Determination of the Best Treatment Option in Stage III, Resectable, Non-small Cell Lung Cancer Patients by Decision Analysis Method

The aim of this study was to determine the best treatment strategy in stage III, resectable non-small cell lung cancer (NSCLC) patients by decision analysis method. A decision tree was prepared with data col­lected from randomized clinical trials containing the treatment in this group of patients. Treatment outcomes were evaluated by life expect­ancy measure. “Quality- adjusted life expectancy” measure and Mark­ov models were used to evaluate the effects of treatment methods on patient quality of life. Baseline utility values were estimated from simi­lar studies and sensitivity analyses were conducted with a broad range of values. The predictions reached by these models were in agreement with the present treatment preferences. If quality of life was excluded, neoadjuvant, concurrent chemoradiotherapy provides 0.21 year more life expectancy than immediate surgery and adjuvant therapy. Concur­rent chemoradiotherapy provides 0.97 year more life expectancy than sequential chemoradiotherapy. As a neoadjuvant treatment, chemo­radiotherapy obtains 1.74 years longer life expectancy than chemo­therapy alone. But when decision analysis was calculated by “qual­ity- adjusted life expectancy” measure or Markov models, the strategy consisting of immediate surgery and postoperative chemotherapy was the best treatment strategy (but with only 0.05 year longer quality- adjusted life expectancy). Both of these models were found sensi­tive to utility values. If utility values of patients could be established confidently and accurately, the decision analysis method can be used successfully for the determination of the best treatment option.