Living Systematic Review & Meta-Analysis · Randomized Controlled Trials

Radiotherapy and Immune Checkpoint Inhibitors in Solid Tumors

An ongoing, continuously updated meta-analysis evaluating the survival impact of combining radiotherapy with immune checkpoint inhibitors (ICIs) across solid tumors. Search updated through January 15, 2026.

41Randomized trials
15,049Patients included
35ICI vs no-ICI trials
6RT vs no-RT trials
11Tumor types
Search updated through: January 15, 2026 — next update scheduled July 2026

Key results

Random-effects meta-analysis (REML)
💉Immune checkpoint inhibitors (ICIs) added to radiotherapy — 35 trials

Trials comparing ICI + radiotherapy versus radiotherapy alone.

Overall Survival (OS) · n=28 trials

HR 0.88 (95% CI 0.75–1.02) p = 0.083 Excl. glioblastoma: HR 0.83 (0.70–0.99), p=0.034

Progression-Free Survival (PFS) · n=27 trials

HR 0.80 (95% CI 0.68–0.93) p = 0.003 Excl. glioblastoma: HR 0.72 (0.61–0.86), p<0.001

Event-Free Survival (EFS) · n=7 trials

HR 0.73 (95% CI 0.55–0.99) p = 0.041
Sequencing effect: Adjuvant ICIs confer significantly greater benefit than concurrent or induction strategies. OS: pooled HR 0.81 vs 0.98 (interaction p=0.045). PFS: pooled HR 0.69 vs 0.94 (interaction p=0.013).
☢️Radiotherapy added to ICIs — 6 trials

Trials comparing ICI + radiotherapy versus ICIs alone. NSCLC (n=3), SCLC (n=1), kidney (n=1), advanced solid tumors (n=1).

Overall Survival (OS) · n=5 trials

HR 0.76 (95% CI 0.50–1.15) p = 0.198

Progression-Free Survival (PFS) · n=6 trials

HR 0.77 (95% CI 0.50–1.18) p = 0.224
Interpretation: Favorable trends but no statistically significant benefit. Limited by small number of trials and between-study heterogeneity.

Forest plots

Generated by R · metafor package
figures/Forest_OS_by_tumor_type.png
Forest plot
Forest plot not yet available
Export this figure from R and push to your GitHub repo. The website loads it automatically.
# Export OS forest plot
pdf(file.path(out_dir, "Forest_OS_by_tumor_type.pdf"), ...)
forest_with_two_bottom_pools(...)
dev.off()
pdf_convert(..., format="png", dpi=300)
↓ Download PDF

Subgroup analyses

Meta-regression · REML · Generated by R
figures/Subgroup_OS_Timing.png

Select subgroup factor

Select a subgroup factor above
Click any factor button to load its forest plot. Export subgroup figures from R using the naming convention below, then push to GitHub.
# Example: export Timing subgroup OS plot
png("figures/Subgroup_OS_Timing.png", width=2400, height=1400, res=200)
# your subgroup forest plot code
dev.off()

PRISMA flow diagram

Study selection — Jan 2010 to Jan 2026
IDENTIFICATION Records identified PubMed + EMBASE (n = 5,126) Cross-referencing (n = 1) Duplicates removed n = 679 SCREENING Unique records screened n = 4,447 Excluded on title/abstract n = 4,188 ELIGIBILITY Full texts assessed n = 259 Excluded — full text (n=218) Not most recent report (n=79) Ineligible design/protocol (n=59) No survival outcomes (n=59) No ICIs / other reasons (n=21) INCLUSION Included in meta-analysis n = 41 randomized trials 15,049 patients ICI vs no ICI 35 trials OS · PFS · EFS RT vs no RT 6 trials OS · PFS

