Maintenance immunotherapy after concurrent chemoradiotherapy remains the standard therapeutic approach in patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC). The efficacy of pembrolizumab without chemotherapy in stage Ⅳ NSCLC has incited interest in similar approaches for LA-NSCLC. Several recent investigations involving the synergistic potential of immunotherapy combined with radiotherapy (iRT) have generated encouraging results. This review discusses the existing studies and prospective directions of chemotherapy-free iRT strategies in unresectable LA-NSCLC. Although the initial findings of chemotherapy-free iRT strategies have shown promising efficacy, we must consider the methodologic limitations of current studies and the myriad of challenges that accompany the implementation of chemotherapy-free iRT. These challenges include determining the optimal dose and fractionation, precise target volume delineation, and identification of additional suitable patient cohorts. Furthermore, the feasibility of chemotherapy-free iRT as a novel treatment modality for select patients with LA-NSCLC is contingent upon validation through randomized phase Ⅲ trials.

In cancer radiotherapy (RT), each step can be digitalized, from CT simulation, planning, dose verification, and image guidance to treatment delivery. Therefore, RT may be the most digitized discipline in the field of internal medicine. Then, questions arise. What potential development opportunities does the development of network transmission technologies, such as blockchain and 5G, provide to promote the progress of tumor RT? What will the future of smart RT (SART) look like? The purpose of this article is to introduce briefly the main characteristics of blockchain and 5G transmission technologies and share ideas to imagine the “tomorrow” of smart RT, hoping to provide a more accurate, safe, and comfortable RT experience for patients in the future.