Ultrasound Cancer Treatment: Sound Waves Fight Tumors
spectrum.ieee.org332 points by rbanffy a day ago
332 points by rbanffy a day ago
We are more than a decade away from knowing if Histosonics technology will actually be a meaningful treatment modality. It definitely is 'cool' in that there is no incision. However, whenever you deliver ultrasound energy from outside of the body, accuracy goes down; you are also limited by anatomy in the path of the ultrasound (e.g. going through the rib cage with ultrasound is not trivial). Folks I have spoken to who have bought these units say they are only allowed to use them if the tumor is superficial (i.e. near the skin). On top of that patient motion due to breathing definitely causes inaccuracies and complications. One doctor said it's an expensive paperweight (but it does bring patients in who ask for it).
Also, the clinical efficacy is not fully understood. Researchers are most excited by an enhanced abscopal effect (i.e. natural immune response), but that's not a proven phenomenon. Finally, it is really expensive (~$1.5M) so it will be difficult to scale outside of research hospitals and cancer centers. Of course, I don't want to be too negative. It's a win for patients when they have more options.
Full disclosure: I am co-founder of Current Surgical, where we are developing a minimally invasive system based on miniaturized focused ultrasound to achieve precise thermal ablation (not cavitation). Our device can both see and destroy tissue from the same sensors, we can achieve millimeter accuracy. And because the technology can be integrated into any number of surgical tools (needle, catheter, etc) we can potentially reach any anatomy.
May I ask: > Folks I have spoken to who have bought these units say they are only allowed to use them if the tumor is superficial <
Is this because of: - the efficiency is going down massivly (maybe into useless)
or
- using it "below superficial" might cause other/new problems?
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body? 2024 meta analysis of seeding I didn't see ultrasound in there: https://pubmed.ncbi.nlm.nih.gov/39605885/
Here is a study on AEs specifically from this type of ultrasound: https://journals.plos.org/plosone/article?id=10.1371/journal...
Quote: "Cavitation detaches cancer cells/emboli from the primary site and thereby releases them into the circulation, leading to metastasis"
What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body?
Welp I put it to you like this - if you DON'T use this then you have a gorillion cancer cells among which very likely one genetically predisposed to adventure throughout the body as turbocancer.
If you use this, or radiotherapy, or whatever, presumably there is just a lump of dead tissue where the cancer was, signifying at best you cured it but at worst, knocked it down - specifically if you knocked it down from a gorillion to a million cells, genereally speaking if the body has been seeded or the tumor persists - the tumor will take longer to rebuild back up where it was. The latter is manifested as another such and such months of life, making the therapy "life extending"
Cancers aren't perfectly optimized to metastasize, and metasteses (rather than, e.g., bulk pressure from the original tumor) are usually what kills you. It's perfectly possible that the procedure kills 90% or 99% of the cells in the original tumor but increases migration of the remaining cells such that the net effect reduces patient survival.
Don't cancer metastases have more to do with cancer mutations allowing the cancer cells to form new tumors? Some cancer types tend do not develop the ability to colonize new tumors while others do regularly.
It's quite a bit about that, but it doesn't detract from my point. Mechanical disturbance alone can spread cancer and increase mortality.
"The risk of tumor seeding after liver biopsy is 2.7%"
https://easl.eu/wp-content/uploads/2018/10/Hepatocellular-Ca...
Tissue containment systems for uterine morcellation
https://www.fda.gov/medical-devices/safety-communications/up...
> gorillion
i'd never heard of that counter before so i googled it:
> The word "gorillion" is often used by white supremacists and Holocaust deniers in the form of "six gorillion", which mocks the figure of six million Jews that died during the Holocaust.
may want to look at using different verbiage.
Most non-shitty people probably picked it up from Meme stock sub cultures and wallstreetbets
Of course, one should ask themselves why so much of that culture is fed from and feeds into outright hateful people like nazis and Eugenicists and vague wife haters, and conspiracy theorists who "aren't nazis" but sure seem to believe everything is the fault of the jews.
