Device-agnostic public trials of ablation technologies against surgery
Focused ultrasound, histotripsy, heat and electric-field ablation can destroy tumours without an incision, but each maker runs its own small study. Publicly-funded trials would compare them fairly against surgery.
A public trials programme comparing non-invasive and minimally invasive ablation (histotripsy, high-intensity focused ultrasound, microwave and radiofrequency ablation, irreversible electroporation) with surgical resection in indications where ablation is plausible: small hepatocellular carcinoma and liver metastases, small renal masses, localised prostate cancer, early pancreatic tumours in inoperable patients, and thyroid nodules. Trials are device-agnostic within a class, use oncological and functional co-primary endpoints, and are run by the surgical and interventional trials network. Manufacturers contribute devices and training but do not control design or data. Regulatory clearance of these devices has largely rested on technical success, not comparative cancer outcomes.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.