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 September 3, 2026.

51Randomized trials
16,678Patients included
42ICI vs no-ICI trials
9RT vs no-RT trials
12Tumor types
Search updated through: September 3, 2026 — next update scheduled March 2027

Key results

Random-effects meta-analysis (REML)
💉Immune checkpoint inhibitors (ICIs) added to radiotherapy — 42 trials

Trials comparing ICI + radiotherapy versus radiotherapy alone.

Overall Survival (OS) · n=33 trials

HR 0.86 (95% CI 0.75–1.00) p = 0.046 Excl. glioblastoma: HR 0.82 (0.70–0.96), p=0.016

Progression-Free Survival (PFS) · n=33 trials

HR 0.78 (95% CI 0.68–0.90) p < 0.001 Excl. glioblastoma: HR 0.72 (0.61–0.84), p<0.001

Event-Free Survival (EFS) · n=8 trials

HR 0.71 (95% CI 0.53–0.95) p = 0.022
Sequencing effect: Adjuvant ICI schedules show the most favorable pooled estimates (OS HR 0.80, PFS HR 0.70) versus concurrent (OS HR 0.94, PFS HR 0.88); induction is similar to adjuvant. The adjuvant-versus-concurrent difference was significant in v1 (OS p=0.035, PFS p=0.017) but is attenuated and no longer significant with the added trials (OS p=0.07, PFS p=0.07).
☢️Radiotherapy added to ICIs — 9 trials

Trials comparing ICI + radiotherapy versus ICIs alone. NSCLC (n=3), SCLC (n=3), kidney (n=2), advanced solid tumors (n=1).

Overall Survival (OS) · n=8 trials

HR 0.89 (95% CI 0.63–1.25) p = 0.499

Progression-Free Survival (PFS) · n=9 trials

HR 0.88 (95% CI 0.63–1.23) p = 0.450
Interpretation: Across nine trials there is no statistically significant benefit for either OS (HR 0.89, 95% CI 0.63–1.25) or PFS (HR 0.88, 0.63–1.23), with substantial between-study heterogeneity (OS I²=64%). Estimates remain limited by the small number of trials.

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 — cumulative, Jan 2010 to Sep 2026
IDENTIFICATION Records identified PubMed + EMBASE (n = 7,182) Cross-referencing (n = 1) Duplicates removed n = 1,006 SCREENING Unique records screened n = 6,176 Excluded on title/abstract n = 5,862 ELIGIBILITY Full texts assessed n = 314 Excluded — full text (n=263) Not most recent report (n=95) Ineligible design/protocol (n=71) No survival outcomes (n=71) No ICIs / other reasons (n=26) INCLUSION Included in meta-analysis n = 51 randomized trials 16,678 patients ICI vs no ICI 42 trials OS · PFS · EFS RT vs no RT 9 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
September 2026 · v2.0 — First living update
Second version — 51 trials, 16,678 patients
Six-month search update of PubMed and EMBASE (through 3 September 2026), same predefined strategy and eligibility criteria. Ten new randomized trials added (7 ICI vs no-ICI, 3 RT vs no-RT), including the first rectal cancer trials. Main changes versus v1: First, pooled OS for ICIs added to radiotherapy reached statistical significance — HR 0.86 (95% CI 0.75–1.00, p=0.046), and HR 0.82 (0.70–0.96, p=0.016) excluding glioblastoma. Second, the PFS benefit strengthened to HR 0.78 (0.68–0.90, p<0.001) and EFS to HR 0.71 (0.53–0.95, p=0.022). Third, the advantage of adjuvant over concurrent ICI timing was attenuated and is no longer statistically significant with the added trials (adjuvant vs concurrent: OS p=0.07, PFS p=0.07; v1 p=0.035 and p=0.017). Adjuvant schedules keep the most favorable pooled estimates (OS HR 0.80, PFS HR 0.70) versus concurrent (OS 0.94, PFS 0.88); induction is similar to adjuvant.
51 trials16,678 patients10 new trials+ rectal cancerOS now significant
March 2027 · v3.0 — Scheduled
Next update — search through early 2027
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
Send us an email

This will open your default email client (e.g. Outlook) with both corresponding authors pre-filled as recipients.

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 51 included randomized trials
💉ICI trials — ICIs added to radiotherapy (42 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.
  4. You R, et al. Standard chemoradiotherapy with concurrent and adjuvant camrelizumab in high-risk nasopharyngeal carcinoma: multicentre, randomised, open-label, phase 3 trial. BMJ. 2026;390:e085863. [NCT04453826]
  5. Chun SH, et al. Randomized phase II trial of consolidation pembrolizumab after definitive chemoradiotherapy in locally advanced nasopharyngeal carcinoma (KCSG HN19-09, CONPELAN). Head Neck. 2026. doi:10.1002/hed.70329

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).
  8. Simone CB, et al. SWOG/NRG S1914: randomized phase III trial of induction/consolidation atezolizumab plus SBRT versus SBRT alone in high-risk, early-stage NSCLC. J Clin Oncol. 2025;43(16_suppl):8003. [NCT04214262]

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.
  6. Liu D, et al. Induction camrelizumab plus chemotherapy followed by chemoradiotherapy and consolidation camrelizumab in limited-stage SCLC: a randomized phase II trial. J Thorac Oncol. 2025 (abstract). [ChiCTR2000032275]

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.

Rectal cancer

  1. Wu F, et al. Short-course radiotherapy-based total neoadjuvant therapy plus tislelizumab for locally advanced rectal cancer (Neo-STAR): early outcomes of a randomized phase II trial. Cancer Commun (Lond). 2026. doi:10.34133/cancomm.0041
  2. Xiao W, et al. Long-term survival of neoadjuvant chemoradiotherapy with or without PD-1 antibody sintilimab in pMMR locally advanced rectal cancer: a randomized clinical trial. J Clin Oncol. 2026;44(16_suppl):3610. [NCT04304209]

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).
  4. Oaknin A, et al. Maintenance dostarlimab after chemoradiation for high-risk locally advanced cervical cancer (GEICO 78-C/ATOMICC): randomized phase II trial. ESMO Open. 2026 (abstract). [NCT03833479]

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 (9 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. Bozorgmehr F, et al. Consolidative thoracic radiotherapy with atezolizumab maintenance in extensive-stage SCLC: the phase 2 TREASURE randomized clinical trial (AIO-TRK-0320). JAMA Oncol. 2026. doi:10.1001/jamaoncol.2026.2330
  6. Grønberg BH, et al. Concurrent thoracic radiotherapy, platinum/etoposide chemotherapy and durvalumab in extensive-stage SCLC: a phase III trial. J Clin Oncol. 2026;44(17_suppl):LBA8005. [NCT05223647]
  7. Li W, et al. PD-1 inhibitors plus split-course radiotherapy in advanced kidney cancer. J Oncol. 2022;2022:8100323.
  8. Lalani AA, et al. Cytoreductive stereotactic hypofractionated radiotherapy with ipilimumab/nivolumab for metastatic kidney cancer (CYTOSHRINK): randomized phase II trial. J Clin Oncol. 2026;44(7_suppl):416. [NCT04090710]
  9. Spaas M, et al. Checkpoint inhibitors in combination with SBRT in patients with advanced solid tumors (CHEERS). JAMA Oncol. 2023;9(9):1205–13.