Update timeline

Version history of the living review
January 2026 · v1.0 — Initial publication
First version — 41 trials, 15,049 patients
Systematic search of PubMed and EMBASE (Jan 2010–Jan 2026), plus one trial identified through cross-referencing. 41 randomized trials included: 35 ICI vs no-ICI and 6 RT vs no-RT trials. Pre-registered on PROSPERO (CRD42024596888).
41 trials15,049 patientsOS · PFS · EFSPROSPERO: CRD42024596888
July 2026 · v2.0 — Scheduled
Second update — search through July 2026
Planned update using the same predefined search strategy and eligibility criteria. New eligible studies will be incorporated and results published here.
Scheduled6-month cycle
Living review protocol: The search is updated every six months using the same predefined strategy and eligibility criteria. Future updates remain focused on immune checkpoint inhibitors to preserve methodological consistency over time.

Downloads

Automatically updated when R pushes new figures to GitHub
💉Forest plots — ICIs added to RT
📊
OS — All tumors
Forest_OS_by_tumor_type
↓ PDF
📊
PFS — All tumors
Forest_PFS_by_tumor_type
↓ PDF
📊
EFS — All tumors
Forest_EFS_by_tumor_type
↓ PDF
🖼️
OS — PNG
Forest_OS_by_tumor_type
↓ PNG
🖼️
PFS — PNG
Forest_PFS_by_tumor_type
↓ PNG
🖼️
EFS — PNG
Forest_EFS_by_tumor_type
↓ PNG
☢️Forest plots — RT added to ICIs
📊
OS — RT vs no RT
Forest_OS_RTvsNoRT
↓ PDF
📊
PFS — RT vs no RT
Forest_PFS_RTvsNoRT
↓ PDF
🖼️
OS — PNG
Forest_OS_RTvsNoRT
↓ PNG
🖼️
PFS — PNG
Forest_PFS_RTvsNoRT
↓ PNG
📁Data files
📄
Available tumor types
results/available_tumors.json
↗ View

About this study

📄Publication

Title: The survival impact of combining radiotherapy and immune checkpoint inhibitors in patients with solid tumors: a systematic review and living meta-analysis of randomized controlled trials.

Journal: European Journal of Cancer (EJC)  ·  Type: Systematic review & meta-analysis  ·  PROSPERO: CRD42024596888

👥Authors — Amsterdam UMC & Gustave Roussy
MTMathijs L. Tomassen # CPClaudia E. Pronk # EDEric Deutsch JVJoost J.C. Verhoeff BSBen J. Slotman HLHanneke W.M. van Laarhoven IBIdris Bahce AAAbrahim Al-Mamgani TGTanja D. de Gruijl SSSuresh Senan FSFamke L. Schneiders * PRPeter S.N. van Rossum *

# Shared first author  ·  * Shared last author

📬Contact

Questions about the meta-analysis, methodology, or collaboration? Click the button below to send us an email directly.

Mathijs L. Tomassen, MD Corresponding author
Department of Radiation Oncology, Amsterdam UMC
Peter S.N. van Rossum, MD, PhD Corresponding author
Department of Radiation Oncology, Amsterdam UMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
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Disclaimer
This website presents results from a peer-reviewed living meta-analysis published in the European Journal of Cancer. Results are updated every six months as new trials become available; updated results have not yet undergone peer review and should be considered preliminary until published.

The information is intended for scientific communication only. No rights can be derived from the data or results presented here.

© Tomassen et al. All rights reserved. Content may not be reproduced without prior written permission from the authors.

Citations

All 41 included randomized trials
💉ICI trials — ICIs added to radiotherapy (35 trials)

