Abstract
We report the results of transcatheter intraarterial perfusion of liver with the emulsion of iodized oil and cytostatics performed as palliative treatment in three patients with hepatic metastases of pancreatic endocrine tumors. Two patients had insulinoma and one patient had glucagonoma. They were also treated by medical therapy from the time the diagnosis was made. Intraarterial perfusion of the liver was achieved by Lipiodol® emulsified with streptozotocin and 5-fluorouracil. Regarding these three patients therapeutic responses were different in duration of hormone secretion decrease. Relief of hypoglycemic attacks and a significant decrease of plasma immunoreactive insulin concentration within 12 months without any additional therapy was observed in the patient with insulinoma (case no. 2). This patient had slightly increased immunoreactive glucagon concentration from the time of diagnosis. A decrease of immunoreactive insulin levels in other patient with insulinoma and an increase in plasma glucose to the euglycemic range during two months allowed a reduction of doses of somatostatin analogue and diazoxide. Due to rapid progression of the disease, intraarterial perfusion of liver was repeated three months later with the same results. Remission of symptoms was partial in the case of glucagonoma. Immunoreactive glucagon levels were not changed and there was no significant benefit of the treatment. Intraarterial perfusion of liver with iodized oil and cytostatics could be an effective, safe and repeatable method of palliating symptoms of malignant pancreatic tumors, especially in inoperable but nonterminal cases. It could allow reduction of additional medical therapy, but success of the treatment is not predictable.
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Chng J.L.C., Anderson J.V., Williams S.J., Carr D.H., Bloom S.R. Remission of symptoms during long term treatment of metastatic pancreatic endocrine tumours with long acting somatostatin analogue. Br. Med. J. 292: 981, 1986.
Bosquet F., Grimaldi A. Les cancers endocrines du pancreas. Ann. Med. Interne 138: 61, 1987.
Bloom S.R., Polak J.M. Glucagonoma syndrome. Am. J. Med. 82 (Suppl 5B): 25, 1987.
Mallinson C.N., Bloom S.R., Warin A.P., Salmon P.R., Cox B. A glucagonoma syndrome. Lancet 2: 1, 1974.
Chuang V.P. Chemoembolization: transcatheter management of neoplasms. JAMA 245: 1151, 1981.
Mavligit G.M. Intraarterial chemoocclusion therapy for cancer. Cancer Bulletin 36: 5, 1984.
Iwai K., Maeda H., Konno T. Use of oily contrast medium for selective drug targeting to tumor: enhanced therapeutic effect and x-ray image. Cancer Res. 44: 2115, 1984.
Lang E.K. Current and future applications of angiography in the abdomen. Radiol. Clin. North Am. 17: 55, 1979.
Vinik A.I., Moattari A.R. Treatment of endocrine tumors of the pancreas. Endocrinol. Metab. North Am. 18: 483, 1989.
Ohneda A., Otsuki M., Fujiya H., Yaginuma N., Kokubo T., Ohtani H. A malignant insulinoma transformed into a glucagonoma syndrome. Diabetes 28: 962, 1979.
D’Arcangues CM., Awoke S., Lawrence G.D. Metastatic insulinoma with long survival and glucagonoma syndrome. Ann. Intern. Med. 100: 233, 1984.
Lamberts S.W.J., Krenning E.P., Klijn J.G.M., Reubi J.C. The clinical use of SMS analogues in the treatment of cancer. Bailliere’s Clin. Endocrinol. Metab. 4: 29, 1990.
Altimari A.F., Bhoopalam N., O’Dorisio T.M., Lange C.L., Sandberg L, Prinz R.A. Use of somatostatin analog (SMS 201-995) in the glucagonoma syndrome. Surgery 100: 989, 1986.
Thompson N.W., Eckhauser F.E. Malignant islet-cell tumors of the pancreas. World J.Surg. 8: 940, 1984.
Jian R., Seyrig J.A., Roche A., Modigliani R., Lenormand Y., Hautefeuille M. Improvement of metastatic glucagonoma by hepatic artery embolization. Gastroenterology 87: 481, 1984.
Clouse M.E., Lee R.G.L., Duszlak E.J., Lokich J.J., Alday MT. Hepatic artery embolization for metastatic endocrine secreting tumors of the pancreas, report of two cases. Gastroenterology 85: 1183, 1983.
Manche A., Wood S.M., Adrian T.E., Welbourn R.B., Bloom S.R. Pancreatic polypeptide and calcitonin secretion from a pancreatic tumour — clinical improvement after hepatic artery embolization. Postgrad. Med. J. 59: 313, 1983.
Wells J.L., Heath D.A., West R.J. Hepatic artery embolization in the treatment of intractable hypoglycaemia. J. Roy. Soc. Med. 83: 592, 1990.
Assaad S., Carrasco C.H., Vassilopoulou-Sellin R., Samaan N. Glucagonoma Syndrome, rapid response following arterial embolisation of glucagonoma metastatic to liver. Am. J. Med. 82: 533, 1987.
Grote R., Schmoll E., Rosenthal H., Bokemeier B. Chemoembolization of hepatocellular carcinoma-computed tomographic follow-up observation. ROEFO 151: 15, 1989.
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Nešović, M., Ćirić, J., Radojković, S. et al. Improvement of metastatic endocrine tumors of the pancreas by hepatic artery chemoembolization. J Endocrinol Invest 15, 543–547 (1992). https://doi.org/10.1007/BF03348803
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DOI: https://doi.org/10.1007/BF03348803