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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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Liver Metastasis in segment VII before (A) and after (B) TACE.
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f3-medscimonit-17-8-cs103: Liver Metastasis in segment VII before (A) and after (B) TACE.

Mentions: To our knowledge, comparative studies of the different local methods are not available. Even specialized centers are mostly unable, to offer all a.m. therapies. Due to the good vascularization 3 chemoembolizations were conducted so far, treating the four largest hepatic metastases. In control imaging those lesions did not show any more vitality. (Figures 3B, 3B) After the first treatment she did not suffer of any more hypoglycemias for 3 months. With recurring hypoglycemias we conducted 2 consecutive chemoembolizations within one week. In follow up examinations the patient reported of not having any clinical symptoms yet. For each intervention our patients spent just two nights in the clinic. She tolerated the treatments well, not suffering of any side effects of the chemoembolizations. This therapeutic regimen holds the potential to be continued in case of need. Due to the small number of metastatic insulinomas, no controlled studies of the therapeutic effect of the above mentioned interventions exist for this specific tumor. In a recent study comparing transarterial chemoembolization versus transarterial embolisation alone a prolonged survival (31.5 months to 18.2 months) and an improved response rate (50% to 25%) was demonstrated [13]. As in our case, most of the patients had already undergone chemotherapy before, however only in ⅓ of the patients have had a previous surgical tumor mass reduction in this study.


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)

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

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

f3-medscimonit-17-8-cs103: Liver Metastasis in segment VII before (A) and after (B) TACE.
Mentions: To our knowledge, comparative studies of the different local methods are not available. Even specialized centers are mostly unable, to offer all a.m. therapies. Due to the good vascularization 3 chemoembolizations were conducted so far, treating the four largest hepatic metastases. In control imaging those lesions did not show any more vitality. (Figures 3B, 3B) After the first treatment she did not suffer of any more hypoglycemias for 3 months. With recurring hypoglycemias we conducted 2 consecutive chemoembolizations within one week. In follow up examinations the patient reported of not having any clinical symptoms yet. For each intervention our patients spent just two nights in the clinic. She tolerated the treatments well, not suffering of any side effects of the chemoembolizations. This therapeutic regimen holds the potential to be continued in case of need. Due to the small number of metastatic insulinomas, no controlled studies of the therapeutic effect of the above mentioned interventions exist for this specific tumor. In a recent study comparing transarterial chemoembolization versus transarterial embolisation alone a prolonged survival (31.5 months to 18.2 months) and an improved response rate (50% to 25%) was demonstrated [13]. As in our case, most of the patients had already undergone chemotherapy before, however only in ⅓ of the patients have had a previous surgical tumor mass reduction in this study.

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