"Gorillion" as I saw it was about the "Ape" context of wallstreetbets discourse. The Ape framing is actually non-hateful, referencing the new Planet of the Apes movies where someone makes a dumb analogy to a bundle of sticks: "Ape together strong"
They are similarly fans of calling people and things retarded, but that was getting reddit itself to nag them. So they switched to "regarded", because they aren't very clever.
Other gems of this community include frequent references to making "wife changing money" and an insistence that after GME totally turns out to not have been a scam and they bring down the entire american economy through literal shenanigans, that they will all collectively be crowned king, and totally won't oppress anyone, but also they relish the expectation that they will be able to smugly say "I told you so" to all the people suffering in their new regime.
They also adore doing the kind of "theory crafting" that is usually done by the most crazy person you know trying to "prove" bill gates did 9/11 because of that wingdings thing from 20 years ago.
But culture leaks, so this person might have just picked it up somewhere.
We simply won’t know until they do the inevitable phase2/3 RCTs. They will need to show that this method helps people survive longer or with better quality of life than the current standard of care.
HistoSonics has studies published with 50 patients. Their upcoming study with 5000 liver patients obviously will give more information, but we already have some.
And with that said, these studies are more relevant than the top of thread linking to a review from 2011 looking at papers from 2005-2006 for ultrasound cavitation causing metastases.
...they also appear to have been acquired by an investment group this past year:
https://www.fusfoundation.org/posts/transformational-milesto...
>>> ... the study found that removing the parachute prior to jumping led to a shocking increase in mortality among skydivers.
When there's a clear causal mechanism, additional research that doesn't propose a clear resolution to the underlying problem doesn't negate the clear causal mechanism. Releasing a bunch of loose cancer into the body is a clear causal mechanism, so unless you're filtering it or killing the loose cancer somehow, I'm not sure what those studies could tell you that overcomes the underlying problem. And until they address that problem, it's going to be limited to a quality of life type application - stopping the tumor from killing you now with the certainty of metastasis killing you later.
The thing about this kind of 'just so' story causal mechanism is that we still have to actually do the science to find out. Your body does filter and kill potentially cancerous cells all the time already. And cancer cells aren't like, some super thing that evolved to kill you specifically. My just-so story goes like this: 'the cancer cells die because they're suddenly outside of the specific bodypart that they were exploiting'. And we're probably both right, depending on the location of the cancer, the type of cancer, etc.
All life, from humans to cells to chromosomes, has only one purpose - to survive. It turns out that reproduction is an effective way to survive. Also, cooperation is an effective way to survive. The cells in our bodies cooperate for survival. Sometimes cells survive better by no longer cooperating, and reproducing as fast as possible. This winds up killing the host, but the cancer cells don't know that.
And so humans evolve to enforce better cooperation among the cells.
So, no, cancer cells did not evolve to kill you. They do evolve for short term gain, however.
It's an endless struggle.
It's not unlike the struggle between civilized people and criminals.
So what's the problem? The vast majority of cancer treatments seek only to put the condition into remission for a while. Realistically that's often all that can be done.
Putting it into remission is basically the opposite of causing it to metastasize.
The evidence seems to be that the cells are destroyed, not just split up: https://pmc.ncbi.nlm.nih.gov/articles/PMC9404673/
How do they prevent good cells from being destroyed on the way? Shaped sound waves adding up locally?
Yes exactly - focus at a point. You don't reach threshold pressures until you have sufficient summed waves.
> Releasing a bunch of loose cancer into the body is a clear causal mechanism
I'm not in cancer field, but I'm not sure it is. AFAIK the cells that metastasize need to undergo EMT. Simply releasing them from the tumor doesn't mean the cells can attach and survive in the distal site.
The surface of cancer that protects it from the bodies defenses breaking up + parallel chemo or clonal antibody treatments should take care of that. But the principle critical view is correct.
Chemo post-histrophy would remove any lingering cancer cells effectively. Cancer cells need lots of fuel or they stop replicating, and this is what traditional chemo is great at stopping.
Is the idea that you would need less chemo after the tumor is broken up to remove any remaining cancer cells versus just starting out with chemo to remove the tumor?
