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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 | Effi- cacy of pyropheophorbide-α-hexyl ether for photody- namic therapy of rat 9L gliosareoma显示文摘 | AUTRY S A EDWARDS B F BOGGAN J E | 1993 | Optical Methods for Tumor Treatment and Detection1993，，： | 1 |
| 3 | Membrane ther- mostability and heat tolerance of spring wheat 显示文摘 | Shanahan J F Edwards I B Quick J S | 1990 | Crop Sci- ence1990，30，2： | 1 |
| 4 | OMEGA EP high-energy petawatt laser: progress and prospects显示文摘 | D N Maywar J H Kelly L J Waxer S F B Morse I A Begishev J Bromage C Dorrer J L Edwards L Folnsbee M J Guardalben S D Jacobs R Jungquist T J Kessler R W Kidder B E Kruschwitz S J Loucks J R Marciante R L McCrory D D Meyerhofer A V Okishev J B Oliver G Pien | 2008 | Journal of Physics: Conference Series2008，，3： | 1 |
| 5 | The full canonical ensemble of a granular system显示文摘 | Edwards S F | 2005 | PhysicaA2005，353，： | 1 |
| 6 | Community genomics among stratified microbial assemblages in the ocean's interior显示文摘 | DeLong E F Preston C M Mincer T Rich V Hallam S J Frigaard N U Martinez A Sullivan M B Edwards R Brito B R Chisholm S W Karl D M | | 0，，5760： | 1 |
| 7 | Fecal coliform and strep- tococcus concentrations in runoff from grazed pastures in Northwest Arkansas显示文摘 | Edwards D R Coyne M S Vendrell P F | 1997 | Jawra Journal of the American Water Resources Associa- tion1997，33，2： | 1 |
| 8 | public preferences across europe for different forest stand types as sites for rec- reation显示文摘 | Edwards D M Jay M Jensen F S | 2012 | Ecology & Society2012，17，1： | 1 |
| 9 | Development and validation of the Chinese version of the diabetes management self-efficacy scale 显示文摘 | Wu S F V Courtney M Edwards H | 2008 | Int J Nurs Stud2008，45，4： | 1 |
| 10 | Diffusion-weighted imaging of the prostate and rectal wall: comparison of hiexponential and monoexponential modelled diffusion and associated perfusion coefficients显示文摘 | Riches S F Hawtin K Charles Edwards E M | 2009 | NMR Biomed2009，22，3： | 1 |
| 11 | Impaired apoptosis, extended duration of immune responses, and a lupus-like autoimmune disease in IEX-1-transgenic mice显示文摘 | Zhang Y Schlossman S F Edwards R A Ou C N Gu J Wu M X | 2002 | Proc Natl Acad Sci USA2002，99，： | 1 |
| 12 | Theory of powders显示文摘 | Edwards S F Oakeshott R B S | 1989 | Physica A1989，157，： | 1 |
| 13 | Mannieh bases and other compounds derived from benzsuberone 显示文摘 | Tarbell D S Wilson H F Edward Ott | 1952 | Journal of the American Chemical Society1952，74，24： | 1 |
| 14 | Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women 显示文摘 | Charles S F Edward L G Graham A C | 1999 | The New England Journal of Medicine1999，340，1： | 1 |
| 15 | Geochemistry and tectonic significance of peridotites from the South Sandwich arc- basin system, South Atlantic 显示文摘 | Pearce J A Barker P F Edwards S J | 2000 | Contributions to Mineralogy and Petrology2000，139，1： | 1 |
| 16 | Purification and Properties of the Threespine Stickleback (Gasteristeus aeuleatrs)Lactate Dehydrogenase LDh-B4 and LDH-C4 Isochzymes显示文摘 | Marek S Z Jaduiga G Edward F S | 1997 | Comp Bioehem physiol1997，117，4： | 1 |
| 17 | Endothelial cell injury in cardiovascular Surgery: Ischemia reperfusion 显示文摘 | Edward M Vemas S Lovem F | 1996 | Ann Thorac Surg1996，62，： | 1 |
| 18 | Role-Based Access Control Models显示文摘 | Ravi S Edward C Hal L F | 1996 | IEEE Computer1996，29，2： | 1 |
| 19 | Granular antropy: explicit, calculations for planar assemblies显示文摘 | Blumenfeld R Edwards S F | 2003 | Phys Rev Lett2003，90，： | 1 |
| 20 | The transmission of stress in an aggregate显示文摘 | Edwards S F Oakeshott R B S | 2005 | Physica D2005，38，： | 1 |
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