Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Pancreas. 2013 Apr;42(3):397-404. doi: 10.1097/MPA.0b013e31826d3a17.
This study aimed to develop expert consensus for the use of systemic treatments for unresectable metastatic well-differentiated (grade 1-2) carcinoid tumors using the RAND/UCLA modified Delphi process.
After a comprehensive literature review, 404 patient scenarios addressing the use of systemic treatments for carcinoid tumors were constructed. A multidisciplinary panel of 10 physicians assessed the scenarios as appropriate, inappropriate, or uncertain (on a 1-9 scale) or as an area of disagreement before and after an extended discussion of the evidence.
Experts were medical and surgical oncologists, interventional radiologists, and gastroenterologists. Among rated scenarios, disagreement decreased from 14% before the meeting to 4% after. Consensus statements about midgut carcinoids included the following: (1) Somatostatin analogs are appropriate as first-line therapy for all patients; (2) In patients with uncontrolled secretory symptoms, it is appropriate to increase the dose/frequency of octreotide long-acting repeatable up to 60 mg every 4 weeks or up to 40 mg every 3 weeks as second-line therapy for refractory carcinoid syndrome. Other options may also be appropriate. Consensus was similar for non-midgut carcinoids.
The Delphi process provided a structured methodological approach to assist clinician experts in reaching consensus on the appropriateness of specific medical therapies for the treatment of advanced carcinoid tumors.
本研究旨在使用 RAND/UCLA 修改后的 Delphi 流程，针对无法切除的转移性分化良好（1-2 级）类癌肿瘤的系统治疗方法制定专家共识。
在全面的文献回顾之后，构建了 404 个涉及类癌肿瘤系统治疗方法的患者病例。一个由 10 名医生组成的多学科小组，根据病例情况进行评估，评估结果包括适当、不适当或不确定（1-9 分），或在对证据进行深入讨论之前和之后存在分歧。
专家组成员包括医学和外科肿瘤学家、介入放射学家和胃肠病学家。在评估病例中，意见分歧从会议前的 14%减少到会议后的 4%。关于中肠类癌的共识声明包括以下内容：（1）生长抑素类似物适用于所有患者的一线治疗；（2）对于有不可控分泌症状的患者，可增加奥曲肽长效重复制剂的剂量/频率，每 4 周 60 毫克或每 3 周 40 毫克，作为难治性类癌综合征的二线治疗。其他选择也可能是合适的。对于非中肠类癌也存在类似的共识。
Delphi 流程提供了一种结构化的方法学方法，有助于临床医生专家就治疗晚期类癌肿瘤的特定医学疗法的适当性达成共识。
