Kloeber Jake A, Ebner Daniel K, Jethwa Krishan R, Merrell Kenneth W, Halfdanarson Thorvardur R, Callaghan Cameron M
Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA.
Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA.
JCEM Case Rep. 2024 Sep 27;2(10):luae175. doi: 10.1210/jcemcr/luae175. eCollection 2024 Oct.
Insulin-producing pancreatic tumors are a common subtype of neuroendocrine tumor. Standard of care includes surgical resection of the pancreatic tumor and medical management with somatostatin analogs. For patients with metastatic disease, tumor control and hypoglycemic symptom relief can be achieved through surgical resection of the tumor, hepatic artery embolization, radiofrequency ablation, or radioembolization using radioactive isotopes as well as with systemic therapy such as somatostatin analogs and everolimus. We present the case of a 74-year-old male with metastatic insulin-producing pancreatic carcinoma. After a long history of successfully controlling his hypoglycemic episodes post-liver wedge resection, bland embolizations subsequently failed to maintain control of the frequency and severity of his hypoglycemic symptoms. Stereotactic body radiotherapy (SBRT) with protons was used to achieve symptomatic control and led to partial radiographic response with complete resolution of his hypoglycemic episodes. This case demonstrates the potential utility of proton SBRT in metastatic insulinomas.
胰岛素瘤是神经内分泌肿瘤的一种常见亚型。标准治疗方案包括手术切除胰腺肿瘤以及使用生长抑素类似物进行药物治疗。对于转移性疾病患者，可通过手术切除肿瘤、肝动脉栓塞、射频消融或使用放射性同位素进行放射性栓塞以及采用生长抑素类似物和依维莫司等全身治疗来实现肿瘤控制和缓解低血糖症状。我们报告一例74岁男性转移性胰岛素瘤患者的病例。在经历了长期成功控制肝楔形切除术后低血糖发作的病史后，单纯栓塞术随后未能维持对其低血糖症状发作频率和严重程度的控制。采用质子立体定向体部放疗（SBRT）实现了症状控制，并导致部分影像学缓解，其低血糖发作完全消失。该病例证明了质子SBRT在转移性胰岛素瘤中的潜在应用价值。
