Spinal cord compression after radiolabeled metaiodobenzylguanidine analogue therapy in advanced malignant insulinoma

Abstract

SUMMARYMalignant insulinomas are frequently diagnosed at a late stage. Medical management is necessary to slow progression of the disease and control of hypoglycemic symptoms when cure by surgical treatment is not possible. Multimodal treatment, in these cases, has been used with variable clinical response. We describe a 68-yr-old woman who presented response failure to usual treatment and was alternatively treated with radiolabeled metaiodobenzylguanidine ([

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

“…Included in the recent literature are reports of the control of the symptoms of the insulinoma hormone-excess state by using: everolimus[•39, 40–46, 170, 171]; tyrosine kinase inhibitor sunitinib[•50]; PRRT[44, 55, 58–60, •61, •76, 170, 172]; liver directed therapies including TACE/TAE[44, 70, 72, •73, 74 75, •76, 172–17444, 70, 172]; RFA and use of ablative treatment(ethanol, microwave of primary/metastases[81, 83–87, •89, 90, 92, •93, 175, •176, 177, 178]; by increasing the dosage of octreotide/Lanreotide in refractory cases[153, 155]; use of cytoreductive surgery[157, 158, 160, 172, 174]; use of 131 I-MIBG[•111] and with pasireotide in octreotide resistant cases[125]. …”

“…In one report[55] involving 5 patients with metastatic insulinomas, with poorly controlled hypoglycemia on standard therapies, treatment with 177 Lu-DOTA-octreotate or •111 In-octreotide resulted in stable disease for a mean follow-up of 27 months with no hypoglycemic episodes. In three reports of 8[•89], 4[90] and 4[92] patients with insulinomas which were not operable in a number of cases, ethanol injection of the primary insulinoma controlled the symptoms of the insulinoma in all cases.…”

SAP deletion promotes malignant insulinoma progression by inducing CXCL12 secretion from CAFs via the CXCR4/p38/ERK signalling pathway

“…Malignant insulinoma is usually diagnosed in a late stage and approximately 50% of patients already have metastatic disease at the time of diagnosis. 34 When distant metastasis has occurred, the median survival time is approximately 2 years. 35 The medical treatment of malignant insulinoma includes surgical resection, chemotherapy and tumour‐targeted radiotherapy.…”

“…Insulinomas are the most common functioning pNET and 2.4%–17.9% of insulinomas are malignant. Malignant insulinoma is usually diagnosed in a late stage and approximately 50% of patients already have metastatic disease at the time of diagnosis 34 . When distant metastasis has occurred, the median survival time is approximately 2 years 35 .…”