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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 | Prevention and Control of Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010显示文摘 | Fiore Anthony E Uyeki Timothy M Broder Karen Finelli Lyn Euler Gary L Singleton James A Iskander John K Wortley Pascale M Shay David K Bresee Joseph S Cox Nancy J | 2010 | MMWR. Morbidity and Mortality Weekly Report2010，，： | 1 |
| 3 | Summary cache: a scalable wide-area Web cache sharing protocol显示文摘 | FAN L CAO P ALMEIDA J BRODER A Z | 2000 | IEEE-ACM Trans on Networking2000，8，3： | 1 |
| 4 | Summary cache : A scalable wide--area web cache sharing protocol显示文摘 | Fan Li Cao P Almeida J and Broder A | 2000 | IEEE/ A CM Transactions on Networking2000，8，3： | 1 |
| 5 | Graph structure in the web显示文摘 | Broder A Kumar R Maghoul F Raghavan P Rajagopalan S Stata R Tomkins A Wiener J | 2000 | Computer Networks2000，33，： | 1 |
| 6 | Early hemorrhage growth in patients with intracerebral hemorrhage显示文摘 | Brott T Broderic J Kothari R | 1997 | Stroke1997，28，1： | 1 |
| 7 | Ultra-structural and cyto- chemical investigations of the antagonistic effect of Verticillium lecanii on cumumber powdery mildew显示文摘 | Askary H Benhamou N Broder J | 1997 | Phytopathology1997，87，3： | 1 |
| 8 | Granulomatous infectious diseases associated with tumor necrosis factor antagonists显示文摘 | Wallis R S Broder M S Wong J Y | | 0，，09： | 1 |
| 9 | Human Resource Management, Information Technology, and the Competitive Edge 显示文摘 | BRODERIC R BOUDREAN J | 1992 | Academy of Management Executive1992，6，2： | 1 |
| 10 | Summary cache:A scalable wide-area web cache sharing protocol显示文摘 | P Cao J Almeida A Broder | 2000 | IEEE/ACM transactions on networking2000，8，3： | 1 |
| 11 | Determinants of Teaching Quality: what's Important to Students 显示文摘 | Broder J M Dorfmao J H | 2006 | Research in High Education2006，，35： | 1 |
| 12 | Infiltrating benign lipomas of the extremities显示文摘 | Regan M J Bickel WH Broders AC | 1946 | Surg Gynecol Obstet1946，54，： | 1 |
| 13 | Granulomatous infections due to tumor necrosis factor blockade:correction显示文摘 | Wallis RS Broder M Wong J | | 0，，： | 1 |
| 14 | Molecular foundations of cancer:new targets for intervention显示文摘 | Kap J E Broder S | 1995 | Nature medicion1995，，1： | 1 |
| 15 | Determinants of teaehing guality: What' s important to students?显示文摘 | BRODER J M DORFMAN J H | 1994 | Research in higher ed- ucation1994，22，35： | 1 |
| 16 | Graph structure in the web显示文摘 | A Broder R Kumar F Maghoul P Raghavan S Rajagopalan R Stata A Tomkins J Wiener | 2000 | Computer Networks2000，33，： | 1 |
| 17 | Ear ly hemo r rhage grow th in pat ients with int racerebrebral hemo r rhage 显示文摘 | Brott T Broder ieck J Ko thar I R | 1997 | St roke1997，28，： | 1 |
| 18 | Short-term TNFot shedding is Independent of cytoplasmic phosphorylation or furin cleavage of Adaml7 显示文摘 | Schwarz J Broder C Helmstetter A | 2013 | Biochim Biophys Acta2013，1833，12： | 1 |
| 19 | Merkel, Ingrid Stober, The Hydro - geochemistry of Arsenic in the Clara Mine Germany 显示文摘 | Yinian Zhu Broder J | 2003 | Mine Water and the Environment2003，22，： | 1 |
| 20 | Early hemorrhage growth in patients with intracerebral hemorrhage显示文摘 | Brott T Broderic J Kotharis R | 1997 | Stroke1997，28，1： | 1 |
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