Decision theory analysis of the enteric morbidity and surgical staging in the treatment of advanced cervical cancer

Decision theory analysis is a systematic approach to decision making under conditions of uncertainty. Using formal decision analysis, we analyzed the clinical course of 275 patients with advanced cervical cancer. As selection in the application of surgical staging made survival comparisons difficult, enteric morbidity was used as a valued outcome. While the probability of severe enteric morbidity in patients who undergo extended field radiotherapy and surgical staging is twice as high as that in those not receiving extended portals and undergoing surgical staging (0.095 versus 0.050), the increased precision of defining those patients in need of extended portals resulted in very little increased morbidity in the total group. The difference in probability of enteric morbidity in patients with surgical staging and those without was 0.065 versus 0.061. Efforts to increase the proportion of patients with metastatic disease in the surgical staging group by using as stratifying parameters undifferentiated histology or possibly, in premenopausal patients, progesterone receptor levels may allow for the best survival therapeutic ratio as the maximum survival benefit will be gained by a minimum of enteric morbidity.