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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 | Rethinking corporate environmental management显示文摘 | Greeno J L Robinson S N | 1992 | Columbia Journal of World Business1992，27，3： | 1 |
| 3 | Chemotherapy--induced thrombosis 显示文摘 | Haddad T C Greeno E W | 2006 | Thromb Res2006，118，： | 1 |
| 4 | Understanding and Solving Word Arithmetic Problems 显示文摘 | Kintsch W Greeno J G | 1985 | Psychological Review1985，92，1： | 1 |
| 5 | Similarity between Stimuli: An Experimental Test of the Luce and Restle Choice Models显示文摘 | Rumelhart D L Greeno J G | 1971 | Journal of Mathematical Psychology1971，8，3： | 1 |
| 6 | Chemotherapy-induced thrombosis显示文摘 | Haddad TC Greeno EW | 2006 | Thromb Res2006，118，5： | 1 |
| 7 | Chemotherapy-induced thrombosis显示文摘 | Haddad TC Greeno EW | 2006 | Thromb Res2006，118，5： | 1 |
| 8 | Situativity and Symbols: Response to Vera and Sim on显示文摘 | Greeno J G Moore J L | 1993 | Cognitive Science1993，17，1： | 1 |
| 9 | Situativity and Symbols: Response to era and Simon 显示文摘 | Greeno J G Moore J L | 1993 | Cognitive Science1993，，17： | 1 |
| 10 | Chemotherapy-induced thrombosis显示文摘 | Haddad TC Greeno EW | 2006 | ThrombRes2006，118，5： | 1 |
| 11 | On claims that answers the wrong questions显示文摘 | Greeno J G | 1997 | Educational Researcher1997，25，1： | 1 |
| 12 | The situativity of knowing, learning and research显示文摘 | Greeno J G | 1998 | American Psychologist1998，53，1： | 1 |
| 13 | Chemotherapy-induced thrombosis显示文摘 | Haddad TC Greeno EW | 2006 | Thromb Res2006，118，： | 1 |
| 14 | Understanding and solving word arithmetic problems显示文摘 | Kinstch W Greeno J G | | 0，，01： | 1 |
| 15 | Chemotherapy-induced thrombosis 显示文摘 | Hadda TC Greeno EW | 2006 | Thromb Res2006，118，5： | 1 |
| 16 | Performance of flow cytometry to screen urine for bacteria and white blood ceils prior to urine culture显示文摘 | Giesen CD Greeno AM Thompson KA | 2013 | Clin Biochem2013，46，9： | 1 |
| 17 | Understanding and solving word arithmetic problems显示文摘 | GREENO J G | 1985 | Psychology Review1985，92，： | 1 |
| 18 | Chemotherapy-induced thrombosis显示文摘 | Haddad TC Greeno EW | 2006 | Thromb Res2006，118，： | 1 |
| 19 | Response: On claims that answer the wrong questions显示文摘 | GREENO J G | 1997 | Educational Researcher1997，26，1： | 1 |
| 20 | The effect of per ceived control over eating on the life satisfaction of women and men: results from a community sample显示文摘 | JACKSON C WILLIAMS EL | 1998 | Int J Eat Disord1998，24，4： | 1 |
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