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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 | A generalized assignment heuristic for vehicle routing显示文摘 | Fisher M L Jaikumar R | 1981 | Networks1981，11，2： | 2 |
| 3 | Right lobe living donor liver transplantation显示文摘 | Marcos A Fisher R A Ham J M | 1999 | Transplantation1999，68，6： | 1 |
| 4 | Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss:Early treatment diabetic retinopathy study report 18显示文摘 | Davis M D Fisher M R Gangnon R E | 1998 | Invest Ophthalmol Vis Sci1998，39，： | 1 |
| 5 | Resuspension and diffusive flux of nitrogen and phosphorus in a hypereutrophie lake 显示文摘 | Reddy K R Fisher M M Ivanoff D | 1996 | Journal of Environmental Quality1996，25，36： | 1 |
| 6 | Modification meltingroperties of duplex of the DNA by attachment of a GC-rich DNAsequence as determined by denaturing gradient gel electrophoresis 显示文摘 | MERSY R M FISHER S G MANIATIS T | 1985 | Nucleic Acids Res1985，13，9： | 1 |
| 7 | Direct least square fitting of ellipses显示文摘 | FITZGIBBON A PILU M FISHER R B | 1999 | IEEE Transac tions on Pattern Analysis and Machine Intelli gence1999，21，5： | 1 |
| 8 | Redox regulation of tyro- sine phosphorylation in human spermatozoa and its role in human spermatozoa and its role in human sperm function 显示文摘 | Aitken R J Paterson M Fisher H | 1995 | J Cell Sci1995，108，： | 1 |
| 9 | 查看详情显示文摘 | Stillahn J M Trevino K J Fisher E R | | 0，，： | 1 |
| 10 | Methane emission from rice fields as influenced by solar radiation, temperature, and straw incorporation显示文摘 | Sass R L Fisher F M Turner F T | 1991 | Global Biogeochemical Cycles1991，5，4： | 1 |
| 11 | Interactions with big data analytics显示文摘 | Fisher D deline R Czerwinski M | 2012 | Interactions2012，19，3： | 1 |
| 12 | Operative intervention in delivery is associated with compromised early mother-infant interaction显示文摘 | Rowe M H J Fisher J R | 2001 | British Journal of Obstetrics and Gynaecology2001，108，10： | 1 |
| 13 | An analysis of the hypothesis that amino acid requirements for chicks should be stated as a proportion of the dietary protein显示文摘 | Morris T R Gous R M Fisher C | 1999 | World Poult Sci1999，55，： | 1 |
| 14 | Five - year results of a randomized Clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treat ment of breast cancer 显示文摘 | Fisher B Bauer M Margolese R | 1985 | N Engl J med1985，312，11： | 1 |
| 15 | An in situ HVEM study of dislocation generation at Al/SiC interfaces in metal matrix composites显示文摘 | VOGELSANG M ARSENAULT R J FISHER R M | 1986 | Metall Trans A1986，17，： | 1 |
| 16 | Sparse representation in structured dictionaries with application to synthetic aperture radar显示文摘 | VARSHNEY K R CETIN M FISHER J W | 2008 | IEEE Transactions on Signal Processing2008，56，8： | 1 |
| 17 | Methane emissions from rice paddies: a process study summary 显示文摘 | Sass R L Fisher F M Jr | 1997 | Nutrient Cycling in Agroecosystems1997，49，13： | 1 |
| 18 | HIV infection is blocked in vitro by recombinant soluble CD4 显示文摘 | FISHER R A BERTONIS J M MEIER W | 1988 | Nature1988，331，6151： | 1 |
| 19 | Dose-volume histogram analysis as predictor of radiation pneumonitis in primaryung cancer patients treated with radiotherapy显示文摘 | Fay M Tan A Fisher R | 2005 | IntJ Radiat Oncol Biol Phys2005，61，5： | 1 |
| 20 | Evaluating the biological relevance of putative enhancers using Tol2 trans-poson-mediated transgenesis in zebrafish 显示文摘 | Fisher S Grice E A Vinton R M | 2006 | Nat Protoc2006，1，3： | 1 |
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