MALIGNANT INSULINOMA - PERMANENT HEPATIC-ARTERY EMBOLIZATION OF LIVERMETASTASES - PRELIMINARY-RESULTS

Purpose: To evaluate permanent hepatic artery embolization of liver me tastases 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 foll ow-up and demonstrated multiple hypervascular metastases 0.5-3 cm in d iameter 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. Per Permanent occlusion was achieved by using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil as a n embolizing agent. Results: In all patients, embolization of the hepa tic artery was technically feasible and complete occlusion could be ob tained. In two patients, collaterals originating from the right inferi or phrenic artery were embolized superselectively 3 months after bilob ar embolization. CTAP at that time revealed marked decrease in tumor s ize of more than 50%. All patients responded to the treatment. as conf irmed by normalization of measurable hormone levels, glucose levels, a nd disappearance of symptoms. Two patients are still alive after 24 an d 31 months from the time of the first embolization. Current investiga tions revealed normal laboratory data and no further tumor progression in the liver, The third patient died 15 months after the first emboli zation; she also had developed ileus due to local recurrence of the pr imary tumor and lymph node metastases.Conclusion: Hepatic arterial emb olization appears to be an effective means of palliation for liver met astases of malignant insulinoma. Long-term improvement seems most like ly to be the result of extensive ischemia from permanent occlusion.