Histotripsy is a nonthermal, noninvasive, focused ultrasound that supposedly mechanically disrupts tumors. What could go wrong? This retrospective study evaluated outcomes for 972 adults treated from 2023–2026. Nearly 70% of treatments were for metastatic liver disease (including 260 colorectal and 121 pancreatic primaries), with the remaining 30% for primary liver tumors. The vast majority (88%) were treated in a single outpatient session, which is great. Unfortunately, more than 1 in 10 did not live another 30 days. Is histotripsy more powerful than imagined..? Given a lack of granular data on the extent of disease for these patients, it is more likely less powerful than hoped, particularly outside the context of data-driven optimal patient selection. | Sears, JAMA Newt Open 2026
