An international modified Delphi study to prioritise levels of evidence and outcomes to appraise radiotherapy innovation in the ESTRO Value-Based Radiation Oncology framework

This international Delphi study, led by the European Society of Radiation Oncology as part of their Value-Based Radiation Oncology programme, brought together key experts from the radiation oncology community to build consensus on both the level of evidence and the endpoints that are essential to support clinical implementation or policy decisions (eg, reimbursement) for different types of radiotherapy innovations. Although randomised trial evidence remained a high priority across most innovation types, other evidence, such as high-quality prospective observational studies or alternative designs such as pragmatic trials, was found to be a suitable alternative in specific scenarios. In addition, the importance of a broader set of clinical endpoints beyond overall survival was acknowledged, including quality of life, local control, and functional endpoints. These consensus criteria aim to inform the development of a structured appraisal framework for radiotherapy innovation, guiding health-care providers and policy makers in identifying and promoting high-value radiotherapy that offers meaningful benefit to patients and supports implementation.