Beyond local control: radiotherapy-immunotherapy combinations from in situ vaccination to systemic immune remodeling.

Combining radiotherapy with immunotherapy can enhance systemic antitumor immunity, but success depends on balancing local control with immune activation, with some approaches showing promise in specific cancers.

• Why it matters: Understanding how radiotherapy modulates the tumor immune microenvironment is crucial to overcoming immunosuppressive effects and improving systemic cancer control.
• What they did: The authors review preclinical and clinical evidence, analyzing radiation dose, fractionation, and delivery techniques, and highlight strategies like low-dose RT and spatial-fractionation to optimize immune responses.
• The result: Effective combinations can improve survival in certain cancers, such as unresectable non-small cell lung cancer, but challenges remain in others; future advances depend on biomarker-guided patient selection and precise treatment timing.