Glioblastoma

  1. Omuro A, et al. Radiotherapy combined with nivolumab or temozolomide for newly diagnosed glioblastoma with unmethylated MGMT promoter. Neuro Oncol. 2023;25(1):123–34. [CheckMate-498]
  2. Brown NF, et al. Ipilimumab with temozolomide vs. temozolomide alone after surgery and chemoradiotherapy in recently diagnosed glioblastoma. Neuro-Oncology Advances. 2025;7(1). [Ipi-Glio]
  3. Sim HW, et al. NUTMEG: A randomized phase II study of nivolumab and temozolomide versus temozolomide alone in newly diagnosed older patients with glioblastoma. Neurooncol Adv. 2023;5(1):vdad124.
  4. Cabarrou B, et al. STERIMGLI: Hypo-fractionated stereotactic re-irradiation plus durvalumab vs re-irradiation alone for recurrent glioblastoma. Neuro-Oncology. 2025;27(Suppl_5):v99.
  5. Lim M, et al. Phase III trial of chemoradiotherapy with temozolomide plus nivolumab or placebo for newly diagnosed glioblastoma with methylated MGMT promoter. Neuro Oncol. 2022;24(11):1935–49. [CheckMate-548]

Head and neck cancer

  1. Tao Y, et al. Long-term results of KEYNOTE-412: pembrolizumab plus CRT for locally advanced HNSCC. J Clin Oncol. 2025;43(16_suppl):6013.
  2. Bourhis J, et al. Nivolumab added to cisplatin and radiotherapy versus cisplatin and radiotherapy alone after surgery for HNSCC (NIVOPOST-OP). The Lancet. 2025.
  3. Uppaluri R, et al. Neoadjuvant and adjuvant pembrolizumab in locally advanced head and neck cancer (KEYNOTE-689). N Engl J Med. 2025;393(1):37–50.
  4. Haddad R, et al. Atezolizumab in high-risk locally advanced squamous cell carcinoma of the head and neck (IMvoke010). JAMA. 2025;333(18):1599–607.
  5. Lee NY, et al. Avelumab plus chemoradiotherapy versus chemoradiotherapy alone in locally advanced HNSCC (JAVELIN Head and Neck 100). Lancet Oncol. 2021;22(4):450–62.

Nasopharyngeal cancer

  1. Liang Y-L, et al. Adjuvant PD-1 blockade with camrelizumab for nasopharyngeal carcinoma (DIPPER). JAMA. 2025;333(18):1589–98.
  2. Liu S-L, et al. Neoadjuvant and adjuvant toripalimab for locoregionally advanced nasopharyngeal carcinoma (B2019-014-01). Lancet Oncol. 2024;25(12):1563–75.
  3. Liu X, et al. Induction-concurrent chemoradiotherapy with or without sintilimab in locoregionally advanced nasopharyngeal carcinoma (CONTINUUM). The Lancet. 2024;403(10445):2720–31.

NSCLC

  1. Zhou Q, et al. Sugemalimab versus placebo after chemoradiotherapy in stage III NSCLC (GEMSTONE-301). Lancet Oncol. 2022;23(2):209–19.
  2. Spigel DR, et al. Five-year survival outcomes from PACIFIC: durvalumab after chemoradiotherapy in stage III NSCLC. J Clin Oncol. 2022;40(12):1301–11.
  3. Pircher A, et al. KEYNOTE-867: stereotactic body radiotherapy with pembrolizumab for unresected stage I/II NSCLC. Ann Oncol. 2024.
  4. Wu Y-L, et al. PACIFIC-5: consolidation durvalumab in unresectable stage III NSCLC after chemoradiotherapy. J Hematol Oncol. 2025;18(1):111.
  5. Wang Y, et al. InTRist: induction toripalimab plus chemotherapy followed by concurrent CRT in bulky unresectable stage III NSCLC. J Clin Oncol. 2025;43(16_suppl):8012.
  6. Chang JY, et al. Stereotactic ablative radiotherapy with or without immunotherapy for early-stage NSCLC (I-SABR). Lancet. 2023;402(10405):871–81.
  7. Bradley JD, et al. Durvalumab with chemoradiotherapy for unresectable stage III NSCLC: final results from PACIFIC-2. Ann Oncol. 2024;9(suppl_3).

