Curative surgical excision, by open laparotomy or laparoscopy, is the treatment of choice when possible. The open surgical approach is used if the tumor is suspected to be malignant, since en bloc lymphadenectomy is performed for malignant tumors without distant metastases. Intraoperative ultrasound aids the localization of tumor extent and the relationship to other anatomic structures.
Standard treatment options:
- Single small lesion in head or tail of pancreas:[1-4]
- Enucleation, if feasible.
- Large lesion in the head of the pancreas that is not amenable to enucleation:[1-4]
- Single large lesion in body/tail:[1-4]
- Distal pancreatectomy.
- Multiple lesions: occur in 10%, often in association with multiple endocrine neoplasia syndrome type 1 (MEN-1):[1-4]
- Distal pancreatectomy with enucleation of tumors in the head of the pancreas.
- Metastatic lesions: lymph nodes or distant sites:[5-12]
- Resect when possible.
- Consider radiofrequency or cryosurgical ablation, if not resectable.
- Combination chemotherapy.
- Pharmacologic palliation: diazoxide 300 to 500 mg/day.
- Somatostatin analogue therapy.
Patients with hepatic-dominant disease and substantial symptoms caused by tumor bulk or hormone-release syndromes may benefit from procedures that reduce hepatic arterial blood flow to metastases (hepatic arterial occlusion with embolization or with chemoembolization).[6,8-12] Such treatment may also be combined with systemic chemotherapy in selected patients.Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with insulinoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.References
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