Choice of Treatment for Stage I Floor-of-Mouth Cancer: A Decision Analysis

Controversy exists over optimal treatment of stage I floor-of-mouth cancers, with advocation of either primary radiotherapy or surgical resection with or with-out 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.