Abstract
Purpose
To evaluate permanent hepatic artery embolization of liver metastases of malignant insulinoma as a therapeutic procedure.
Methods
Three female patients had persistent severe hypoglycemia after distal pancreatectomy because of a malignant insulinoma. Computed tomography (CT) and CT-portography (CTAP) were used for tumor assessment and follow-up and demonstrated multiple hypervascular metastases 0.5–3 cm in diameter in both lobes of the liver. Unilobar sequential transcatheter embolization of the hepatic artery was performed with an interval of 1–2 months between the procedures. Permanent occlusion was achieved by using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil as an embolizing agent.
Results
In all patients, embolization of the hepatic artery was technically feasible and complete occlusion could be obtained. In two patients, collaterals originating from the right inferior phrenic artery were embolized superselectively 3 months after bilobar embolization. CTAP at that time revealed marked decrease in tumor size of more than 50%. All patients responded to the treatment as confirmed by normalization of measurable hormone levels, glucose levels, and disappearance of symptoms. Two patients are still alive after 24 and 31 months from the time of the first embolization. Current investigations revealed normal laboratory data and no further tumor progression in the liver. The third patient died 15 months after the first embolization; she also had developed ileus due to local recurrence of the primary tumor and lymph node metastases.
Conclusion
Hepatic arterial embolization appears to be an effective means of palliation for liver metastases of malignant insulinoma. Long-term improvement seems most likely to be the result of extensive ischemia from permanent occlusion.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Menegaux F, Schmitt G, Mercadier M, Chigot JP (1993) Pancreatic insulinomas. Am J Surg 165:243–248
Broughan TA, Leslie JD, Soto JM, Hermann RE (1986) Pancreatic islet cell tumors. Surgery 99:671–678
Rossi P, Allison DJ, Bezzi M (1989) Endocrine tumors of the pancreas. Radiol Clin North Am 28:129–161
Marlink RG, Lokich JJ, Robins JR, Clouse ME (1990) Hepatic arterial embolization for metastatic hormone-secreting tumors. Technique, effectiveness, and complications. Cancer 65:2227–2232
Wenisch HJ, Markus BH, Herrmann GH, Usadel KH, Encke A (1992) Multi-visceral upper abdominal resection and orthotopic liver transplantation-A surgical treatment concept for regional metastatic tumors of the endocrine pancreas. Zent bl Chir 117:334–342
Danforth DN Jr, Gorden P, Brennan MF (1984) Metastatic insulin-secreting carcinoma of the pancreas: Clinical course and the role of surgery. Surgery 96:1027–1037
Chuang VP, Wallace S (1981) Hepatic artery embolization in the treatment of hepatic neoplasms. Radiology 140:51–58
Carrasco CH, Chuang VP, Wallace S (1983) Apudomas metastatic to the liver: Treatment by hepatic artery embolization. Radiology 149:79–83
Clouse ME, Lee RG, Duszlak EJ, Lokich JJ, Trey C, Alday MR, Yoburn DC, Diamond J, Crosson AW, Costello P (1983) Peripheral hepatic artery embolization for primary and secondary hepatic neoplasms. Radiology 147:407–411
Tomassetti P, DelVecchio E, Faccioli P, Ricci S, Gambari PI, Roversi R, Barbara L (1994) Treatment of liver metastases of an endocrine pancreatic tumor by hepatic artery chemoembolization with streptozocin. J Clin Gastroenterol 18:170–172
Allison DJ, Booth A (1990) Arterial embolization in the management of liver metastases. Cardiovasc Intervent Radiol 13:161–168
Stokes KR, Stuart K, Clouse ME (1993) Hepatic arterial chemoembolization for metastatic endocrine tumors. J Vasc Intervent Radiol 4:341–345
Geterud K, Tylen U, Stenqvist O, Tisell LE, Ahlman H (1990) Hepatic arterial embolization in the treatment of the midgut carcinoid syndrome and other advanced endocrine tumours metastatic to the liver. J Intervent Radiol 5:69–76
Chuang VP, Wallace S, Soo CS, Charnsangavej C, Bowers T (1982) Therapeutic ivalon embolization of hepatic tumors. AJR 138:289–294
Clouse ME, Lee RGL, Duszlak EJ, Lokich JJ, Alday MT (1983) Hepatic artery embolization for metastatic endocrine-secreting tumors of the pancreas. Gastroenterology 85:1183–1186
D'Arcangues CM, Awoke S, Lawrence GD (1984) Metastatic insulinoma with long survival and glucagonoma syndrome. Ann Int Med 100:233–235
Lee SM, Forbes A, Williams R (1988) Metastatic islet cell tumour with clinical manifestations of insulin and glucagon excess: Successful treatment by hepatic artery embolization and chemotherapy. Eur J Surg Oncol 14:265–268
Graf O, Dock W, Lammer J, Thurnher S, Eibenberger K, Wildling R, Niederle B, Lang E, Lechner G (1994) Determination of optimal time window for liver scanning with CT during arterial portography. Radiology 190:43–47
Doppman JL, Girton M, Kahn ER (1978) Proximal versus peripheral hepatic artery embolization: Experimental study in monkeys. Radiology 128:577–588
Coldwell DM, Stokes KR, Yakes WF (1994) Embolotherapy: Agents, clinical applications and techniques. RadioGraphics 14:623–643
Doppman JL, Girton ME (1984) Bile duct scarring following ethanol embolization of the hepatic artery: An experimental study in monkeys. Radiology 152:621–626
Taourel P, Dauzat M, Lafortune M, Pradel J, Rossi M, Bruel JM (1994) Hemodynamic changes after transcatheter arterial embolization of hepatocellular carcinomas. Radiology 191:189–192
Struk D, Rankin RN, Karlik SJ (1993) Stability studies on cheoembolization mixtures. Invest Radiol 28:1024–1027
Kunstlinger F, Brunelle F, Chaumont P, Doyon D (1981) Vascular occlusive agents. AJR 136:151–156
Cromwell LD, Kerber CW (1979) Modification of cyanoacrylate for therapeutic embolization: Preliminary experience. AJR 132:799–801
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Winkelbauer, F.W., Niederle, B., Graf, O. et al. Malignant insulinoma: Permanent hepatic artery embolization of liver metastases—Preliminary results. Cardiovasc Intervent Radiol 18, 353–359 (1995). https://doi.org/10.1007/BF00338301
Issue Date:
DOI: https://doi.org/10.1007/BF00338301