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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 | Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium study显示文摘 | Keith C Bible Vera J Suman Julian R Molina Robert C Smallridge William J Maples Michael E Menefee Joseph Rubin Kostandinos Sideras John C Morris Bryan McIver Jill K Burton Kevin P Webster Carolyn Bieber Anne M Traynor Patrick J Flynn Boon Cher Goh Hui Tan | 2010 | Lancet Oncology2010，，10： | 1 |
| 3 | An abinitio CFF93 all-atom forcefield for polyearbonates显示文摘 | Sun H Mumby S J Maple J R | 1994 | Journal of the American Chemical Society1994，116，7： | 1 |
| 4 | An ab initio CFF93 all-atom force field for polycarbonates显示文摘 | Sun H Mumby S J Maple J R | 1994 | J Am Chem Soc1994，116，7： | 1 |
| 5 | Ab initio calculations on small molecule analogs of polycarbonates显示文摘 | Sun H Mumby S J Maple J R | 1995 | J Phy Chem1995，99，16： | 1 |
| 6 | Social attachment in giraffe:re sponse to social separation显示文摘 | Tarou L R Bashaw M J Maple T L | | 0，，01： | 1 |
| 7 | An ab initio CFFP3 all-atom force field for polycarbonates显示文摘 | Sun H Mumby S J Maple J R | 1994 | J Am Chem Soc1994，116，： | 1 |
| 8 | Superconductivity and Normal-state Properties of ThU Alloys显示文摘 | COLES B R MAPLE M B HUBER J G | 1970 | Journal of Low Temperature Physics1970，3，2： | 1 |
| 9 | An ab initio CFF93 all-atom force field for polycarbonates显示文摘 | Sun H Mumby S J Maple J R | 1994 | Journal of the American Chemical Society1994，116，7： | 1 |
| 10 | Derivation of class II force fields, 1: Methodology and quantum forcefield for the alkyl functional group and alkane molecules显示文摘 | Maple J R Hwang M J Stockfisch T P | 1994 | Journal of Computational Chemistry1994，15，2： | 1 |
| 11 | Derivation of class II force fields, 3: Characterization of a quantum forcefield for the alkanes显示文摘 | Maple J R Hwang M J Stockfisch T P | 1994 | Israel Journal of Chemistry1994，34，1： | 1 |
| 12 | Social attachment in giraffe:response to social separation显示文摘 | Tarou L R Bashaw M J Maple T L | 2000 | Zoo Biol2000，19，： | 1 |
| 13 | Developing essential skills through case study scenarios 显示文摘 | Sawyer A J Tomlinson S R Maples A J | 2000 | Journal of Accounting Education2000，18，： | 1 |
| 14 | Derivation of force fields formolecular mechanics and dynamics from abinitio energy sur-faces显示文摘 | Maple J R Dinur U Hagler A T | 1988 | Proceedings of the National Academy of Sciences ofthe United States of America1988，85，15： | 1 |
| 15 | An ab initio cff93 all- atom force field for polycarbonates 显示文摘 | Sun H Mumby S J Maple J R | 1994 | Journal of the AmericanChemical Society1994，116，： | 1 |
| 16 | Effect of sulfur additions on soil and the nutrition of wheat显示文摘 | MAHLER R J MAPLES R L | 1987 | Commun Soil Sci Plant Anal1987，18，6： | 1 |
| 17 | Response of wheat to sulfur fertilization显示文摘 | MAHLER R J MAPLES R L | 1986 | Commun Soil Sci Plant Anal1986，17，9： | 1 |
| 18 | Derivation of Force Fields for Molecular Mechanics and Dynamics from Ab Initio Energy Surfaces显示文摘 | Maple J R Dinur U Hagler A T | 1988 | Proceedings of the National Academy of Sciences1988，85，15： | 1 |
| 19 | An Ab Initio CFF93 All- atom Force Field for Polycarbonates显示文摘 | Sun H Mumby S J Maple J R | 1994 | Journal of the Ameri- can Chemical Society1994，116，7： | 1 |
| 20 | Effect of sulfur additions on soil and the nutrition of wheat显示文摘 | Mahler R J Maples R L | 1987 | Commun Soil Sci Plant Anal1987，18，6： | 1 |
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