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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 | Cardiac resynchronization in chronic heart failure 显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，24： | 1 |
| 3 | Cardiac resynchronization in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，24： | 1 |
| 4 | Intra-abdominal synovial sarcoma:a clinicopathological study显示文摘 | Fisher C Folpe AL Hashimoto H | 2004 | Histopathology2004，45，： | 1 |
| 5 | Cardiac resnchronizationg in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，24： | 1 |
| 6 | Detection of apical hypertrophic cardiomyopathy by cardiovascular magnetic resonance in patients with non-diagnostic echocardiography 显示文摘 | Moon JC Fisher NG Mckenna WJ et al | 2004 | Heart2004，90，6： | 1 |
| 7 | Cardiac resynchronization in chronic heart failure 显示文摘 | Abraham WT Fisher WG Smith AL MIRACLE Study Group | 2002 | N Engl J Med2002，346，24： | 1 |
| 8 | Cardiac resynchronization in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | | 0，，： | 1 |
| 9 | Cardiac resynchronization in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，24： | 1 |
| 10 | Modern concepts in the diagnosis and treatment of vitamin D deficiency and its clinical consequences显示文摘 | Edlich R Fisher AL Chase ME | 2009 | J Environ Pathol Toxicol Oncol2009，28，1： | 1 |
| 11 | Intra-abdominal synovial sarcoma : a clinicopathological study 显示文摘 | Fisher C Folpe AL Hashimoto H | 2004 | Histopathology2004，45，3： | 1 |
| 12 | Cardiac resynchronization in chronic heart failure显示文摘 | Fisher WG Smith AL | 2002 | N Engl J Med2002，346，24： | 1 |
| 13 | Residual stress modification by post-weld treatment and its beneficial effect on fatigue strength of welded structure显示文摘 | Cheng X Fisher J W Prask H J el al | 2003 | International Journal of Fatigue2003，，25： | 1 |
| 14 | Technology development and energy productivity in Chi- na 显示文摘 | FISHER - VANDEN K JEFFERSON G H JINGKU M et al | 2006 | Energy Economics2006，28，5： | 1 |
| 15 | Effects of glucose on matrix metalloproteinase and plasmin activities in mesangial cells: possible role in diabetic nephropathy 显示文摘 | McLENNAN S V FISHER E MARTELL S Y at al | 2000 | Kidney Int2000，，： | 1 |
| 16 | Comparison of ceramic‐on‐metal and metal‐on‐metal hip prostheses under adverse conditions显示文摘 | Sophie Williams Mazen Al‐Hajjar Graham H. Isaac John Fisher | 2013 | J Biomed Mater Res2013，，5： | 1 |
| 17 | Cardiac resynchronization in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，： | 1 |
| 18 | Long-term follow-up of axillary node-positive breast cancer patients receiving adjuvant tamoxifen alone: patterns of recurrence 显示文摘 | Fisher BJ Perera FE Cooke AL | 1998 | Int J Radiat Oncol Biol Phys1998，42，1： | 1 |
| 19 | Cardiac resynchronization in chronic heart failure显示文摘 | Abraham WT Fisher WG Smith AL | 2002 | N Engl J Med2002，346，： | 1 |
| 20 | Fluorescent DNA nanotags:supramolecular lfuorescent labels based on intercalating dye arrays assembled on nanostructured DNA templates显示文摘 | Benvin AL Creeger Y Fisher GW | | 0，，07： | 1 |
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