TOPSIS-Based Multi-Criteria Evaluation of Radiotherapy Innovations: A Pilot Proof-of-Concept Study

Introduction: Technological advances in radiotherapy, such as FLASH radiotherapy (FLASH-RT), have shown remarkable potential to enhance tumor control while reducing normal tissue toxicity. However, standardized frameworks to comprehensively assess the value of such innovations remain lacking. Objective: This proof-of-concept study aimed to develop and apply a transparent, reproducible, multi criteria framework to evaluate the overall value of FLASH-RT compared to conventional radiotherapy, integrating clinical, organizational, and economic dimensions. Materials and Methods: A modified Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) within a Multi-Criteria Decision Analysis (MCDA) framework was implemented. Five evaluation domains (clinical benefit, toxicity, patient-reported outcomes, organizational impact, and costs) were weighted through a Delphi consensus of radiation oncology experts. GPT-5 assisted in endpoint extraction from literature, and sensitivity analyses were conducted to assess robustness. Results: FLASH-RT achieved the highest unweighted closeness coefficients (0.60–0.62), indicating a substantial advantage in multidimensional benefit over conventional radiotherapy. After adjusting for study design quality, the coefficients decreased, revealing that current evidence, largely preclinical, offers only incremental clinical advantage. Conclusions: The MCDA-TOPSIS framework proved reliable and adaptable for evaluating radiotherapy innovations, highlighting FLASH-RT’s strong preclinical promise but limited clinical maturity. The methodology offers a transparent quantitative tool for Health Technology Assessment (HTA), supporting evidence-based decision-making and prioritization of high value technologies in radiotherapy.