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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 | Vibration energy transmission and mode conversion at a corner junction of square section rods显示文摘 | Gibbs B M Tattersall J D | 1987 | J Vib Acoust Stress Rel Dsgn1987，109，： | 2 |
| 3 | Long-term aeration management for improved N-removal via SND in a sequencing batch reactor显示文摘 | THIRD K A GIBBS B NEWLAND M | 2005 | Water Research2005，39，： | 1 |
| 4 | Control of com bustion-generated nitrogen oxides by selective non-cata- lytic reduction 显示文摘 | JAVED M T IRFAN N GIBBS B M | 2007 | Journal of Environmental Management2007，83，3： | 1 |
| 5 | Impact of air staging on the fate of NO and N2O in a circulating fluidized-bed combustor 显示文摘 | Wang X S Gibbs B M Rhodes M J | 1994 | Combustion and Flame1994，99，34： | 1 |
| 6 | Experimental and modeling study of the effect of CO and H2 on the urea DeNOx process in a 150kW laboratory reactor显示文摘 | Javed M T Nirnmo W Gibbs B M | 2008 | Chemosphere2008，70，6： | 1 |
| 7 | Calcium-based sorbents for simultaneous NOx/SOx reduction in a down-fired furnace显示文摘 | Patsias A A Nimmo W Gibbs B M | 2005 | Fuel2005，84，1415： | 1 |
| 8 | Control of combustion-generated nitrogen oxides by selective non-catalytic reduction显示文摘 | Javed M T Irfan N Gibbs B M | 2007 | Journal of Environmental Management2007，83，3： | 1 |
| 9 | Control of combustion generated nitrogen oxides by selective non-cata- lytic reduction 显示文摘 | JAVED M T IRFAN N GIBBS B M | 2007 | Journal of Environmental Management2007，83，3： | 1 |
| 10 | Control of combustion-generated nitrogen oxides by selective non-catalytic reduction显示文摘 | Javed M T Irfan N Gibbs B M | 2007 | Journal of Environmental Management2007，83，3： | 1 |
| 11 | Calcium-based sorbents for simultaneous NOx/SOx reduction in a down-fired furnace显示文摘 | Patsias A A Nimmo W Gibbs B M | | 0，，14： | 1 |
| 12 | Experimental and modeling study of the effect of CO and H2 on the urea DeNOx process in a 150kW laboratory reactor显示文摘 | Javed M T Nimmo W Gibbs B M | 2008 | Chemosphere2008，70，6： | 1 |
| 13 | Long-term aeration management for improved N-removal via SND in a sequencing batch reactor显示文摘 | THIRD K A GIBBS B NEWLAND M | 2005 | Water Research2005，39，15： | 1 |
| 14 | Comparisons of pulverized coal combustion in air and in mixtures of 02/C02 显示文摘 | LIU H ZAILANI R Gibbs B M | 2005 | Fuel2005，84，78： | 1 |
| 15 | Calcium magnesium acetate and urea advanced reburning for NO control with simultaneous SO2 reduction显示文摘 | Nimmo W Patsias A A Gibbs B M | | 0，，09： | 1 |
| 16 | Control of combustion-generated nitrogen oxides by selective non-catalytic reduction显示文摘 | Javed M T Irfan N Gibbs B M | 2007 | Journal of Environmental Management2007，83，3： | 1 |
| 17 | Comparisons of pulverized coal combustion in air and in mixture Oz/CO2 显示文摘 | Liu H Zailani R Gibbs B M | 2005 | Fuel2005，84，16： | 1 |
| 18 | Nitrogen sulpher interactions in coal flames显示文摘 | HAMPARTSOUMIAN E NIMMO W GIBBS B M | 2001 | Fuel2001，80，7： | 1 |
| 19 | Comparisons of pul-verized coal combustion in air and in mixtures of O2/CO2显示文摘 | Liu H Zailani R Gibbs B M | 2005 | Fuel2005，84，78： | 1 |
| 20 | Evaluation of the optimal fuel characteristics for efficient NO reduction by coal reburning 显示文摘 | Liu H Hampartsoumian E Gibbs B M | 1997 | Fuel1997，76，11： | 1 |
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