# Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants

Source: https://onco.cc/roadmaps/devices-roadmap/  
OnCo record `devices-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Devices treat cancer with physics rather than chemistry: heat, cold, light, electric fields and sound. After decades at the margins, several now have randomised proof and approvals, and the next generation aims to prime the immune system as it destroys the tumour.

## Summary

Physical therapies were the original alternatives to the knife: brachytherapy placed radium inside tumours a century ago, hyperthermia and photodynamic therapy were tested through the 1980s and 1990s, and needle-based ablation with heat or cold became standard for small liver and kidney tumours. What held the field back was evidence: device trials are hard to blind, rarely funded at drug-trial scale, and reimbursed inconsistently.

That has changed. Tumour treating fields, alternating electric fields worn on the scalp or torso that disrupt cell division, extended survival in glioblastoma (EF-14) and in 2026 won approval in pancreatic cancer after PANOVA-3, the first device to do so. Photoimmunotherapy, an antibody carrying a light-activated dye, is approved in Japan for head and neck cancer. A pretzel-shaped implant that releases gemcitabine inside the bladder cleared carcinoma in situ in most patients in SunRISe-1 and reached the market. Histotripsy, which destroys tissue mechanically with focused sound, is approved in the liver and being studied as an immune primer, and focused ultrasound is opening the blood-brain barrier for drugs in trials.

The pace is set by the same problems as before: trial design and funding for interventions no pharma company owns, sham-controlled evidence, reimbursement, and access outside specialist centres.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-10

## Sources

- EF-14: tumour treating fields plus temozolomide in glioblastoma (JAMA 2017): https://doi.org/10.1001/jama.2017.18718
- PANOVA-3 (Journal of Clinical Oncology 2025): https://doi.org/10.1200/JCO-25-00746

## Connected records

- ideas: [HPV self-testing with same-day treatment as the national cervical programme](https://onco.cc/ideas/idea-acc-hpv-self-sample-same-day-ablation/), [Photoimmunotherapy as an in situ vaccine with PD-1 blockade](https://onco.cc/ideas/idea-photoimmunotherapy-plus-pd1/)
- institutions: [Sunnybrook Odette Cancer Centre](https://onco.cc/institutions/sunnybrook-odette/)
- technologies: [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [DNA origami nanorobots](https://onco.cc/technologies/dna-origami-nanorobots/), [Electrochemotherapy](https://onco.cc/technologies/electrochemotherapy/), [Focused ultrasound & histotripsy](https://onco.cc/technologies/hifu-histotripsy/), [Focused-ultrasound blood-brain barrier opening](https://onco.cc/technologies/bbb-focused-ultrasound/), [Histotripsy as an immune primer](https://onco.cc/technologies/histotripsy-immune-priming/), [Hyperthermia](https://onco.cc/technologies/hyperthermia/), [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [Intratumoural gene electrotransfer (IL-12 plasmid)](https://onco.cc/technologies/il12-electroporation/), [Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)](https://onco.cc/technologies/bcg-and-intravesical-therapy/), [Irreversible electroporation (NanoKnife)](https://onco.cc/technologies/irreversible-electroporation/), [Laser interstitial thermal therapy (LITT)](https://onco.cc/technologies/litt/), [Magnetic nanoparticle hyperthermia](https://onco.cc/technologies/magnetic-nanoparticle-hyperthermia/), [Oncology pharmacy automation and compounding robots](https://onco.cc/technologies/pharmacy-automation/), [Partial nephrectomy, ablation & active surveillance of small renal masses](https://onco.cc/technologies/partial-nephrectomy-active-surveillance/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/), [Photoimmunotherapy & photodynamic therapy](https://onco.cc/technologies/photoimmunotherapy/), [Photothermal (plasmonic) nanoparticle ablation](https://onco.cc/technologies/photothermal-nanoparticles/), [Radiodynamic therapy and radiosensitising nanoparticles](https://onco.cc/technologies/radiodynamic-therapy/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Sonodynamic therapy](https://onco.cc/technologies/sonodynamic-therapy/), [Thermal ablation (RFA, microwave, cryo)](https://onco.cc/technologies/thermal-ablation/), [Thermal ablation and cryotherapy for cervical precancer](https://onco.cc/technologies/precancer-ablation/), [Tumour treating fields (TTFields)](https://onco.cc/technologies/ttfields/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/), [Radical oncology: what could change the war by 2035](https://onco.cc/roadmaps/frontier-2035/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)
- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/)
- drugs: [Aminolevulinic acid (topical, for photodynamic therapy)](https://onco.cc/drugs/aminolevulinic-acid/), [Cetuximab sarotalocan](https://onco.cc/drugs/cetuximab-sarotalocan/), [Gemcitabine intravesical system (TAR-200)](https://onco.cc/drugs/tar-200/), [Nadofaragene firadenovec](https://onco.cc/drugs/nadofaragene-firadenovec/), [Optune / Optune Pax (TTFields)](https://onco.cc/drugs/optune/)
- companies: [Alpha Tau Medical](https://onco.cc/companies/alpha-tau-medical/), [Ananya Health](https://onco.cc/companies/ananya-health/), [Biofrontera](https://onco.cc/companies/biofrontera/), [biolitec](https://onco.cc/companies/biolitec/), [Boston Scientific](https://onco.cc/companies/boston-scientific/), [HistoSonics](https://onco.cc/companies/histosonics/), [Insightec](https://onco.cc/companies/insightec/), [iSono Health](https://onco.cc/companies/isono-health/), [Luminate Medical](https://onco.cc/companies/luminate-medical/), [Novocure](https://onco.cc/companies/novocure/), [SonALAsense](https://onco.cc/companies/sonalasense/), [ZAP Surgical Systems](https://onco.cc/companies/zap-surgical-systems/)
- trials: [EF-14](https://onco.cc/trials/ef-14/), [PANOVA-3](https://onco.cc/trials/panova-3/), [STELLAR](https://onco.cc/trials/stellar/), [SunRISe-1](https://onco.cc/trials/sunrise-1/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [The brain: barrier and sanctuary](https://onco.cc/bottlenecks/b-brain-delivery/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- key papers: [Effect of Tumor-Treating Fields Plus Maintenance Temozolomide vs Maintenance Temozolomide Alone on Survival in Patients With Glioblastoma: A Randomized Clinical Trial](https://onco.cc/key-papers/paper-stupp-jama/), [Tumor Treating Fields With Gemcitabine and Nab-Paclitaxel for Locally Advanced Pancreatic Adenocarcinoma: Randomized, Open-Label, Pivotal Phase III PANOVA-3 Study](https://onco.cc/key-papers/paper-panova-3-ttfields-locally-advanced-pancreatic-jco-2025/)

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