Decision analysis of treatment options in pyriform sinus carcinoma.

Decision analysis was used to evaluate the current treatment options for stage III squamous cell carcinoma of the pyriform sinus (surgery, radiation therapy, and combined surgery/radiation therapy). Using published data, a decision tree was constructed based on quality-adjusted weeks of survival. With this model the combination of surgery and postoperative radiation therapy is preferred over either primary surgery or the combination of preoperative irradiation and surgery; primary radiation therapy is least favored. The decision is quite sensitive to the augmentation in survival that postoperative radiation therapy seems to provide over primary surgery. The decision is somewhat sensitive to the operative mortality rate and to the probability of disease-free survival following surgery. Quality of life issues emerge as important variables which need to be considered when planning treatment for patients with stage III pyriform sinus carcinoma.