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Case Study: Prof. Liu Xin's Team at the Second Hospital of Lanzhou University Achieves Surgical Conversion in a Giant Hepatocellular Carcinoma Using Vispearl® Radiopaque Drug-Eluting Embolic Microspheres

Jun 05, 2026 08:00 CST Updated 08:00
H&H Healthcare

R&D and Producer of Interventional Medical Devices for Heart Disease



Introduction

The latest "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2026 Edition)" recommend transarterial chemoembolization (TACE) as the preferred treatment for patients with CNLC stage IIa, IIIa, and some stage IIIb. The international BCLC staging guidelines also recommend TACE as the first-line treatment for patients with BCLC stage B.

HuiHe Healthcare Radiopaque Drug-Eluting Microspheres Vispreal®With a unique small particle size range of 40–90 μm, it can meet diverse clinical needs. The radiopacity of Vispearl not only allows for intraoperative tracking of drug-eluting microspheres but also enables immediate post-procedural assessment of embolization efficacy and precise localization of tumor lesions throughout follow-up, aligning more closely with the principles of refined TACE.

This issue’s case report shares the experience of Professor Liu Xin’s team at the Second Hospital of Lanzhou University in applying Vispearl®Treatment of a Case of Massive Hepatocellular Carcinoma with Radiopaque Drug-Eluting Embolization Microspheres: A Case Report of Surgical Resection Assisted by Interventional Targeted Immunotherapy


Prof. Liu Xin’s Team
The Second Hospital of Lanzhou University




Case Details



Basic Information: 65-year-old maleSex

Chief Complaint:Chief Complaint: Abdominal distension and discomfort for over one week

History of Present Illness:One week prior to admission, the patient experienced abdominal distension and pain without any obvious precipitating factors, which worsened after meals.

Past Medical History:History of Hepatitis B; No Viral Replication

Laboratory Tests:ALT 89 U/L，AST 85U/L， TBIL μmol/L，ALB 41.4 g/L，AFP 2.42 ng/mL

Imaging Examination:Preoperative CT revealed hepatocellular carcinoma (HCC) in the right lobe of the liver, measuring approximately 16.8 cm × 17.8 cm × 20.5 cm, with invasion of the right branch of the portal vein.

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Surgical Plan:

Diagnosed with HCC, CNLC stage IIIa, BCLC stage C. After MDTSurgical resection was assessed as having insufficient residual liver volume. FormulateTreatment Plan: Interventional Therapy + Targeted Immunotherapy for Downstaging.




Surgical Procedure




First TACE + HAIC Treatment
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Embolic agents: Embolization was performed using 100–300 μm radiopaque drug-eluting microspheres loaded with 60 mg of epirubicin, in combination with gelatin sponge particles.

HAIC Regimen: Oxaliplatin 85 mg/m²2+ Calcium Folinate 300mg/m²2+5-FU2500mg/m2 48h

Targeted Immunotherapy (4 days post-TACE): Atezolizumab 1200 mg + Bevacizumab 1000 mg


Second TACE Treatment (1.5 Months Later)

Imaging Examination:High-density shadows are visible within the HCC lesion in the right lobe of the liver, measuring 11.2 cm x 10.1 cm, with indistinct boundaries from the right branch of the portal vein.

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TACE Treatment:

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Embolic agents: Radiopaque drug-eluting microspheres (40–90 μm) loaded with 60 mg epirubicin + polyvinyl alcohol blank embolic microspheres;

Principle: Precisely superselect the tumor-feeding vessels, preserve normal vessels, and achieve complete embolization;

Targeted Immunotherapy (4 days post-TACE): Atezolizumab 1200 mg + Bevacizumab 1000 mg.


Surgical Resection (After 1 Month)

Preoperative Laboratory Tests: ALT 88 U/L, AST 55 U/L, TBIL 11.3 μmol/L, ALB 43.7 g/L, AFP 2.97 ng/mL, PIVKA-II 31.6 ng/mL

Imaging Examination:

Abdominal Contrast-Enhanced CT: Hepatocellular carcinoma (HCC) in the right lobe of the liver, measuring 11.2 cm × 9.8 cm. High-density deposits are visible within the lesion, which shows no significant enhancement. The right branch of the portal vein is adjacent to the lesion.

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Abdominal MRI with Primovist:HCC in the right lobe of the liver, 10.1 cm × 8.1 cm × 8.8 cm, with no significant enhancement observed after contrast administration.

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Postoperative:

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Postoperative Follow-up



One-Month Postoperative Follow-up:

Laboratory Tests: ALT 42 U/L, AST 383 U/L, TBIL 13.3 μmol/L, ALB 40.6 g/L

Imaging findings: Post-hepatectomy for HCC in the right lobe of the liver, with no enhancing lesions observed in the surgical bed.

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Four-Month Postoperative Follow-up:

Laboratory Tests: ALT 39 U/L, AST 33 U/L, TBIL 14.5 μmol/L, ALB 41.9 g/L, AFP 2.11 ng/mL

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Expert Commentary



This case confirms that, for liver cancerThe synergistic effect of comprehensive treatment is key.Comprehensive Conversion Therapy Strategy Based on D-TACE: An Effective Pathway to Overcome the Bottleneck of Unresectable Liver Cancer and Achieve Surgical Resection

Precautions for the Clinical Application of D-TACE TechnologyPrecision Embolization Infusion: Precise superselective embolization of the tumor-feeding arteries maximizes the slow and sustained drug release from drug-eluting microspheres while minimizing embolization of non-target tissues.

Meanwhile, in clinical practice, the interventional regimen and microsphere particle size should be dynamically adjusted based on the patient’s liver function, performance status, and tumor vascularity.



Expert Profile




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Liu Xin | Professor


Associate Chief Physician

Head of the Interventional Radiology Ward, The Second Hospital of Lanzhou University


  • Member of the Young Committee, China Chapter of the International Union of Angiology (IUA)

  • IMIA Innovation Alliance, Member of the Gansu Provincial Innovation Alliance

  • Committee Member, Gansu Branch of the Chinese Society of Microcirculation

  • Member of the Interventional Radiology Professional Committee, Gansu Medical Association

  • Member of the Youth Committee on Peripheral Intervention, Gansu Province

  • Committee Member, Tumor Hyperthermia Committee of Gansu Anti-Cancer Association



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Wen Yurong | Professor


Associate Chief Physician

The Second Hospital of Lanzhou University, Department of Interventional Radiology


  • Youth Committee of the Interventional Radiology Society, Gansu Medical Association

  • Member of the First Committee on Interstitial Implant Therapy for Tumors, Gansu Anti-Cancer Association

  • Committee Member, Professional Committee on Interventional Oncology, Gansu Anti-Cancer Association

  • Specializes in interventional oncology and interventional diagnosis and treatment of various types of hemorrhage

  • First Prize in the Gansu Provincial Peripheral Interventional Skills Competition

  • Participated in the Research Projects Approved by the Gansu Provincial Administration of Traditional Chinese Medicine

  • Published 2 SCI-indexed papers and 3 CSCD-indexed papers in the past 5 years.


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