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Metastatic insulinoma - prolonged survival after multimodal approach.

Hagel AF, Hagel WH, Lindner AS, Kammerer FJ, Neurath MF, Konturek PC, Harsch IA - Med. Sci. Monit. (2011)

Bottom Line: To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine.We regard this as the result of a multimodal approach and the extensive use of local tumor therapy.The different therapeutic options for local tumor therapy are reported and discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany. Alexander.Hagel@uk-erlangen.de

ABSTRACT

Background: Metastatic insulinoma is a disease associated with a poor life expectancy.

Case report: The case of a presently 68 year old female with malignant, metastatic insulinoma is reported. Due to severe clinical symptoms surgical tumor mass reduction was conducted. Furthermore the patient underwent a chemotherapy using streptozotocine and fluorouracil. After two years without any symptoms, the remaining hepatic metastases increased in size and again hypoglycemias occurred. To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine. After the first treatment the patient was hypoglycemia - free for 3 months, after another more extensive chemoembolization the patient is presently symptom free for 8 months.

Conclusions: Since the diagnosis of extended disease was established, the patient has survived for 36 months. We regard this as the result of a multimodal approach and the extensive use of local tumor therapy. The different therapeutic options for local tumor therapy are reported and discussed.

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Related in: MedlinePlus

Angiography before (A) and after (B) TACE: Liver metastasis in segment VI.
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f2-medscimonit-17-8-cs103: Angiography before (A) and after (B) TACE: Liver metastasis in segment VI.

Mentions: Two years later the hypoglycemias reoccured, the filiae increased in size and the Chromogranin A levels rose. Having already “utilized up” chemotherapy and surgical options, the decision was made for a transarterial chemoembolization (TACE) using Epirubicine. After treatment of lesions in hepatic segments 6 and 7, the hypoglycemias vanished for about 3 months (Figure 2A, B). The patient and the family underwent counselling for the self-injection of glucagon. After reoccurence of hypoglycemias, another chemoembolization of a lesion in segment 6 was conducted. The remaining vital parts in segment 7 were also treated during this session. After a third TACE of a filia in segment 4 one week later, the patient was symptom free. The embolisations were well tolerated. No complications occurred during and after the embolisations. Presently 18 months after the last intervention she didn’t suffer of any hypoglycemias or any other symptoms.


Metastatic insulinoma - prolonged survival after multimodal approach.

Hagel AF, Hagel WH, Lindner AS, Kammerer FJ, Neurath MF, Konturek PC, Harsch IA - Med. Sci. Monit. (2011)

Angiography before (A) and after (B) TACE: Liver metastasis in segment VI.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539604&req=5

f2-medscimonit-17-8-cs103: Angiography before (A) and after (B) TACE: Liver metastasis in segment VI.
Mentions: Two years later the hypoglycemias reoccured, the filiae increased in size and the Chromogranin A levels rose. Having already “utilized up” chemotherapy and surgical options, the decision was made for a transarterial chemoembolization (TACE) using Epirubicine. After treatment of lesions in hepatic segments 6 and 7, the hypoglycemias vanished for about 3 months (Figure 2A, B). The patient and the family underwent counselling for the self-injection of glucagon. After reoccurence of hypoglycemias, another chemoembolization of a lesion in segment 6 was conducted. The remaining vital parts in segment 7 were also treated during this session. After a third TACE of a filia in segment 4 one week later, the patient was symptom free. The embolisations were well tolerated. No complications occurred during and after the embolisations. Presently 18 months after the last intervention she didn’t suffer of any hypoglycemias or any other symptoms.

Bottom Line: To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine.We regard this as the result of a multimodal approach and the extensive use of local tumor therapy.The different therapeutic options for local tumor therapy are reported and discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany. Alexander.Hagel@uk-erlangen.de

ABSTRACT

Background: Metastatic insulinoma is a disease associated with a poor life expectancy.

Case report: The case of a presently 68 year old female with malignant, metastatic insulinoma is reported. Due to severe clinical symptoms surgical tumor mass reduction was conducted. Furthermore the patient underwent a chemotherapy using streptozotocine and fluorouracil. After two years without any symptoms, the remaining hepatic metastases increased in size and again hypoglycemias occurred. To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine. After the first treatment the patient was hypoglycemia - free for 3 months, after another more extensive chemoembolization the patient is presently symptom free for 8 months.

Conclusions: Since the diagnosis of extended disease was established, the patient has survived for 36 months. We regard this as the result of a multimodal approach and the extensive use of local tumor therapy. The different therapeutic options for local tumor therapy are reported and discussed.

Show MeSH
Related in: MedlinePlus