title: Metastatic insulinoma - prolonged survival after multimodal approach.
abstract: BACKGROUND
  Metastatic insulinoma is a disease associated with a poor life expectancy.
  
  
  METHODS
  The case of a presently 68 year old female with malignant, metastatic insulinoma is reported. Due to severe clinical symptoms surgical tumor mass reduction was conducted. Furthermore the patient underwent a chemotherapy using streptozotocine and fluorouracil. After two years without any symptoms, the remaining hepatic metastases increased in size and again hypoglycemias occurred. To reachieve an asymptomatic state and further reduction in tumor mass, the decision was made for transarterial chemoembolization with streptozotocine. After the first treatment the patient was hypoglycemia - free for 3 months, after another more extensive chemoembolization the patient is presently symptom free for 8 months.
  
  
  CONCLUSIONS
  Since the diagnosis of extended disease was established, the patient has survived for 36 months. We regard this as the result of a multimodal approach and the extensive use of local tumor therapy. The different therapeutic options for local tumor therapy are reported and discussed.
authors.affiliation: Department of Medicine 1, University of Erlangen-Nuremberg, Erlangen, Germany. Alexander.Hagel@uk-erlangen.de
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Hagel
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Hagel
authors.forename: Annette S
authors.initials: AS
authors.lastname: Lindner
authors.forename: Ferdinand J
authors.initials: FJ
authors.lastname: Kammerer
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.forename: Peter C
authors.initials: PC
authors.lastname: Konturek
authors.forename: Igor A
authors.initials: IA
authors.lastname: Harsch
mesh_terms: D000368:Aged; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000628:therapy; D007340:Insulinoma / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary*; D015996:Survival Rate