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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 | Purification and identification of potentially bioactive peptides from enzyme-modified cheese显示文摘 | S S HA ILESELASSIE B H LEE B F GIBBS | 1999 | Journal of Dairy Science1999，82，8： | 1 |
| 3 | Surfactant-enhanced remediation of contaminated soil,a review显示文摘 | MULLIGAN C N YONG R N GIBBS B F | | Engineering Geology0，60，： | 1 |
| 4 | Heavy metal removal from sedimends by biosurfactants显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | Journal of Hazardous Material2001，，85： | 1 |
| 5 | Ambroxol inhibits the release of histamine, leukotrienes and cytokinesfrom human leukocytes and mast cells显示文摘 | GIBBS B F SCHMUTZLER W VOLLRATHL I B et aI | 1999 | Inftamm Res1999，48，2： | 1 |
| 6 | Remediation Technolo- gies for Metal-Contaminated Soils and Groundwater:An Evaluation 显示文摘 | MULLIGAN C N YONG R N GIBBS B F | 2001 | Engineering Geology2001，60，1： | 1 |
| 7 | Metal removal from contaminated soil and sediments by the biosurfactant surfactin显示文摘 | Mulligan C N Yong R N Gibbs B F | 1999 | Environ Sci Technol1999，33，： | 1 |
| 8 | An evaluation of technologies for the heavy metal remediation of dredged sediments显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | Journal of Hazardous Materials2001，85，： | 1 |
| 9 | Production and characterization of bioactive peptides from soy hydrolysate and soy-fermented food 显示文摘 | Gibbs B F Zougman A Masse R | 2004 | Food Research International2004，37，2： | 1 |
| 10 | Surfactant-enhanced remediation of contaminated soil a review显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | Engineering Geology2001，60，14： | 1 |
| 11 | Histological typing of lung and pleural tumours: third edition 显示文摘 | Gibbs A R Thunnissen F B | 2001 | J Clin Pathol2001，54，7： | 1 |
| 12 | Remediation technologies for metal-contaminated soils and groundwater:an evaluation Engineering显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | Geology2001，60，14： | 1 |
| 13 | Production and characterization of bioactive peptides from soy hydrolysate and soy fermented food 显示文摘 | Gibbs B F Zoygman A Masse R | 2004 | Food Research Internetional2004，37，： | 1 |
| 14 | Encapsula- tion in the food industry : a review 显示文摘 | GIBBS B F KERMASHA S ALLI I | 1999 | Journal of Food Sciences and Nutrition1999，50，3： | 1 |
| 15 | Heavy metal remov- al from sediments by biosurfactants显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | J Harzard Mater2001，85，： | 1 |
| 16 | Purificationand identification of potentially bioactive peptidesfrom enzyme-modified cheese显示文摘 | SSHA ILESELASSIE B H LEE B F GIBBS | 1999 | Journal of DairyScience1999，82，8： | 1 |
| 17 | Power law relationships between bond length, bond strength and electron density distributions 显示文摘 | Gibbs G V Hill F C Boisen M B | 1998 | Phys Chem Miner1998，25，： | 1 |
| 18 | Effects of Crude Enzyme of Lacto- bacillus Casei LLG on Water Soluble Peptides of Enzyme-Modified Cheese 显示文摘 | PARK S Y GIBBS B F Lee B H | 1995 | Food Research International1995，28，： | 1 |
| 19 | Remediation technologies for metal-contaminated soils and groundwater: An evaluation 显示文摘 | Mulligan C N Yong R N Gibbs B F | 2001 | Engineering Geologist2001，60，14： | 1 |
| 20 | Cellular heterogeneity in DNA damage and growth inhibition induced by ICI D1694, thymidylate synthase inhibitor, using single cell assays 显示文摘 | Schtiber C Gibbs J F Yin M B etal | 1994 | Biochemical Pharmacology1994，48，5： | 1 |
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