Table 1_Beyond local control: radiotherapy–immunotherapy combinations from in situ vaccination to systemic immune remodeling.docx

Acting as an in situ vaccine, RT initiates antitumor immunity via immunogenic cell death and cGAS-STING activation. However, RT concurrently triggers counter-regulatory immunosuppression—upregulating PD-L1/TGF-β, expanding Tregs/MDSCs, and inducing T-cell exhaustion—limiting durable systemic control.</p>Methods<p>We integrate preclinical mechanisms and key clinical evidence for radioimmunotherapy combinations.

We analyze how radiation dose, fractionation, and delivery techniques remodel the tumor immune microenvironment and outline matching therapeutic strategies</p>Key findings<p>Optimal combination requires balancing local tumor control with systemic immune activation while preserving lymphoid reserves. Consolidation durvalumab following concurrent chemoradiotherapy has been shown to improve survival in patients with unresectable stage III non-small cell lung cancer, and SBRT combined with PD-(L)1 blockade has demonstrated benefits in oligometastatic settings.