Elective neck dissection or "watchful waiting": optimal management strategy for early stage N0 tongue carcinoma using decision analysis techniques.

BACKGROUND

Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage N0 oral tongue carcinoma.

METHODS

On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value (EV) was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed.

RESULTS

The results showed that the decision model favored elective neck dissection (EV = 0.87), over "watchful waiting" (EV = 0.77). One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group, and a salvage rate threshold value 0.73 for the "watchful waiting" group.

CONCLUSIONS

These results suggested that elective neck dissection strategy of the neck should be applied for early stage N0 oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, "watchful waiting" strategy would be preferable.