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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 | Framing effects within the ethical decision making process of consumers显示文摘 | Bateman C R Fraedrich J P Iyer R | 2002 | Journal of Business Ethics2002，36，12： | 1 |
| 3 | Optimal multiperiod operational planning for utility systems显示文摘 | IYER R R GROSSMANN I E | 1997 | Computers Chemical Engineering1997，21，8： | 1 |
| 4 | Mining clinical text for signalsof adverse drug-drug interactions显示文摘 | Iyer SV Harpaz R Lependu P | 2014 | J Am Inform Assoc2014，21，2： | 1 |
| 5 | Network virtualiza-tion: technologies,perspectives, and frontiers 显示文摘 | Wang A Iyer M Dutta R | 2013 | Journal of Lightwave Techology2013，31，4： | 1 |
| 6 | Diagnosis, staging, and surveillance of cervical carcinoma显示文摘 | Kaur H Silverman P M Iyer R B | 2003 | AJR2003，180，6： | 1 |
| 7 | Controversies in themultimodality management of locally advanced esophageal canc-er: evidence-based review of surgery alone and combined-modali-ty therapy 显示文摘 | IYER R WILKINSON N’DEMMY T | 2004 | Ann Surg Oncol2004，11，7： | 1 |
| 8 | Transcriptome sequencing across a prostate cancer cohort identifies PCAT-1,an unannotated lincRNA implicated in disease progression显示文摘 | PRENSNER J R IYER M K BALBIN O A | 2011 | Nat Biotechnol2011，29，8： | 1 |
| 9 | An efficient boosting algorithm for combining preferences显示文摘 | Freund Y Iyer R Schapire R E | 2003 | Journal of Machine Learning Research2003，，4： | 1 |
| 10 | Microarchitectural anatomy of a commercal TCP/IP stack显示文摘 | LLIKKAL R IYER R NEWELL D | 2004 | Communication Technology Laboratory2004，5，10： | 1 |
| 11 | Exposure to low-level chemicals and ionizing radiation: reactive oxygen species and cellular pathways显示文摘 | Lehnert BE Iyer R | 2002 | Hum Exp Toxicol2002，21，2： | 1 |
| 12 | Price Competition under Stockpiling and Flexible Con- sumption显示文摘 | BELL D R IYER G PADMANABHAN V | 2002 | Journal of Marketing Research2002，39，8： | 1 |
| 13 | Negotiating critical,postcritical lit- eracy : The problematic of text analysis 显示文摘 | Iyer R | 2007 | Literacy2007，，3： | 1 |
| 14 | PCAT-1,a long noncoding RNA,regulates BRCA2 and controls homologous recombination in cancer显示文摘 | PRENSNER J R CHEN W IYER M K | 2014 | Cancer Res2014，74，6： | 1 |
| 15 | Microstructural Changes During Welding and Subsequent Heat Treatment of 18Ni (250-Grade) Maraging Steel 显示文摘 | Shamantha C R Narayanan R Iyer K J L | 2000 | Materials Science and Engineering2000，287，： | 1 |
| 16 | Filarial antigens impair the function of human dendritic cells during differentiation显示文摘 | SEMNANI R T SABZEVARI H IYER R | 2001 | Infect Immun2001，69，9： | 1 |
| 17 | Exploring the metabolic and genetic control of gene expression on a genomic scale显示文摘 | DeRisi J Iyer V R Brown P O | 1997 | Science1997，278，： | 1 |
| 18 | Some properties of noether charge and a proposal for dynamical black hole entropy显示文摘 | Iyer V Wald R M | 1995 | Phys Rev1995，，52： | 1 |
| 19 | Lipoxygenase inhibitors from the essen- tial oil of garlic显示文摘 | Block E Iyer R Grisioni S | 1988 | J Am Chem Soe1988，110，23： | 1 |
| 20 | Literacy models across nations:Lit- eracy and critical literacy in teacher training pro- grams in India 显示文摘 | Iyer R | 2010 | Procedia Social and Behavioral Sciences2010，，2： | 1 |
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