Systematic review and meta-analysis of studies of histotripsy for liver tumors

Histotripsy is a non-invasive, non-ionizing, non-thermal mehtod of mechanical tumor disruption, FDA-approved for the treatment of liver tumors. Systematic review and meta-analysis of studies published between 2015 and 2025 evaluated safety and efficacy of histotripsy for primary and secondary liver tumors. Ten studies (553 patients) met the inclusion criteria. No studies exhibited a high risk of bias; seven demonstrated a moderate risk of bias. The pooled technical success rate was 94.1% (95% CI 90.4-96.4; I²=0%). Four studies reporte grade ≥ 3 complications with a pooled event rate of 7.0% (95% CI 2.0-21.5; I²=76.4%). The pooled event rate for absence of nodular enhancement was 89.3% (95% CI 48.2-98.7; I²=61.6%). The pooled mean tumor volume reduction was 49.4% (95% CI 9.0-89.8; I²=99.6%). The pooled off-target tumor effect rate was 10% (95% CI 5.0-20.0; I²=6.6%). No significant publication bias was detected for mortality and safety outcomes. All radiological control outcomes showed substantial heterogeneity across studies. The authors conclude that histotripsy has high rates of technical feasibility and local control with a favorable side effect profile.