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| 1 | Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors显示文摘AIM:To evaluate systemic treatment choices in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors(PNETs)and provide consensus treatment recommendations.METHODS:Systemic treatment options for pancreatic neuroendocrine tumors have expanded in recent years to include somatostatin analogs,angiogenesis inhibitors,inhibitors of mammalian target of rapamycinand cytotoxic agents.At this time,there is little data to guide treatment selection and sequence.We therefore assembled a panel of expert physicians to evaluate systemic treatment choices and provide consensus treatment recommendations.Treatment appropriateness ratings were collected using the RAND/UCLA modified Delphi process.After studying the literature,a multidisciplinary panel of 10 physicians assessed the appropriateness of various medical treatment scenarios on a 1-9 scale.Ratings were done both before and after an extended discussion of the evidence.Quantitative measurements of agreement were made and consensus statements developed from the second round ratings.RESULTS:Specialties represented were medical and surgical oncology,interventional radiology,and gastroenterology.Panelists had practiced for a mean of15.5 years(range:6-33).Among 202 rated scenarios,disagreement decreased from 13.2%(26 scenarios)before the face-to-face discussion of evidence to 1%(2)after.In the final ratings,46.5%(94 scenarios)were rated inappropriate,21.8%(44)were uncertain,and30.7%(62)were appropriate.Consensus statements from the scenarios included:(1)it is appropriate to use somatostatin analogs as first line therapy in patients with hormonally functional tumors and may be appropriate in patients who are asymptomatic;(2)it is appropriate to use everolimus,sunitinib,or cytotoxic chemotherapy therapy as first line therapy in patients with symptomatic or progressive tumors;and(3)beyond first line,these same agents can be used.In patients with uncontrolled secretory symptoms,octreotide LAR doses can be titrated up to 60 mg every4 wk or up to 40 mg every 3 or 4 wk.CONCLUSION:Using the Delphi process allowed physician experts to systematically obtain a consensus on the appropriateness of a variety of medical therapies in patients with PNETs. | Jonathan R Strosberg George A Fisher Al B Benson Lowell B Anthony Bulent Arslan John F Gibbs Edward Greeno Renuka V Iyer Michelle K Kim William J Maples Philip A Philip Edward M Wolin Dasha Cherepanov Michael S Broder | 2015 | World Journal of Gastroenterology2015，21，8： | 2 |
| 2 | Analysis of stained objects in histological sections by spectral imaging and differential absorption显示文摘 | Woemer B M Edwards D A | 1999 | Journal of Histochemistry & Cytochemistry1999，47，10： | 1 |
| 3 | OMEGA EP high-energy petawatt laser: progress and prospects显示文摘 | D N Maywar J H Kelly L J Waxer S F B Morse I A Begishev J Bromage C Dorrer J L Edwards L Folnsbee M J Guardalben S D Jacobs R Jungquist T J Kessler R W Kidder B E Kruschwitz S J Loucks J R Marciante R L McCrory D D Meyerhofer A V Okishev J B Oliver G Pien | 2008 | Journal of Physics: Conference Series2008，，3： | 1 |
| 4 | Graded levels of phytase past industry standards improve broiler performance显示文摘 | SHIRLEY R B EDWARDS H M | 2003 | Poult Sci2003，82，： | 1 |
| 5 | Community genomics among stratified microbial assemblages in the ocean's interior显示文摘 | DeLong E F Preston C M Mincer T Rich V Hallam S J Frigaard N U Martinez A Sullivan M B Edwards R Brito B R Chisholm S W Karl D M | | 0，，5760： | 1 |
| 6 | Inbred-progeny selection is predicted to be inferior to half-sib selection for three maize popu|ations 显示文摘 | Wardyn B M Edwards J W Lamkey K R | 2009 | Crop Science2009，49，2： | 1 |
| 7 | Aualysis of stained objects in histological sections by spectral imaging and differential absorption显示文摘 | Woerner B M Edwards D A | 1999 | Journal of Histochemistry & Cytochemistry1999，47，10： | 1 |
| 8 | 1990, Photosynthetic characteristics of cassava(Manihot esculenta), a C3 species with ehlorenchymatous bundle sheath cell 显示文摘 | Edwards G E Sheta E Moore B D Dai Z Franceschi V R Cheng S H Lin C H Ku M S B | 1990 | Plant and Cell Physiology1990，31，8： | 1 |
| 9 | Effect of endosperm starch granule size distribution on milling yield in hard wheat 显示文摘 | Edwards M A Osborne B G Henry R J | 2008 | Journal of Cereal Science2008，48，： | 1 |
| 10 | Development of high-performance KrF and Raman laser facilities for intertial confinement fusion and other applications显示文摘 | Bailly-Salins R Edwards B | 1993 | Laser and Particle Beams1993，11，2： | 1 |
| 11 | Graded levels of phytase past industry standards improves broiler performance显示文摘 | Shirley R B Edwards H M | 2003 | Poult Sci2003，82，： | 1 |
| 12 | Quanti- tative evaluation of la-hydroxycholecalciferol as a cholecalciferol substitute for broilers显示文摘 | Edwards H M Shirley R B Escoe W B | 2002 | Poultry Sci- ence2002，81，5： | 1 |
| 13 | Ceramide mediates lung fibrosis in cystic fibrosis 显示文摘 | Ziobro R Henry B Edwards M J | 2013 | Bioehem Biophys Res Commun2013，434，4： | 1 |
| 14 | Graded levels of phytase past industry standards improves broiler performance显示文摘 | Shirley R B Edwards H M Jr | 2003 | Poultry Science2003，82，4： | 1 |
| 15 | Laser surface-contouring and spline data-smoothing forresidual-stress measurement显示文摘 | PRIME M B SEBRING R J EDWARDS J M | 2004 | Experimental Mechanics2004，44，2： | 1 |
| 16 | Quantita- tive evaluation of lcx-hydroxycholecalciferol as a cholecalciferol substitute for broilers显示文摘 | Edwards H M Jr Shirley R B Escoe W B | 2002 | Poultry Science2002，81，5： | 1 |
| 17 | Long-Term Results of a Selective Surgical Approach to Management of Zollinger-Ellison Syndrome in Patients with MEN-1显示文摘 | Mortellaro Vincent E Hochwald Steven N McGuigan James E Copeland Edward M Vogel Stephen B Grobmyer Stephen R | 2009 | The American Surgeon2009，，8： | 1 |
| 18 | Diversification in substrate usage by glutathione synthetases from soya bean (Glycine max),wheat (Triticum aestivum) and maize (Zea mays)显示文摘 | Skipsey M Davis B G Edwards R | 2005 | Biochem J2005，391，3： | 1 |
| 19 | Evolution of white matter lesions in neurofibromatosis type Ⅰ:MR findings显示文摘 | Sevick R J Barkovich A J Edwards M S B | 1992 | AJR1992，159，7： | 1 |
| 20 | A test of climate, sun, and culture relationships from an 1810-year Chinese cave record显示文摘 | Zhang P Z Cheng H Edwards R L Chen F H Wang Y J Yang X L Liu J Tan M Wang X F Liu J H An C L Dai Z B Zhou J Zhang D Z Jia J H Jin L Y Johnson K R | 2008 | Science2008，322，5903： | 1 |
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