Background: Histotripsy is a novel, non-invasive, focused ultrasound therapy that mechanically disrupts targeted tissues through cavitation, offering a precise and non-thermal alternative to conventional locoregional therapies with preservation of vascular and biliary structures. There are limited reports on the early use of histotripsy in primary and secondary liver tumors. Materials and Methods: Patients undergoing histotripsy for the treatment of primary and secondary liver tumors were retrospectively analyzed. The response to histotripsy was evaluated by assessing computed tomography findings in the first 3 months post-procedure period. Results: Twenty-seven patients were included in the study. Nine (33%) received histotripsy with downstaging or bridging intent, whereas 18 (67%) received histotripsy as part of a palliative treatment approach. Among patients with downstaging or bridging intent, seven of eight (87.5%) evaluable patients showed no lesion growth ≤3 months post-procedure. In palliative patients, growth remained controlled during the first 3 months in three of nine (33%) cases, while increasing in the remaining six (67%). Interestingly, tumoral size decreased in tumors not targeted by histotripsy in four patients, including one palliative patient who was not responding to multiple prior treatments. After histotripsy, three patients were successfully downstaged for liver resection and five were eligible for liver transplantation. Conclusion: Histotripsy presents great potential for the treatment of liver tumors, achieving high rates of short-term local disease control while offering vascular and biliary protection advantages, unlike thermal methods. Further work is required to understand a possible response away from the target. Histotripsy, in combination with systemic therapies, could aid in bridging or downstaging patients with advanced disease to achieve surgical resection or transplantation.

Transplant oncology is a rapidly evolving discipline that incorporates oncology, transplant medicine, and surgery. As the field continues to grow, there remains an opportunity to enhance patient selection, detect recurrence after liver transplantation, and optimize treatment after recurrence. Liquid biopsies are an emerging resource to improve patient care. In this review, we evaluate the most recent available data on circulating tumor DNA and how it pertains to primary and metastatic hepatobiliary malignancies. We discuss the opportunities and current limitations to clinical practice, especially in relation to total hepatectomy and liver transplantation. We conclude that as both transplant oncology and our understanding of circulating tumor DNA continue to evolve, rigorous, prospective study is required to integrate this technology into a clinical paradigm.

BackgroundFrailty reflects diminished physiologic reserve and predicts poor outcomes after injury, while social determinants of health independently influence injury risk and recovery. Whether neighborhood social vulnerability is associated with frailty in injured adults, and whether that association is graded across levels of deprivation, remains poorly defined. We hypothesized that greater neighborhood deprivation is associated with progressively (dose-dependently) higher odds of frailty among adult trauma patients.Patients and MethodsRetrospective cross-sectional study of adult trauma patients (≥18 years) presenting to a single American College of Surgeons-verified Level I trauma center between 2014 and 2021. Neighborhood deprivation was measured with the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), derived from geocoded home addresses and categorized into quartiles of increasing deprivation. Frailty was defined using the 5-item modified Frailty Index (mFI-5). Multivariable logistic regression estimated the association between deprivation quartile and frailty, adjusting for age, sex, and mechanism of injury. Results are reported as adjusted odds ratios (OR) with 95% confidence intervals (CI).ResultsAmong 7,273 included patients, 72% were non-frail, 18% pre-frail, and 10% frail. Odds of frailty increased stepwise across ADI quartiles relative to the least deprived quartile (Q2: 1.35 [1.09–1.67]; Q3: 1.47 [1.17–1.84]; Q4: 1.55 [1.20–2.01]). A similar graded association was observed for SVI in the two most vulnerable quartiles (Q3: 1.28 [1.03–1.60]; Q4: 1.50 [1.14–1.96]). The gradient was most pronounced among geriatric patients (age ≥60y), in whom the highest ADI quartile carried the greatest odds of frailty (1.81 [1.31–2.50]).ConclusionNeighborhood social vulnerability demonstrates a graded, dose-dependent association with frailty in adult trauma patients, that is most marked in older adults. To our knowledge, this is the first demonstration of a dose-dependent deprivation-frailty relationship in an injured population. These findings support the concept of biologic embedding of social disadvantage and may inform community-based prevention strategies and early identification of social needs during hospitalization.