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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 | Reoperation for prosthetic aortic valve obstruction in the era of echocardiography: trends in diagnostic testing and comparison with surgical findings显示文摘 | Steven E Girard Fletcher A Miller Thomas A Orszulak Charles J Mullany Samantha Montgomery William D Edwards Henry D Tazelaar Joseph F Malouf A.Jamil Tajik | 2001 | Journal of the American College of Cardiology2001，，2： | 2 |
| 3 | Active Ap- pearance Models 显示文摘 | Cootes T F Edwards G J Taylor C J | 2001 | IEEE Trans on PAMI2001，23，6： | 1 |
| 4 | A systemic review of treatments for the painful heel 显示文摘 | Atkins D Crawford F Edwards J | 1999 | Rheumatology (Oxford)1999，，38： | 1 |
| 5 | Development and verification of a one-dimensional ablation code including pyrolysis gas flow 显示文摘 | Amar A J Blackwell B F Edwards J R | 2009 | Journal of Thermophysics and Heat Transfer2009，23，1： | 1 |
| 6 | Characterazation of plastein reaction products formed by pepsin, α-chymotrypsin, and papain treat- ment of egg albumin hydrolysates显示文摘 | Edwards J H Shipe W F | 1978 | Food Science1978，43，4： | 1 |
| 7 | A review of lat- est research findings on the health promotion properties of tea 显示文摘 | Christiane J D Edward R F | 2001 | Journal of Nutritional Biochemistry2001，12，： | 1 |
| 8 | Effi- cacy of pyropheophorbide-α-hexyl ether for photody- namic therapy of rat 9L gliosareoma显示文摘 | AUTRY S A EDWARDS B F BOGGAN J E | 1993 | Optical Methods for Tumor Treatment and Detection1993，，： | 1 |
| 9 | Membrane ther- mostability and heat tolerance of spring wheat 显示文摘 | Shanahan J F Edwards I B Quick J S | 1990 | Crop Sci- ence1990，30，2： | 1 |
| 10 | 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 |
| 11 | A biomarker panel for peripheral arterial disease显示文摘 | Fung E T Wilson A M Zhang F Harris N Edwards K A Olin J W | 2008 | Vasc Med2008，13，： | 1 |
| 12 | Event-related potential studies of attention 显示文摘 | Luck Steven J Woodman Geoffrey F Vogel Edward K | 2000 | Trends in Cognitive Sciences2000，4，11： | 1 |
| 13 | CN + CH2CO and NCO+ CH2CO reactions显示文摘 | Edwards M A Hershberger J F | 1998 | Chem Phys1998，234，： | 1 |
| 14 | Characterization of plastein reaction products formed by pepsin, α -chymotrypsin, and papain treatment of egg albumin hydrolysates显示文摘 | J H Edwards W F Shipe | 1978 | Journal of Food Science1978，43，： | 1 |
| 15 | Quantitative assessment of fetal ventricular function: establishing normal values of the my ocardial performance index in the fetus 显示文摘 | Eidem BW Edwards J M Cetta F | 2001 | Echocardiography2001，18，1： | 1 |
| 16 | Active appearance models 显示文摘 | Cootes T F Edwards G J Taylor C J | 2001 | IEEE Transactions on Pattern Analysis and Machine Intelli- gence2001，23，6： | 1 |
| 17 | Effect of dietary fat and cholesterol on the in vitro incorporation of acetate-14C into hen liver and ovarian lipids 显示文摘 | JOSEPH F W EDWARD C N RALPH M J | 1967 | The Journal of Nutrition1967，93，： | 1 |
| 18 | A systemic review of the treatment of painful heel显示文摘 | Atkins D Crawford F Edward J | | 0，，： | 1 |
| 19 | Active appearance models 显示文摘 | Cootes T F Edwards G J Taylor C J | 2001 | IEEE Transactions on Pattern Analysis and Machine Intelli- gence2001，23，6： | 1 |
| 20 | Handling Charac- teristics of Car-Trailer Systems: A State of the Art Survey 显示文摘 | EDWARD F KURTZ J RONALD J A | 1977 | Vehicle System Dynamics1977，6，4： | 1 |
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