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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 | AgCl and Ag2S as additives to CuI in Mg-CuI seawater activatied batteries显示文摘 | RENUKA R | 1997 | Journal of Applied Electrochemistry1997，27，12： | 1 |
| 3 | Pseudohypo parathyroidism with hypercalcemia 显示文摘 | Renuka RB Roger T Robert R | 2001 | Endocr2001，10，： | 1 |
| 4 | Temporal relation of cardiac hypertrophy, oxidative stress, and fatty acid metabolism in spontaneously hypertensive rat 显示文摘 | Purushothaman S Nair Renuka R Harikrishnan VS | 2011 | Molecular and Cellular Biochemistry2011，351，12： | 1 |
| 5 | Antioxidant efficacy of phytochemical extracts from defatted rice bran in the bulk oil system显示文摘 | RENUKA DEVI R JAYALEKSHMY A ARUMUGHAN C | 2007 | Food Chemistry2007，104，2： | 1 |
| 6 | Influence of allotropic modifications of sulphur on the cell voltage in Mg-CuI(S) seawater activated battery显示文摘 | Renuka R | 1999 | Materials Chemistry and Physics1999，59，1： | 1 |
| 7 | AgC1 and Ag2S as additives to Cul in Mg-Cul seawater activated batteries显示文摘 | Renuka R | 1997 | Journal of Applied Electrochemistry1997，27，12： | 1 |
| 8 | AgC1 and Ag2S as additive to Cul in Mg-Cul seawater activated batteries 显示文摘 | RENUKA R | 2011 | Corrosion Science2011，53，： | 1 |
| 9 | Temporal relation of cardiac hypertrophy, oxidative stress, and fatty acid metabolism in spontaneously hypertensive rat 显示文摘 | Purushothaman Sreeja Renuka Nair R Harikrishnan V S | 2011 | Molecular and Cellular Biochemistry2011，351，12： | 1 |
| 10 | Exenccphaly in a live, full term fetus 显示文摘 | Renuka Ⅳ Sasank R Devi SI | 2009 | J Pediatr Neurosci2009，4，2： | 1 |
| 11 | Pseudohypo parathyroidism withhypercalcemia显示文摘 | Renuka RB Roger T Robert R | 2001 | Endocr2001，10，： | 1 |
| 12 | J Power Sources显示文摘 | Renuka R Ramamurthy S Muralidharan K | 1998 | 76:1971998，76，： | 1 |
| 13 | Pseudohypoparathyroidism with hypercalcemia显示文摘 | Renuka RB Roger T Robort R | 2001 | Endocr2001，10，： | 1 |
| 14 | J Appl Electrochem显示文摘 | Renuka R Srinivasan L Ramamurthy S | 2001 | 31:6552001，31，： | 1 |
| 15 | Influnce of allotropic modifications of sulphur on the cell voltage in Mg-CuI seawater activated battery显示文摘 | RENUKA R | 1999 | Materials Chemistry and Physics1999，59，： | 1 |
| 16 | Temporal relation of cardiac hypertrophy,oxidative stress,and fatty acid metabolism in spontaneously hyper- tensive rat显示文摘 | Purushothaman Sreeja Renuka Nair R Harikrishnan VS | 2011 | Molecular and Cellular Biochemistry2011，351，12： | 1 |
| 17 | Sinonasal neuro endocrine carcinoma extending into orbit-a case report显示文摘 | Renuka Ⅳ Rao BS Sasank R | 2008 | Indian J Otolaryngol Head Neck Surg2008，60，2： | 1 |
| 18 | Effect of citrate and gluconate ions on the behavior of zinc in 3M NaOH显示文摘 | R Renuka S Ramamurthy K Muralidharan | 1996 | J Power Sources1996，78，： | 1 |
| 19 | C Arunmughan Photochemical charac-terization of defatted rice bran and optimization of Process for their extraction and enrichment显示文摘 | R Renuka Devi | | 0，，03： | 1 |
| 20 | Peptides Identify the Critical Hotspots Involved in the Biological Activation of the Insulin Receptor显示文摘 | Renuka C P Ku-chuan Hsiao James R B | 2002 | J Biol Chem2002，277，22： | 1 |
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