SCLC

  1. Higgins KA, et al. Chemoradiation ± atezolizumab in limited-stage SCLC (NRG/Alliance LU005). J Clin Oncol. 2025:JCO-25-01569.
  2. Cheng Y, et al. Durvalumab after chemoradiotherapy in limited-stage SCLC (ADRIATIC). N Engl J Med. 2024;391(14):1313–27.
  3. Zhang P, et al. Toripalimab consolidation after concurrent CRT in limited-stage SCLC (2019-FXY-243). J Clin Oncol. 2024;42(16_suppl):8098.
  4. Peters S, et al. Consolidation nivolumab and ipilimumab versus observation in limited-disease SCLC after chemoradiotherapy (STIMULI). Ann Oncol. 2022;33(1):67–79.
  5. Gong Y, et al. AdvanTIG-204: ociperlimab plus tislelizumab and CRT in first-line limited-stage SCLC. JTO Clin Res Rep. 2025;6(11):100911.

Esophageal cancer

  1. Kelly RJ, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer after neoadjuvant CRT (CheckMate-577). J Clin Oncol. 2025;43(16_suppl):4000.
  2. Park S, et al. Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma (ESR-14-10737). Cancer. 2022;128(11):2148–58.

Pancreatic cancer

  1. Zhu X, et al. SBRT plus pembrolizumab and trametinib versus SBRT plus gemcitabine for locally recurrent pancreatic cancer. Lancet Oncol. 2022;23(3):e105–15.

Cervical cancer

  1. Lorusso D, et al. Pembrolizumab with chemoradiotherapy for high-risk locally advanced cervical cancer (KEYNOTE-A18). Lancet. 2024;403(10434):1341–50.
  2. Monk BJ, et al. Durvalumab versus placebo with chemoradiotherapy for locally advanced cervical cancer (CALLA). Lancet Oncol. 2023;24(12):1334–48.
  3. Chargari C, et al. Atezolizumab in combination with chemoradiation in locally advanced cervical cancer (ATEZOLACC). Int J Gynecol Cancer. 2025;35(2).

Prostate cancer

  1. Fizazi K, et al. Final analysis of ipilimumab versus placebo following radiotherapy in postdocetaxel metastatic castration-resistant prostate cancer (CA184-043). Eur Urol. 2020;78(6):822–30.

Sarcoma

  1. Mowery YM, et al. Pembrolizumab, radiotherapy, and surgery versus radiotherapy and surgery for stage III soft tissue sarcoma (SU2C-SARC032). Lancet. 2024;404(10467):2053–64.

Cutaneous squamous-cell carcinoma

  1. Rischin D, et al. Adjuvant cemiplimab or placebo in high-risk cutaneous squamous-cell carcinoma. N Engl J Med. 2025;393(8):774–85.
  2. Koyfman SA, et al. KEYNOTE-630: adjuvant pembrolizumab versus placebo for high-risk locally advanced cutaneous SCC. J Clin Oncol. 2025;43(16_suppl):6000.
☢️RT trials — Radiotherapy added to ICIs (6 trials)
  1. Schoenfeld JD, et al. Durvalumab plus tremelimumab alone or in combination with low-dose or hypofractionated radiotherapy in metastatic NSCLC (NCI-2016-01325). Lancet Oncol. 2022;23(2):279–91.
  2. Kothari G, et al. Nivolumab and stereotactic ablative body radiation therapy in advanced NSCLC (NIVORAD). Int J Radiat Oncol Biol Phys. 2025.
  3. Theelen W, et al. Pembrolizumab with or without radiotherapy for metastatic NSCLC (PEMBRO-RT & MDACC pooled analysis). Lancet Respir Med. 2021;9(5):467–75.
  4. Owonikoko TK, et al. Tremelimumab and durvalumab with or without radiation for relapsed SCLC (NCI-2016-00026). J Clin Oncol. 37(15_suppl):8515.
  5. Li W, et al. PD-1 inhibitors plus split-course radiotherapy in advanced kidney cancer. J Oncol. 2022;2022:8100323.
  6. Spaas M, et al. Checkpoint inhibitors in combination with SBRT in patients with advanced solid tumors (CHEERS). JAMA Oncol. 2023;9(9):1205–13.