AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment (AU)
Humans , Male , Female , Middle Aged , Endocrine Gland Neoplasms/drug therapy , Endocrine Gland Neoplasms/metabolism , Endocrine Gland Neoplasms/radiotherapy , Endocrine Gland Neoplasms/therapy , Endocrine Gland Neoplasms/diagnosis , Pancreas/abnormalities , Liver Transplantation/methods
AIM: Malignant insulinoma is an infrequent functional endocrine tumor of the pancreas. Adequate therapy is a demanding challenge for oncologists and endocrinologists. OBJECTIVE: To evaluate the results of multidisciplinary management of malignant insulinoma. MATERIALS AND METHODS: Retrospective review of patients with malignant insulinoma treated from 1995 to 2011. RESULTS: Seven patients with malignant insulinoma were included: four males and three females; median age was 61.8 years (range 37-78). Six tumors were sporadic and one was diagnosed in a patient with a type 1 multiple endocrine neoplasia (MEN-1). Surgery was performed in six cases and one patient was considered unresectable. Hypoglycemias persisted in all cases and somatostatin analogs, glucocorticoids and diazoxide were used. Two patients received everolimus. Other techniques were chemoembolization and internal radiation therapy with yttrium-90. Successful liver transplant was done in the patient with MEN-1. CONCLUSION: Hypoglycemia management is complex and requires multiple therapies. Further evaluations will be necessary to determine the best treatment.
Insulinoma/therapy , Pancreatic Neoplasms/therapy , Adult , Aged , Chemoembolization, Therapeutic/methods , Diazoxide/therapeutic use , Everolimus , Female , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Radiotherapy/methods , Retrospective Studies , Sirolimus/analogs & derivatives , Sirolimus/therapeutic use , Treatment Outcome , Vasodilator Agents/therapeutic use , Yttrium Radioisotopes/therapeutic use
Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better disease-free survival, particularly in the worst-prognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.
Antineoplastic Agents, Hormonal/administration & dosage , Breast Neoplasms/drug therapy , Breast Neoplasms/mortality , Administration, Oral , Adult , Aged , Anastrozole , Antineoplastic Agents, Hormonal/adverse effects , Aromatase Inhibitors/administration & dosage , Aromatase Inhibitors/adverse effects , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Chemotherapy, Adjuvant , Disease-Free Survival , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Mastectomy/methods , Middle Aged , Neoplasm Staging , Nitriles/administration & dosage , Nitriles/adverse effects , Randomized Controlled Trials as Topic , Risk Assessment , Survival Analysis , Tamoxifen/administration & dosage , Tamoxifen/adverse effects , Time Factors , Treatment Outcome , Triazoles/administration & dosage , Triazoles/adverse effects
