New procedure allows doctors to treat liver tumors using sound waves

Histotripsy treats hard-to-reach liver tumors using sound. The FDA cleared a new histotripsy device called Edison in October 2023.
3D imaging of the liver tumor
Posted at 6:23 PM, May 02, 2024

Doctors have begun treating liver tumors with a new knife-free procedure called histotripsy after the FDA cleared commercialization of a new device last year. The technique can work alongside or potentially replace harsh chemo, surgery or radiation treatments.

Scripps News met Jeff Perino of Mission Viejo, California, to document his nonsurgical procedure at Providence Mission Hospital.

Perino’s day-to-day consists of a lot of “F's” — family, faith and fitness. The father starts most days with a jaunty six-mile run.

"During COVID, that was especially important. I knew that it affected the lungs and it affected your smell. So I figured if I can't run and my lungs don't work, then things are bad. On top of that, there is a flower bush on the route. So every day I'd run as long as I could breathe and felt good, and as long as I could smell the flower bush, I knew I didn't have COVID,” he shared."I'm strong in my faith, too. So I listen to a lot of daily devotionals and things that really keep my mind right."

Perino was diagnosed with Stage 4 colon cancer in fall of 2023. It spread to his renal glands above his kidney. Doctors found tumors in his liver, too.

"More than 10. Sometimes we stop counting, unfortunately, when it's a lot," said Dr. Ahmad Abou Abbass, Perino’s liver surgeon.

"When I was first diagnosed a lot of people, when they'd talk to me, they kind of look at me,” Perino said. "I could sense that they were looking at me as if I was dying. And I was like, no, that's not the angle we're taking here."

Man sitting in a doctors office

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A patient can live without their colon, but not their liver. So, doctors first focused on Perino’s liver tumors. After an aggressive round of chemo to shrink the tumors, Perino is being treated with histotripsy.

Histotripsy treats hard-to-reach liver tumors using sound. The FDA cleared the histotripsy device called Edison in October 2023 for commercialization. It's made by Histosonics, a company formed by the University of Michigan researchers who developed the treatment. The University of Michigan has called histotrispy an “alternative to cancer treatments such as surgery, radiation and chemotherapy, which often have significant side effects.”

Abbass says histotripsy adds to aggressive cancer treatment plans doctors are having to implement more often as they see more young patients with cancers that have spread.

"There's no incisions or needles, patients don't interrupt any sort of systemic therapy,” Dr. Kevin Burns, Perino’s Interventional Radiologist said. "It uses bubbles inside of the cell to rapidly expand and contract to destroy all the cells. But it keeps all the proteins intact and turns it into a liquid. And that liquid gets absorbed by the lymphatic system in the liver. And that can potentially expose your body to all these new antigens that have been hiding from the body.”

For the “histo”, as doctors shorthand it, Perino was put under anesthesia to keep his body, lungs, and liver perfectly still. As we observed, the care team moved a large monitor connected to a mechanical arm, which shoots through a vessel of water on top of the body.

Ultrasound allowed Burns to see Perino's 3-centimeter liver tumor. And as the Edison arm slowly moved around, little by little, ultrasound waves hit the diseased tissues in a red target on the screen that Burns had set over a dark black spot.

Burns told us that microbubbles form and then collapse to break apart the lesion, and the destroyed cancer cells are cleaned up by the immune system.

The histotripsy keeps healthy tissue intact. Early studies show it also trains the immune system to target other cancer cells elsewhere.

"Hopefully it will give him a systemic response and will help him fight the cancer in his body," Abbass said.

"Nonetheless I’m going to evict those suckers," Jeff Perino told Scripps News on his first post-histotrispy run, five days later.

He said the only side effect he felt was exhaustion that felt like bad jet lag two days after surgery.

Perino says he's now back to full speed. In about a week, he'll have a roughly 8-hour surgery to remove the remaining tumors. After that, doctors will evaluate his next step.

"God's got this, and I'm just along for the journey,” he says.