Real World Guide for Delivering Immunotherapy with Radiotherapy.

Abstract

Immunoradiotherapy, the combination of radiotherapy (RT) and immunotherapy, represents a promising advancement in cancer treatment by enhancing local and systemic tumor control and improving patient response rates. While RT has long been a cornerstone of oncologic care, its efficacy is often opposed by various tumor resistance mechanisms. Immunotherapy, which leverages the immune system to combat cancer, offers a complementary means to enhance RT's effectiveness. Despite the potential of this combination, integrating immunotherapy into standard RT protocols remains challenging, due to the convoluted interplay between radiation and immune responses. This review provides a real-world guide for optimizing immunoradiotherapy in clinical practice, focusing on four critical areas: pre-treatment factors, immunotherapy sequencing, RT planning, and post-treatment follow-ups. Key considerations include prior patient treatments, the timing of immunotherapy, radiation dosing/fractionation strategies, tumor size, organs at risk, and effective post-RT monitoring, which collectively will help tailor a precise approach. Moreover, with the ever-increasing utilization of artificial intelligence (AI), we will discuss recent methods to integrate AI into RT planning and personalized immunoradiotherapy. By addressing these complexities, this review aims to bridge the gap between research and clinical practice, facilitating the successful application of immunoradiotherapy into the oncology field.