title: Surgery Versus Interferon Alpha-2b Treatment Strategies for Ocular Surface Squamous Neoplasia: A Literature-Based Decision Analysis.
abstract: OBJECTIVE
  To compare treatment strategies for ocular surface squamous neoplasia (OSSN), ranging from surgical excision to empiric topical interferon alpha-2b (IFN-α2b).
  
  
  METHODS
  A decision model was constructed to determine which of 4 treatment strategies minimized expected persistence/recurrence of disease in patients with OSSN: excision followed by repeat excision for positive surgical margins, excision followed by IFN-α2b for positive margins, incisional biopsy followed by IFN-α2b for positive biopsies, and empiric treatment with IFN-α2b. Probabilities were estimated from literature published between 1983 and 2015. Expected values for the probability of recurrence could range from 0 (no persistence/recurrence) to 1 (persistence/recurrence). Sensitivity analyses were performed for each variable.
  
  
  RESULTS
  Excision followed by IFN-α2b for positive margins was estimated to minimize persistence/recurrence of OSSN (expected value 0.13 versus 0.17 for empiric IFN-α2b, 0.22 for excision-only, and 0.30 for incisional biopsy-directed IFN-α2b). The optimal strategy was sensitive to 3 variables: efficacy of IFN-α2b, recurrence after negative surgical margins, and accuracy of excisional biopsy.
  
  
  CONCLUSIONS
  In our decision analysis using studies published between 1983 and 2015, surgical excision followed by IFN-α2b for positive margins is the favored strategy for minimizing persistence/recurrence of OSSN. Future prospective studies would add to the certainty of these conclusions.
authors.affiliation: *Geisel School of Medicine at Dartmouth, Hanover, NH;†The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH;‡Bascom Palmer Eye Institute, University of Miami, Miami, FL;§Department of Ophthalmology, University of California San Francisco, San Francisco, CA;¶Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, CA; and‖Section of Ophthalmology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Siedlecki
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tapp
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Larson
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
authors.forename: Thomas
authors.initials: T
authors.lastname: Lietman
authors.forename: Michael E
authors.initials: ME
authors.lastname: Zegans
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D003230:Conjunctival Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D013508:Ophthalmologic Surgical Procedures; D011336:Probability; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012086:Reoperation; D012680:Sensitivity and Specificity
chemical_list: D000970:Antineoplastic Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins