Histotripsy Adoption in Interventional Oncology Presents Opportunities and Challenges in the United Kingdom

Histotripsy, a novel ultrasound-based tumor ablation technology, is placed to reshape the future of interventional oncology (IO), according to a review published in the May 2026 issue of the British Journal of Radiology. The article, authored by investigators out of Leeds and published on behalf of the British Institute of Radiology, examines the early clinical adoption of acoustic cavitation histotripsy and evaluates the opportunities and barriers associated with integrating the technology into routine cancer care.

Mechanism of action

The authors describe histotripsy as “the first non-invasive, non-ionising, non-thermal ultrasound-based ablation technology available for cancer treatment.”¹ In contrast to established modalities like radiofrequency, microwave ablation, and cryoablation, histotripsy uses focused ultrasound pulses to produce acoustic cavitation (or “bubble clouds”), resulting in precise tissue fractionation while minimizing the risk of damage to surrounding structures. Because it does not involve heat, it is also immune to the heat-sink effect, which is a marked advantage over thermal high-intensity focused ultrasound (HIFU).

Key trials

Initial clinical experience has focused primarily on liver tumors, with the first in-human feasibility results reported in 2022 (the THERESA trial)² and the first clinical cases performed in the #HOPE4LIVER trial³; the latter led to the 2023 US Food and Drug Administration (FDA) approval of the HistoSonics Edison Histotripsy System (HistoSonics, Inc.) for this purpose.

Application of the System to solid renal tumors is being prospectively evaluated in the CAIN trial, with full results expected in 2026.⁴ In the United States, the #HOPE4KIDNEY trial will evaluate the safety and effectiveness of the System, with the aim of submitting for FDA approval.⁵

Beyond these is the GANNON trial, which will target pancreatic tumors and is recruiting as of early 2026.⁶

The review also highlights growing interest in potential immunomodulatory effects, with preclinical studies suggesting that histotripsy-induced tumor destruction may stimulate antitumor immune responses—a phenomenon partially seen in 1 patient from THERESA.²

The emergence of histotripsy reflects a broader trend toward less invasive, image-guided cancer therapies. For IOs, the technology may expand treatment options for patients who are poor surgical candidates or whose tumors are located near critical structures where thermal ablation carries higher risk. Also, because histotripsy does not require probe placement, it may reduce procedure-related complications such as bleeding or infection. In addition, histotripsy is associated with shorter patient recovery times than surgery and other ablative techniques, which may cut overall costs and improve patient experience.

That being said, the authors caution that adoption remains in its early stages. Additional prospective studies and multicenter registries will be needed to better define patient selection criteria, standardize protocols, and compare effectiveness against established therapies.

From a healthcare systems perspective, successful implementation—particularly in the United Kingdom—will depend on multidisciplinary collaboration among interventional radiologists, oncologists, surgeons, and anesthesiologists, as well as the ability to secure sufficient funding for research and devices. The authors emphasize that evidence generation, workforce development, and equitable access will be essential to realizing the technology's clinical potential.

Although histotripsy remains an emerging technology, its unique mechanism of action and noninvasive treatment approach have positioned it as a highly promising development in IO. Further clinical studies will be necessary to determine its effects in the long-term vs traditional treatments, and obstacles relating to cost and integration will need to be weighed before broad adoption.

1. Ng HHL, Chan VWS, Howell L, et al. Early adoption of image-guided histotripsy therapy in interventional oncology: challenges and opportunities in the United Kingdom. Br J Radiol. 2026;99(1181):833-846. doi:10.1093/bjr/tqag047
2. Vidal-Jove J, Serres X, Vlaisavljevich E, et al. First-in-man histotripsy of hepatic tumors: the THERESA trial, a feasibility study. Int J Hyperthermia. 2022;39(1):1115-1123. doi:10.1080/02656736.2022.2112309
3. Wah TM, Pech M, Thormann M, et al. A multi-centre, single arm, non-randomized, prospective European trial to evaluate the safety and efficacy of the HistoSonics system in the treatment of primary and metastatic liver cancers (#HOPE4LIVER). Cardiovasc Intervent Radiol. 2023;46(2):259-267. doi:10.1007/s00270-022-03309-6
4. Wah TM, Amaral JF, Laeseke PF. Treatment of primary solid renal tumours using histotripsy: study protocol for the CAIN feasibility trial. Cardiovasc Intervent Radiol. 2025;48(6):857-865. doi:10.1007/s00270-025-04035-5
5. The HistoSonics Edison™ system for treatment of primary solid renal tumors using histotripsy (#HOPE4KIDNEY) (#HOPE4KIDNEY). ClinicalTrials.gov identifier: NCT05820087. Updated December 22, 2025. Accessed June 3, 2026. https://clinicaltrials.gov/study/NCT05820087
6. The HistoSonics Edison™ system for treatment of pancreatic adenocarcinoma using histotripsy (GANNON). ClinicalTrials.gov identifier: NCT06282809. Updated January 15, 2026. Accessed June 3, 2026. https://clinicaltrials.gov/study/NCT06282809