The Evolving Interplay of SBRT and the Immune System, along with Future Directions in the Field

Mihailo Miljanic, Steven Montalvo, Maureen Aliru, Tidie Song, Maria Leon-Camarena, Kevin Innella, Dragan Vujovic, Ritsuko Komaki, Puneeth Iyengar

Research output: Contribution to journalComment/debatepeer-review

2 Scopus citations


In this commentary, we describe the potential of highly ablative doses utilizing Stereotactic Body Radiation Therapy (SBRT) in single or few fractions to enhance immune-responsiveness, how timing of this approach in combination with immune-checkpoint inhibitors may augment treatment-effect, and whether Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR) is an avenue for future advancement in the continued endeavor to foster a systemic effect of therapy beyond the radiation treatment field. The ablative potential of SBRT may support an increase in tumor-antigen presentation, enhancement of immune-stimulatory components, and an improvement in tumor-microenvironment immune cell infiltration. Furthermore, the latest advancement of ablative radiation delivery is PULSAR-based therapy, whereby ablative doses are delivered in pulses of treatment that may be several weeks apart, combined with adaptive treatment to tumor changes across time. The benefits of this novel approach include the ability to optimize direct tumor control by assessment of tumor size and location via dedicated imaging acquired prior to each delivered pulse, and further potentiation of immune recognition through combination with concurrent immune-checkpoint blockade.

Original languageEnglish (US)
Article number4530
Issue number18
StatePublished - Sep 2022


  • SAbR
  • SBRT
  • SBRT and immunotherapy
  • adaptive radiation therapy
  • immunotherapy in combination with radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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