The combination of systemic therapy and transarterial chemoembolization in the treatment of symptomatic hepatic metastases of malignant insulinoma

Purpose: The objectives to present the case of a patient with malignant insulinoma and to show the feasibility of the combination of systemic treatment and transarterial chemoembolization of liver metastases in malignant insulinoma, for symptomatic patients with severe hypoglycemia, who are resistant to systemic treatment. Case: We describe the case of 52-year-old patient, initially treated from pancreatic adenocarcinoma with liver metastasis. After 6 years, based on clinical characteristics, an oncologist raised suspicion on malignant insulinoma. After re-evaluation of the original histological sample, diagnosis of malignant insulinoma was concluded. Consequently, the patient was treated with somatostatin analogs and mTORinhibitor. Despite of the treatment, a progression of liver metastasis was observed, which resulted in life-threatening hypoglycemia, dependent on continual glucose dosing, and was refractory to the treatment with octreotide. In collaboration with radiologist, transarterial chemoembolisation of liver metastasis was performed. As soon as after the first application, improvement of hypoglycemia occurred, in addition to improvement of efficacy of lanreotide in the following treatment. Conclusion: Intervention radiology currently one of the possible therapeutic approaches in the treatment of patients with liver malignancies. Endovascular treatment possibilities became the method of choice for patients with progressive disease and symptoms with no benefit of systemic treatment. (author)