Chemotherapy isn't always successful, and depends on the tumor's characteristics, but the idea is yes, less chemo. Histrophy is similar to resection, physically removing a tumor. I've seen chemo options for both scenarios with resectable cancers. For example, hormonal therapy is usually prescribed after resectable breast cancer, regardless of outcome. Or, chemo first to shrink the tumor, and have better surgical margins.
The keto diet is also very good for this because many (but not all) cancer cells can't metabolize ketones. However recent research from Columbia Medical School suggests that it can promote metastasis.
Edited for politeness:
Cancer metabolism isn’t a 2-bit meme. Tumors adapt. If they couldn’t, they wouldn’t metastasize.
It's a good thing you edited for politeness because you seemed to be basing your understanding of what I said based on stuff you read on Reddit.
A number of studies show that, in humans, the keto diet (the medical keto diet[1] and not the meat heavy Internet version) causes metabolic stress in breast cancer cells and in several other types of cancer, due to their significantly increased metabolic needs. It's like the difference between a normal human and Michael Phelps during Olympic competition. The cancer cells can process ketones, but not efficiently enough to fuel their activity so they starve.
In humans this eventually results in the death or deactivation of the cancerous cells (deactivation being the primary way that tumors "adapt" to a starvation diet). There have been few, if any, reported cases of metastasis in the types of cancers studied in humans. This outcome is statistically significant enough that multiple cancer treatment centers recommend the medical keto diet to human patients as part of a treatment regime.
As mentioned, the recent study from 2024 shows that this type of metabolic stress can, in mice cause the cancerous cells to metastasize in a last-ditch attempt to survive. However, very little of the cancer research conducted on mice has applications to human cancers. For example, chemotherapy has also been shown to cause metastasis in mice, and a number of earlier studies attempting to replicate the keto research in humans shows that the keto diet in mice increases tumor growth, which is the opposite effect it has in humans.
[1] The medical keto diet is basically just fat and vitamins. No carbs, and minimal to no protein because protein can get converted into glucose by gluconeogenesis. It is not a diet anyone would want to be on longer than strictly necessary. One of my friends had stage 4 metastatic lung cancer, which she discovered during a company-sponsored mud run. Surgery was not an option and chemotherapy was not working. With less than 4 months to live, she went on the medical keto diet and the two-punch combo of keto and chemo put the cancer into remission for almost three years. (Note: She only maintained the diet for a few months after ending chemo treatment. Unfortunately not all of the cancer cells had died, some had merely deactivated. Four years after remission the cancer cells reactivated with a vengeance and she died the day after she started showing symptoms.)
Metastasis is not just random tumor cell going for a hike, they are seeded with extracellular vesicles carrying particular mix of microRNAs, growth factors, vimentin and other stuff.
> What are the chances that breaking up a tumor this way seeds cancer elsewhere in the body?
that's discussed in the article
I read it three time and can't see anything related.
they mention at the end that the destruction of tissue exposes proteins normal and abnormal to the immune system, with the abnormal ones no longer hidden by tumor structures. if you then search (kagi, google, etc) for this there are results where this worked fantastically.
> The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood
Seems a little too speculatively worded, IMO.
It's called the abscopal effect; see e.g. https://pmc.ncbi.nlm.nih.gov/articles/PMC8537037/
Yes, we were doing a clinical trial where the primary tumor was irradiated which causes antigen release. The patients were given immune checkpoint inhibitors at the same time to activate immune cells. It's promising but tricky.
If it was true, couldn't you get the same effect by taking a biopsy, fragmenting the cells, and injecting them back in? Like a vaccination, in fact. Somebody must have studied that approach already.
First issue is that tumors don't necessarily have to be highly immunogenic, e.g. there're tumors that don't present many neoantigens on the surface. This means immune cells can't easily recognize them. Second issue is that tumor microenvironment evolves to be immunosuppressive. There're many different signals that regulate immune cells activation and simply having antigen-specific cells isn't enough. But as someone said in a sister thread, what you're describing is a basis for multiple clinical trials that combine antigen release with immune activation.
