Faculty, Staff and Student Publications
Publication Date
8-1-2024
Journal
Journal of Medical Imaging and Radiation Oncology
DOI
10.1111/1754-9485.13656
PMID
38766899
PMCID
PMC11576491
PubMedCentral® Posted Date
8-1-2025
PubMedCentral® Full Text Version
Author MSS
Abstract
The intrinsic stochasticity of patients' response to treatment is a major consideration for clinical decision-making in radiation therapy. Markov models are powerful tools to capture this stochasticity and render effective treatment decisions. This paper provides an overview of the Markov models for clinical decision analysis in radiation oncology. A comprehensive literature search was conducted within MEDLINE using PubMed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only studies published from 2000 to 2023 were considered. Selected publications were summarized in two categories: (i) studies that compare two (or more) fixed treatment policies using Monte Carlo simulation and (ii) studies that seek an optimal treatment policy through Markov Decision Processes (MDPs). Relevant to the scope of this study, 61 publications were selected for detailed review. The majority of these publications (n = 56) focused on comparative analysis of two or more fixed treatment policies using Monte Carlo simulation. Classifications based on cancer site, utility measures and the type of sensitivity analysis are presented. Five publications considered MDPs with the aim of computing an optimal treatment policy; a detailed statement of the analysis and results is provided for each work. As an extension of Markov model-based simulation analysis, MDP offers a flexible framework to identify an optimal treatment policy among a possibly large set of treatment policies. However, the applications of MDPs to oncological decision-making have been understudied, and the full capacity of this framework to render complex optimal treatment decisions warrants further consideration.
Keywords
Markov Chains, Radiation Oncology, Humans, Clinical Decision-Making, Neoplasms, Monte Carlo Method, clinical decisions, decision-making, Markov decision process, radiation oncology, state-transition Markov model
Published Open-Access
yes
Recommended Citation
McCullum, Lucas B; Karagoz, Aysenur; Dede, Cem; et al., "Markov Models for Clinical Decision-Making in Radiation Oncology: A Systematic Review" (2024). Faculty, Staff and Student Publications. 4397.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4397
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