negative. It's a win for patients when they have more options.
Full disclosure: I am co-founder of Current Surgical, where we are developing a minimally invasive system based on miniaturized focused ultrasound to achieve precise thermal ablation (not cavitation). Our device can both see and destroy tissue from the same sensors, we can achieve millimeter accuracy. And because the technology can be integrated into any number of surgical tools (needle, catheter, etc) we can potentially reach any anatomy.