Modern radiotherapy in inoperable locally advanced non-small cell lung cancer: a review of techniques, dose fractionation, and immuno-synergistic strategies

For patients with inoperable locally advanced non-small cell lung cancer (LA-NSCLC), concurrent chemoradiotherapy followed by durvalumab consolidation is the current standard of care. However, local recurrence remains a predominant therapeutic obstacle. This review therefore aims to synthesize recent advancements in radiotherapy techniques, dose optimization, and immunotherapy integration to provide references for clinical practice and future research. This review synthesizes current literature to evaluate advancements in radiotherapy techniques, dose fractionation strategies, and their integration with immunotherapy. Intensity-modulated radiotherapy (IMRT) has become the standard technique, with long-term follow-up data confirming its survival benefits and safety. Advanced techniques including stereotactic body radiotherapy (SBRT) and particle therapy show potential for dose escalation but are limited by toxicity and a lack of high-level evidence. High-dose-rate brachytherapy (HDR-BT) demonstrates favorable local control with low toxicity and cost-effectiveness, though broader application awaits further validation. Regarding dose strategies, conventional dose escalation failed to improve survival, while hypofractionated radiotherapy shows promise in balancing efficacy and toxicity. The synergy with immunotherapy represents a new paradigm, with clinical trials actively exploring optimal combinations and leveraging radiotherapy's immunomodulatory potential. This review summarizes the current landscape and advancements in radiotherapy for LA-NSCLC. Future treatment strategies should develop personalized approaches based on multidisciplinary collaboration, utilizing precision radiotherapy to safely enhance treatment intensity, applying novel biomarkers to guide clinical decision-making, and optimizing combination strategies with immunotherapy.