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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.
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.
Brachytherapy placed radioactive sources inside tumours within a decade of radium's discovery and remains standard in cervical and prostate cancer. Hyperthermia, heating tumours to 40-43 degrees to sensitise them to radiation and chemotherapy, showed benefit in randomised trials for cervical cancer and sarcoma but never became routine. Photodynamic therapy, a light-activated drug for skin and superficial tumours, was approved in the 1990s. Each worked in a niche; none had the trial machinery to grow beyond it.
Radiofrequency, then microwave and cryoablation, destroyed small liver, kidney and lung tumours through a needle under imaging guidance and became guideline alternatives to surgery for patients who could not have an operation. Irreversible electroporation used high-voltage pulses to kill cells without heat, sparing vessels and ducts near the pancreas. Laser interstitial thermal therapy reached deep brain tumours through a small skull hole. High-intensity focused ultrasound treated prostate cancer from outside the body.
Tumour treating fields, delivered through electrodes worn on the skin for most of the day, disrupt the mitotic spindle in dividing cells. EF-14 showed that adding the device to temozolomide extends survival in newly diagnosed glioblastoma; STELLAR supported approval in mesothelioma; and in 2026 PANOVA-3 made the device the first ever approved for pancreatic cancer, extending survival when added to chemotherapy. The mechanism is unusual enough that the field spent years arguing about it; the randomised data settled the practical question.
Cetuximab sarotalocan, an EGFR antibody carrying a dye that bursts cells when near-infrared light is shone on them, is approved in Japan for recurrent head and neck cancer and is being paired with PD-1 blockade to turn the burst tumour into a vaccine. In the bladder, the TAR-200 pretzel implant releases gemcitabine for weeks and cleared carcinoma in situ in most patients in SunRISe-1; nadofaragene firadenovec became the first bladder gene therapy. Electrochemotherapy and IL-12 gene electrotransfer use electric pulses to get drugs or genes into a tumour directly.
Histotripsy destroys tissue with cavitation bubbles rather than heat, without incision or radiation; it is approved for liver tumours, its inventor was acquired for over two billion dollars, and trials are asking whether the debris it leaves primes an immune response that other ablations do not. Focused ultrasound with microbubbles briefly opens the blood-brain barrier so that chemotherapy or antibodies can reach brain tumours, in trials at Sunnybrook and elsewhere. Sonodynamic therapy activates a drug only where ultrasound hits it, in glioblastoma trials.
Scalp cooling caps preserve hair through chemotherapy and are cleared and increasingly funded; a compression device aims to do the same more cheaply; low-level laser reduces the mouth ulcers of head and neck radiotherapy; a wearable ultrasound images the whole breast in minutes; and a portable freezing device lets a nurse treat cervical precancer in any clinic, which matters where colposcopy does not exist. Infusion pumps, ports and compounding robots are the devices every chemotherapy dose depends on.
Iron-oxide nanoparticles heated by an alternating magnetic field, gold nanoshells heated by light, and nanoparticles that amplify radiotherapy inside the tumour all have first-in-human data and no randomised proof. Radioactive seeds that emit short-range alpha particles from inside a tumour are in trials. DNA origami nanorobots that open only on contact with a tumour are mouse data. Each has a specific, known failure mode (delivery, clearance, toxicity) rather than a vague one, which is what keeps them on the map.
Devices are approved on less evidence than drugs, then struggle for guideline adoption and payment because the trials were small or unblinded. No pharma company funds a device trial, and device companies are small. Sham-controlled designs, standing platform trials for local therapies, and reimbursement tied to registries are the fixes; access outside specialist centres, and outside rich countries, is the larger gap.
Every era's records, trial outcomes and papers, and every watch item, as JSON.
Probability ranges are named estimates that the claim is borne out on roughly a five-year horizon. They are meant to be argued with: propose a revision with your name and reasoning via a pull request to src/data/confidence.ts.
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The evidence behind the 2026 approval of Optune Pax for locally advanced disease, the first new approval in that setting in decades, and an unusual case of a survival gain without a progression-free survival gain.
One roadmap page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
Shares Partial nephrectomy, ablation & active surveillance of small renal masses, Boston Scientific, Irreversible electroporation (NanoKnife), Thermal ablation and cryotherapy for cervical precancer.
Shares HistoSonics, Insightec, Irreversible electroporation (NanoKnife), Focused ultrasound & histotripsy.
Shares Sonodynamic therapy, Insightec, Sunnybrook Odette Cancer Centre, Focused-ultrasound blood-brain barrier opening.
Shares HistoSonics, Irreversible electroporation (NanoKnife), Focused ultrasound & histotripsy, Thermal ablation (RFA, microwave, cryo).
Shares SunRISe-1, Gemcitabine intravesical system (TAR-200), Nadofaragene firadenovec, Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy).
Shares biolitec, Sonodynamic therapy, Cetuximab sarotalocan, Aminolevulinic acid (topical, for photodynamic therapy).
Shares Novocure, Optune / Optune Pax (TTFields), Focused-ultrasound blood-brain barrier opening, Tumour treating fields (TTFields).
Shares Histotripsy as an immune primer, Insightec, Focused-ultrasound blood-brain barrier opening, Focused ultrasound & histotripsy.