There were reports that if you inject the goo from melting the tumor into another mouse, that mouse became much more resistant to that class of tumor[1], so...
[1] - https://news.engin.umich.edu/2023/10/these-bubbles-kill-canc...
I assume the immune system probably already reacts to this in a specific way. For example, a major bruise has a lot of broken up cells, but doesn't warrant a big immune response.
Major damage tends to cause a much larger immune response than a vaccination. That said, they do have therapeutic cancer vaccines that present proteins from cancer (sometimes patient-specific) with adjuvants to help stimulate the immune response.
Interested layman here: IIUC, immunotherapy is currently the holy grail for difficult-to-treat cancers like pancreatic. There are designer mRNA vaccines available that have ridiculous efficacy, but they must be tailored to each individual and so are extremely expensive (and are currently undergoing trials). mRNA COVID vaccines have been shown in some studies to increase the lifespan of pancreatic cancer patients. So, it's not hard for me to imagine that a treatment that gives the immune system a crack at learning to identify and destroy pancreatic cancer cells will boost survivability.
Part of the freak-out about the Trump admin's attacking of scientific research (including, especially, of mRNA research) earlier in the year is that it threatened these trials.
It seems they are initially focused on pancreatic cancer, which has a very low survival rate ~14% [1].
In theory, this may mean that metastisizing this tumour could destroy it in the pancreas, but allow the cells to spread to more treatable locations?
1 - https://www.canceraustralia.gov.au/cancer-types/pancreatic-c...
?? HistoSonics first target was the liver, second was kidney. Pancreas is the third organ they’ve targeted.
It would not be the first therapy that may promote spread while curing the primary site. Hopefully there are measures to assess the cost / benefits.
For sure. Goes without saying in any cancer treatment that cost/benefit is a prime consideration. Still, that will not stop me from asking the question. You can't do that analysis without the answers after all.
I had the opportunity to meet with folks from Histosonics at a Canopy Cancer Collective (pancreas cancer focused group - https://canopycancer.org/) annual meeting a couple of years ago. They had shown very promising results (and approval) with liver cancer, and the applicability to any soft-tissue openly-addressable masses (e.g., not brains in skulls, not lungs full of air) seemed very likely, based on the physics. (Note: I'm a consumer electronics and ML engineer, not a medical devices engineer).
I'm excited to see this option become more broadly available. The ability to precisely target and illicit an inflammatory response is impressive, and Whipples are no joke.
Per the article, this seems even better than the headline would suggest:
> Histotripsy generally seems to stimulate an immune response, helping the body attack cancer cells that weren’t targeted directly by ultrasound. The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood. Researchers are now exploring ways to pair histotripsy with immunotherapy to amplify that effect.
As someone who was recently diagnosed and treated for Uveal Melanoma (get your annual eye exam and retinal scans!), and occasionally struggling with some intrusive thoughts about the potential for liver mets, reading about this treatment brought me so much joy. Bless Zhen Xu!
Hey, I'm curious, did you have symptoms or did you just find it by chance?
no symptoms. first identified the lesion a few years back and it hadn't changed over a few subsequent appointments. exam this year, it had grown a small amount 5mmx5mm to 6mmx8mm - still considered small, but the change was enough for the Drs to recommend treatment. I have been treated by Dr. Dan Gombos[1] at MD Anderson and received excellent care.
I have a relative with the same disease. They went to a an eye doctor because of visual artifacts. Turns out the tumor was so big it caused retinal detachment. Basically, most people get diagnosed at a very late stage because it's mostly asymptomatic.
Could this be applicable and available to the public within a reasonable time horizon? My mother is dealing with a brain tumor located in the pons, and no surgeons will operate because of its location, as the risk is too high. Radiation treatments have also been exhausted and have already caused some necrosis. There was another form of light-based therapy, but it is experimental and carries an incredibly high risk as well. The prognosis has never been good, but we’ve been holding out hope. At this point, treatment consists of nonstop chemotherapy.
Getting the US through the skull bone is next to impossible due to the acoustic impedance mismatch with surrounding tissues. As a stranger I'm deeply sorry for your situation, and thought your question should be answered somehow...
