In November, St. David’s Medical Center in Austin became the first hospital in Central Texas to begin providing histotripsy to treat liver tumors, according to St. David’s information. The U.S. Food and Drug Administration approved the use of the new technology through HistoSonics’ Edison System in 2023.
Dr. Shaun McKenzie, the medical director of surgical oncology at St. David’s Medical Center and and a surgical oncologist at Texas Oncology Surgical Specialists, told Community Impact that histotripsy has resulted in lower recovery time for patients and may cause less harm to a patient’s liver compared to other cancer treatments.
Additionally, McKenzie said he hopes histotripsy could replace older treatment options and allow doctors to treat and cure more patients with liver cancer.
“We were so excited with what we saw and ... the early data,” McKenzie said about histotripsy. “We felt that we needed to be part of the cutting-edge component of treatment of liver tumors.”
How it works
The histotripsy technology works to destroy liver tumors by delivering high-frequency ultrasound waves through a patient’s abdominal wall. Unlike other invasive treatment options, histotripsy does not require doctors to make an incision or deliver a probe into a patient’s tumor.
Histotripsy received FDA-approval to treat liver cancer tumors or tumors that have spread to the liver through other cancers, such as breast or colon cancer. About half of tumors in the liver have spread from another organ, McKenzie said.
The technology does not replace other cancer treatment options but can be used alongside them, such as ablation therapies or radiation. Patients can undergo histotripsy without having to pause other forms of cancer treatment.
One of histotripsy’s benefits is that it can treat tumors that are wrapped around blood vessels—tumors for which doctors could not previously treat for a long time, McKenzie said.
Why it matters
Patients often recover very quickly from histotripsy compared to other cancer treatments, McKenzie said. With histotripsy, patients may experience soreness or fatigue but do not have to wait for incisions to heal, delay other treatments or change their schedules, he said.
”I've had patients that had treatment on Friday and went back to work on Monday,” McKenzie said. “That's unusual for a procedure that actually will destroy tumor tissue.”
With limited data on the new technology, doctors are continuing to explore histotripsy and its potential benefits.
After treating a tumor through histotripsy, McKenzie said he has found that a patient’s liver tends to fill in the area with normal tissue. This is unique from other ablation treatments that permanently kill a potion of the liver once it has been removed, he said.
“It looks like maybe we are injuring less liver in the long term with this treatment than other ablation treatments,” McKenzie said.
A few patients nationwide have had multiple liver tumors respond to the treatment of only one of their tumors through histotripsy, McKenzie said. These observations could suggest that histotripsy stimulates a patient’s immune system to attack other tumors, he said.
Despite its benefits, the histotripsy technology comes at a significant expense for hospitals, which may be why many hospitals have not yet adopted the system, McKenzie said.
Something to note
There has been a significant rise in liver cancer in the United States, with some of the fastest rising incidents in South Texas.
This comes amid an increase in Hepatitis C among the baby-boom generation alongside a more recent rise in obesity, which can cause fatty liver disease, McKenzie said. Fatty liver disease, Hepatitis B or C, and alcoholism can chronically scar the liver and cause liver cancer to develop.
While liver cancer is often silent until it becomes advanced, symptoms can include weight loss, abdominal swelling, confusion, jaundice and worsening liver disease.
People who know they have liver disease can get screened for liver cancer. To help avoid developing liver cancer, people should limit alcohol use, maintain a healthy diet, lose weight, get vaccinated or receive treatments if they’re at risk for Hepatitis C, McKenzie said.
Going forward
Historically, doctors have not been able to cure many patients from liver tumors and liver cancer, McKenzie said.
“About 70% of patients that we meet with liver cancer, we don't even discuss the potential for a cure with them,” McKenzie said. “It's not an option.”
Histotripsy could allow doctors to treat more patients with cancer, which is the second leading cause of death worldwide, according to the World Health Organization. The technology is being studied to potentially treat kidney, prostate and pancreas cancer, McKenzie said.
Moving forward, McKenzie said he hopes physicians will continue to find new treatments that are easier on patients’ bodies and more effective at destroying cancer.
“Our hope is as we develop new treatments that we will find some that are better than the old ones we had, less invasive, less hard on the patient, quicker recovery, but more likely to cure the patient,” McKenzie said.
