Histotripsy for Hepatocellular Carcinoma in Asia-Pacific: Current Evidence, Evidence Gaps, and Future Research Priorities
12 affiliations
- 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- 2Department of Urology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- 3Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei, Taiwan
- 4AI Development Center, Fu Jen Catholic University, New Taipei, Taiwan
- 5Teaching and Research Department, Saint Paul’s Hospital, Taoyuan, Taiwan
- 6Division of Oncology, Department of Internal Medicine, Saint Paul’s Hospital, Taoyuan, Taiwan
- 7Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- 8Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- 9Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- 10Department of Healthcare Administration, College Of Medical and Health Science, Asia University, Taichung, Taiwan
- 11Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- 12Centers for Regional Anesthesia and Pain Medicine,Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
Abstract
Background: Histotripsy is a non-thermal focused-ultrasound ablation technology that produces mechanical tissue fractionation through controlled acoustic cavitation. In hepatocellular carcinoma (HCC), its relevance remains investigational, particularly in settings where conventional thermal ablation may be constrained by heat-sink effects, vascular or biliary proximity, limited hepatic reserve, or the need for repeated local therapy. This review evaluates the evidence without assuming an established clinical role.
Methods: We performed a structured narrative review with systematic literature identification and evidence classification. The structured core search covered PubMed/MEDLINE, Scopus, Embase, and Google Scholar from database inception through February 2026; a targeted update through 20 September 2026 was used to identify newly published clinical studies, safety reports, and reviews. Evidence was classified as direct HCC, mixed liver-tumour, non-HCC clinical extrapolation, or preclinical/mechanistic evidence.
Results: Evidence remains early-stage and heterogeneous. #HOPE4LIVER reported 95.5% technical success and 6.8% major complications in mixed primary and metastatic liver-tumour cohorts, with incomplete HCC-specific outcome reporting. The Hong Kong prospective cohort included 19 patients with HCC, all Child-Pugh A, and reported 95% technical success, 82.5% complete response at 1 month, and no grade III or higher complications. Real-world reports also document vascular injury, haemorrhage, and pseudoaneurysm, underscoring that relative resistance of collagen-rich structures should not be interpreted as proven vascular or biliary safety.
Conclusion: Histotripsy should be regarded as an investigational non-thermal ablation technology for HCC. Current data support technical feasibility and preliminary clinical signals, but not superiority, equivalence, or guideline-defined positioning relative to established therapies. HCC-specific prospective cohorts, standardized safety reporting, long-term oncological outcomes, and comparative studies are required.
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BibTeX
@article{chiang2026histotripsy,
title = {{Histotripsy for Hepatocellular Carcinoma in Asia-Pacific: Current Evidence, Evidence Gaps, and Future Research Priorities}},
author = {Ming-Feng Chiang and Shyh-Chyi Chang and Ben-Chang Shia and Yi-Si Liu and Chiung-Yun Lo and Hai-Pei Hsu and Szu-Yuan Wu},
journal = {Journal of Hepatocellular Carcinoma},
year = {2026},
month = nov,
doi = {10.2147/jhc.s630056},
url = {https://doi.org/10.2147/jhc.s630056},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Histotripsy for Hepatocellular Carcinoma in Asia-Pacific: Current Evidence, Evidence Gaps, and Future Research Priorities
AU - Ming-Feng Chiang
AU - Shyh-Chyi Chang
AU - Ben-Chang Shia
AU - Yi-Si Liu
AU - Chiung-Yun Lo
AU - Hai-Pei Hsu
AU - Szu-Yuan Wu
PY - 2026
DA - 2026/11/01
JO - Journal of Hepatocellular Carcinoma
DO - 10.2147/jhc.s630056
UR - https://doi.org/10.2147/jhc.s630056
AB - Background: Histotripsy is a non-thermal focused-ultrasound ablation technology that produces mechanical tissue fractionation through controlled acoustic cavitation. In hepatocellular carcinoma (HCC), its relevance remains investigational, particularly in settings where conventional thermal ablation may be constrained by heat-sink effects, vascular or biliary proximity, limited hepatic reserve, or the need for repeated local therapy. This review evaluates the evidence without assuming an established clinical role. Methods: We performed a structured narrative review with systematic literature identification and evidence classification. The structured core search covered PubMed/MEDLINE, Scopus, Embase, and Google Scholar from database inception through February 2026; a targeted update through 20 September 2026 was used to identify newly published clinical studies, safety reports, and reviews. Evidence was classified as direct HCC, mixed liver-tumour, non-HCC clinical extrapolation, or preclinical/mechanistic evidence. Results: Evidence remains early-stage and heterogeneous. #HOPE4LIVER reported 95.5% technical success and 6.8% major complications in mixed primary and metastatic liver-tumour cohorts, with incomplete HCC-specific outcome reporting. The Hong Kong prospective cohort included 19 patients with HCC, all Child-Pugh A, and reported 95% technical success, 82.5% complete response at 1 month, and no grade III or higher complications. Real-world reports also document vascular injury, haemorrhage, and pseudoaneurysm, underscoring that relative resistance of collagen-rich structures should not be interpreted as proven vascular or biliary safety. Conclusion: Histotripsy should be regarded as an investigational non-thermal ablation technology for HCC. Current data support technical feasibility and preliminary clinical signals, but not superiority, equivalence, or guideline-defined positioning relative to established therapies. HCC-specific prospective cohorts, standardized safety reporting, long-term oncological outcomes, and comparative studies are required.
SN - 2253-5969
ER -