If you want to dig a little bit, the team of Mathias Fink in Paris explored "time reversal" techniques to get through the skull: one have to emmit from the tumor location, listen with a huge array, reverse the signature and blast. I don't know if this ended with a medical device.
Take care.
The machine has been available for a couple years to treat liver tumors. It’s available in several US cities but not widely available. It uses cavitation to destroy the tumor.
https://www.mdanderson.org/cancerwise/histotripsy-for-liver-...
Due to some family stuff, this is something I've been investigating. My oncologist has said "this will probably be standard care in a few years". The results and studies around this have been excellent.
What this does better than pretty much anything else is it isolates the destruction of cells to just the target. The liver is a VERY "bleedy" organ. It has a ton of blood that flows through it which makes surgery extra hard. In fact, the not this surgery that's next best for our circumstances laparoscopic through the arteries to drop a radioactive pellet in the center of the cancer.
The non-invasive nature of this is going to be very good for the future of cancer treatment. Minimizing scaring and damage to tissue is the number 1 factor to better results.
The only reason my local oncologist does not have this machine is they are still pretty pricey.
When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.
I finished treatment for prostate cancer this summer. Most of my time in the x-ray machine was spent getting the alignment right. They'd take a CT scan, do some image analysis and other computations, then adjust the table some small amount before turning the beam on.
I'm curious how they do the alignment with the histotripsy machine. I would think that they could obviously do an ultrasound scan to get the gross alignment correct. But perhaps there is a CT scan afterwards that lets them make the fine alignment. It probably also helps that the liver is a much larger gland so aiming is less critical?
I'm not sure how they do it exactly. I know just the nature of the machine is that it has a massive array of ultrasound emitters and sensors.
Ideally it'd just be software driven. Take an ultrasound scan, adjust, blast. In theory this could be done in milliseconds to counter patient movements. Pretty nifty really!
I'm unfortunately on the same situation. We made a consultation with people from Baptist Health Miami and it seems like there are several non trivial requirements for such treatment (histotripsy), like the number and location of mets. Hope that this improves in the mear future.
> When I first learned about this, I thought it was pseudo-science BS. It's crazy what can be done with just sound.
I think we were all thinking that. Acoustic Cavitation has also been proposed as a mechanism for enabling cold fusion. https://www.science.org/doi/10.1126/science.1067589
Pretty pricey, yes. HistoSonics is a microcosm of the truth of healthcare spending: it is an amazing technology made by possible by deep and sophisticated capital markets. But, better health technology seems to explain more than 50% of the growth of healthcare spending since medicare (1965), meaning all of the faster-than-GDP growth people gripe about. When people talk about slowing health spending to something manageable, they are talking about not just govt not paying for things like histotrispy - not paying is a shell game, nobody chooses to not pay to save their life, and hence faster than GDP healthcare spending growth is observed everywhere in the West, not just the US. They are talking about somehow making the technology not happen altogether.
I wish there was a way todo chemo locally only. Like a body part has cancer, you add a bypass to that part and put that bodypart on a eccmo chemo poisoning only the affected system part. After that flush out and reconnect.
Histotripsy means "cell pulverizing". We know disruption (pulverization or otherwise) of a tumor bed tends to incite a local inflammatory reaction, and a brisk inflammatory reaction seems to correlate with survival. So the idea here seems to be an extension of high energy ultrasound methods developed for lithotripsy (breaking up kidney stones) to disrupt tumor beds. Not something I'd want for a pre-cancerous lesion, but if it's stage 4 liver mets ... sure. Have at it.
The advancements in imaging, cheap intelligence and non-invasive (mostly) tools like this are amazing. I can easily see a future where we can scan, and analyze, every cell in a body and then selectively manipulate them to achieve the desired effect. I doubt we are actually that far away actually.
Being non-invasive and incredibly precise, this could be a fantastic therapy for brain cancer treatment.
Assuming the costs of the precise powerful machines needed are not too high (this isn't anything like MRI), it could be a therapy for almost any kind of cancer tumor, and even small potential/pre-cancer tumors that are safe to remove without bothering to do a diagnosis.
