Radiofrequency Ablation as a Primary Therapy for Benign Functioning Insulinoma

Abstract

Objective Insulinomas are rare, life-threatening pancreatic neuroendocrine tumors. Surgical removal continues to be the treatment of choice, yet it is associated with considerable risk of morbidity. Here, we describe our patient with insulinoma who was successfully treated with radiofrequency ablation. Methods The patient was a 56-year-old man with no history of diabetes mellitus. He presented with recurrent episodes of transient ischemic attacks and stroke over the last 3 years. Some changes in his behavior and memory were noticed by family members. During his hospital stay for the second transient ischemic attack, frequent hypoglycemia was documented, which was asymptomatic. Insulinoma was confirmed biochemically. Radiological findings were also compatible with pancreatic neuroendocrine tumor. Treatment modalities were explained to the patient. However, he strongly refused surgery. Meanwhile, he was admitted because of a stroke and concurrent hypoglycemia again. In view of his refusal of the surgical treatment and due to his presentation with acute stroke and high-risk status for surgery, radiofrequency ablation was finalized. Results Radiofrequency ablation of the pancreatic tumor using 40.75 Gy over fractions was performed with a favorable outcome. The patient has achieved biochemical normalization and remained euglycemic during his follow- up. Computed tomography scan of the abdomen during follow-up showed a mild regression of the size of the tumor. Conclusion This report shows a treatment challenge that required the use of an alternative treatment option other than the standard of care. It highlights the evolving evidence of radiofrequency as a therapeutic modality for patients with insulinoma.

Current views on the treatment of insulinoma

“…Согласно данным метаанализа S. Fegrachi и соавт., эффективность РЧА при местно-распространенном раке ПЖ сопоставима с результатами оперативного вмешательства с последующей химиотерапией [18]. Лечение инсулиномы с помощью REVIEW Проблемы эндокринологии / Problems of Endocrinology | 49 РЧА сопровождается регрессом клинической симптоматики и размеров опухоли [19,20]. При проведении РЧА также могут возникать побочные эффекты, например, в описании клинического случая M. Kluz и соавт.…”

5-Iodotubercidin Inhibits the Growth of Insulinoma Cells by Inducing Apoptosis

“…However, 16-43% of patients can develop postsurgical complications [2]. One of the safest and feasible nonsurgical invasive surgery approaches is laparoscopic surgery [14,15], and another nonsurgical treatment is EUS-directed ablation with ethanol injection or CT-guided radiofrequency ablation [2,16,17]. Medical treatment is mostly aimed at relieving hypoglycemic symptoms [18] and there are only a few therapeutic drugs targeting primary focus, such as streptozotocin, capecitabine, and temozolomide [19,20].…”

Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs

“…Radiofrequency ablation (RFA) is a minimally invasive treatment based on alternating high-frequency electrical currents from an electrode that produces ionic agitation and generates frictional heat, thus causing coagulation necrosis [25][26][27]. In human medicine, the efficacy of RFA has been reported in several primary tumors and metastases, with improvements in the mass effect as well as controlling the biological activity of the tumor [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. In veterinary medicine, percutaneous ultrasound-guided RFA has been used successfully to treat functioning parathyroid and thyroid masses in dogs [42][43][44][45] and cats [46], respectively.…”