An analysis of the decision-making process in the management of malignant gliomas

The decision to offer surgery or deep X-ray therapy to patients diagnosed as having malignant gliomas on CT scans is often problematical. Decision-tree analysis is used to make the underlying assumptions explicit in either strategy. Using biopsy and CT data obtained from our own experience, and survival figures from the literature, we are able to demonstrate that the decision is to a large extent related to value judgement. Specifically this relates to the assessment of the utility of long-term survival versus the immediate mortality and morbidity of biopsy in addition to possible difficulties in accepting long-term uncertainty of diagnosis if a biopsy is not performed.