The awesome "What's your problem" postcast had an episode with the CEO of this company recently which I really enjoyed: https://www.pushkin.fm/podcasts/whats-your-problem/using-sou...
In general there is a lot of work on ultrasound stimulation now, some of it is scary in other ways:
https://www.nature.com/articles/s41467-025-65080-9
which could imaginably lead to wireheading or something like Niven's "tasp".
There's also
https://news.ycombinator.com/item?id=46008332
Are these guys losers,clueless, or born psychopaths?
I hope for another category :)
Well when I was younger I was into chemical yoga, and you know I lived this one: https://www.youtube.com/watch?v=N6uEMOeDZsA
This to the other one that made the end credits of BtTF is as Sixto to Dylan :)
Will this be applicable to belly/visceral fat? It could be wildly popular.
Yes. There are several methods like high-intensity focused ultrasound (UltraShape and Liposonix) and the ultrasonic cavitation found in medspas.
The former is somewhat effective but based on early research shares the same problems as other active fat loss treatments: lysing the fat cells causes all the relevant hormones to get released into the bloodstream, causing reabsorption by other fat cells. It’s a very gradual process and quite expensive.
A random popular article on ieee.org is not a Phase 3 RCT published in the NEJM.
Click bait is click bait but reliably reels in the gullible.
Thanks for posting this. Sounds super promising, and the explanation of histotripsy's mechanism of action is compelling.
Given the 2023 approval (for liver tumors) and oversubscribed $250m funding round announced in October, it seems like there's a ton of momentum behind this. I also see that the treatment is available at my local hospital system (Inova), which is an encouraging sign of its general availability.
Anyone who's commenting to ask whether it's an option for you or a loved one, check your state's right-to-try laws. Virginia and various other states do apparently have right-to-try laws that cover medical devices: https://triagecancer.org/state-laws/righttotry.
Fuck cancer.
from purely physics , how is cancer cell different from regular cell to react with ultra/infra? is it so different?
It's not.
The key thing is, one of the things most tumors need to do to get past a certain point is avoid getting caught being tumors.
If you can very selectively cause precise tissue death, from any method, then your body will suddenly start looking askance at any tissue that looks like the secretly-full-of-tumor-markers corpse it just found.
And ultrasonic cavitation means you can, in theory, cause very precise tissue death with even less surrounding effect than radiation.
Does this work with lung cancer?
Probably not as lungs are behind the rib cage and filled with air, making two sources of spurious reflections that could be dangerous with high intensity ultrasounds.
Dumb question, but isn't there a risk of spreading cancer causing proteins throughout the body with this approach?
Cancer isn't caused by proteins in the way you might think. Its definitely not infectious at the protein level. You could ask if this disruption spreads out cancer cells themselves and that would be fair to ask. But then the cancer cells were already in your body and were likely trying to migrate to other sites anyway.
Ok, but this might stimulate migration further.
The success of surgery to remove solid tumors usually hinges on whether there are "clean margins," meaning they were able to remove all the bad tissue and a little good surrounding tissue just to be sure. It's likely that the same principle applies using this new procedure: if you blast the whole thing and trust the body to clean up the mess, hopefully there won't be anything left to worry about.
> trust the body to clean up the mess
This is what I'd like to understand better, rather than operate on trust. A couple of other commenters have shared good context.
> Histotripsy generally seems to stimulate an immune response, helping the body attack cancer cells that weren’t targeted directly by ultrasound. The mechanical destruction of tumors likely leaves behind recognizable traces of cancer proteins that help the immune system learn to identify and destroy similar cells elsewhere in the body, explains Wood. Researchers are now exploring ways to pair histotripsy with immunotherapy to amplify that effect.
the article talks about this, the (too vaguely explained) tldr is that pulverization allows neoantigens to be exposed to the immune system rather than hidden within a tumor. i saw elsewhere (weeks ago) an article that this worked excellently, but this article seems to not reference it.
this is one such article:
https://viterbischool.usc.edu/news/2025/11/tricking-tumors-i...
Heavy metal has entered the chat.