An Emerging Paradigm Shift in Liver Ablation: The Potential for Clinical Impact of Nonthermal Ablation Technologies

Percutaneous thermal ablation (TA) is a first-line treatment option for early-stage hepatocellular carcinoma and certain hepatic metastases in patients who are not surgical candidates based on lesion location or patient factors. The traditional treatment goal for TA is destruction of a targeted tumor with an ablative margin, a goal adapted from the hepatic resection literature. Two new non-TA modalities, histotripsy and nanosecond pulsed electric field, have emerged as treatment options with different mechanisms of action compared with TA. There is nascent evidence to suggest that these new technologies might also provoke an immune response, which could provide additional benefit beyond local tumor control. This study examines the available preclinical evidence and data from early human clinical trials for these new technologies and discusses future requirements to realize a potential new paradigm in ablation treatment.