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Titolo:
Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer
Autore:
Gale, RP; Park, RE; Dubois, R; Bitran, JD; Buzdar, A; Hortobagyi, G; Jones, SE; Lazar, GS; Spitzer, G; Swain, SM; Vaughn, CB; Vogel, CE; Martino, S;
Indirizzi:
Salick Hlth Care Inc, Los Angeles, CA USA Salick Hlth Care Inc Los Angeles CA USA th Care Inc, Los Angeles, CA USA
Titolo Testata:
CLINICAL TRANSPLANTATION
fascicolo: 1, volume: 14, anno: 2000,
pagine: 32 - 41
SICI:
0902-0063(200002)14:1<32:DAOAOH>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
NEW-YORK-STATE; CORONARY-ANGIOGRAPHY; RANDOMIZED TRIAL; BYPASS-SURGERY; CAROTID ENDARTERECTOMY; REVASCULARIZATION; ANGIOPLASTY; UNDERUSE; SUPPORT;
Keywords:
autotransplants; breast cancer; Delphi-panel analysis; high-dose chemotherapy;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Gale, RP 11693 San Vicente Blvd,PMB 335, Los Angeles, CA 90049 USA 11693 San Vicente Blvd,PMB 335 Los Angeles CA USA 90049 0049 USA
Citazione:
R.P. Gale et al., "Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer", CLIN TRANSP, 14(1), 2000, pp. 32-41

Abstract

Background: Them is controversy whether high-dose chemotherapy and a bloodcell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. Objective: Determine appropriateness of high-dose chemotherapy and a bloodcell or bone marrow autotransplant in women with breast cancer. Panelists:Nine breast cancer experts from diverse geographic sites and practice settings. Evidence: Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. Process: We used a modified Delphi-panel group judgement process. Clinical variables were permuted todefine 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Conclusions: In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with greater than or equal to 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with less than or equal to 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleural and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those withbone metastases and a complete or partial response or stable disease afterchemotherapy; and 3) inappropriate in other settings.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 11/07/20 alle ore 20:39:39