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A Decision Analysis

CPT Vic Velanovich, MC

Arch Otolaryngol Head Neck Surg. 1990;116(8):951-956.

Abstract
• Controversy exists over optimal treatment of stage I floor-of-mouth cancers, with advocation of either primary radiotherapy or surgical resection with or without a neck dissection. A decision analysis was undertaken to determine the outcomes of these treatment options. The quality-adjusted life expectancies were determined using best estimates from the literature of survival, recurrence, short-term morbidity, and quality of life for radiotherapy and surgical resection. The quality-adjusted life expectancies were as follows: for surgical resection with neck dissection, 18.50 years; for surgical resection without neck dissection, 14.48 years; and for primary radiotherapy, 7.95 years. Sensitivity analysis showed that these results varied with quality of life assumptions and survival data. Therefore, each institution needs to review its own survival data and question patients about quality of life to determine how treatment options fit into the decision analysis.

(Arch Otolaryngol Head Neck Surg. 1990;116:951-956)

Author Affiliations
USA

From the Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco (Calif).

Footnotes
Accepted for publication April 3, 1990.

The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the US government.

Reprint requests to Medical Editing HSHH-CI-ME, Department of Clinical Investigation, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700 (CPT Velanovich).

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