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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 | Acute graft versus host disease following liver transplant:the enemy within显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transpl2004，4，4： | 1 |
| 3 | Monitoring systemic donor lymphocyte macroehimerism to aid the diagnosis of graft-versus-host disease after liver transplantation 显示文摘 | Taylor AL Gibbs P Sudhindran S | 2004 | Transplantation2004，77，3： | 1 |
| 4 | Acute graft versus host disease following liver transplantation:the enemy within显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transplant2004，4，4： | 1 |
| 5 | Monitoring systemic donor lymphocyte rnaeroehimerism to aid the diagnosis of graft-versus-host disease after liver transplantation 显示文摘 | Taylor AL Gibbs P Sunhindran S | 2004 | Transplantation2004，77，3： | 1 |
| 6 | , bi- ology of the skin显示文摘 | Toebak M J Gibbs S Bruynzeel D P et aL Dendritic cells | 2009 | Contact Dermatitis2009，60，1： | 1 |
| 7 | Acute graft versus host disease following liver transplantation: the enemy within 显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transpl2004，4，4： | 1 |
| 8 | Acute graft versus host disease following liver transplantation: the enemy within 显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transplant2004，4，4： | 1 |
| 9 | Molecular analysis of the in vivo metabolism and hiodistribution of metabolically and non metabolically activated combi-molecules of the tri- azene class显示文摘 | Qiu Q Larroque AL Gibbs B | 2009 | Drug metab lett2009，3，1： | 1 |
| 10 | Growth control Listeriainnocua 2030c on vacuum - packaged cold-smoked salmon bylactic acid bacteria显示文摘 | Tome E Gibbs PA Teixeira PC ei al | 2008 | International Journal of Food Microbiology2008，121，3： | 1 |
| 11 | Children's 5-HTILPR genotype moderates the link between maternal criticism and attentional biases specifically for facial displays of anger显示文摘 | Gibb BE Johnson AL Benas JS | 2011 | Cognition Emotion2011，25，6： | 1 |
| 12 | Acute Graft Versus Host Disease Following Liver Transplantation: The Enemy Within 显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transplant2004，4，4： | 1 |
| 13 | Antifolates targeted specifical- ly to the 5olate reeeptor显示文摘 | Jackman AL Theti DS Gibbs DD | 2004 | Adv Drug Deliv Rev2004，56，8： | 1 |
| 14 | Monitoring systemic donor lymphocyte macrochimerism to aid thediagnosisof graft-versus-host disease afterlivertransplantation显示文摘 | Taylor AL Gibbs P Sudhindran S | 2004 | Transplantation2004，77，3： | 1 |
| 15 | Monitoring systemic do- nor lymphocyte macrochime rism to aid the diagnosis of graft graft versus-host disease after liver transplantation 显示文摘 | Taylor AL Gibbs P Sudhindran S | 2004 | Transplantation2004，77，3： | 1 |
| 16 | Monitoring systemic donor lymphocyte macrochimerism to aid the diagnosis of graft versus host disease after liver transplantation 显示文摘 | Taylor AL Gibbs P Sudhindran S etal | 2004 | Transplanta tion2004，77，3： | 1 |
| 17 | Acute graft versus host disease following liver transplantation: the enemy within 显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transplant2004，4，4： | 1 |
| 18 | Autoradiographlc Analysis of Muscarinic Cholinergic and Serotonergic Receptor Alterations Following Methamphetamine Treatmen显示文摘 | R TYLER MCCABE JAMES W GIBB JAMES K WAMSLEY et al | 1987 | Brcrin Reseurch Bulktin1987，19，： | 1 |
| 19 | Monitoring systemic donor lymphocyte macrochime rism to aid the diagnosis of graft graft versus-host disease after liver transplantation显示文摘 | Taylor AL Gibbs P Sudhindran S et a1 | | 0，，03： | 1 |
| 20 | Acute graft versus host disease following liver transplantation:the enemy within显示文摘 | Taylor AL Gibbs P Bradley JA | 2004 | Am J Transpl2004，4，4： | 1 |
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