For a long time, radiation therapy was primarily understood through its direct cytotoxic effects on tumor cells. But increasingly, we're recognizing that radiation is not just a local ablative tool; it's also a potent modulator of the tumor microenvironment and the immune system. Today, we're going to explore this fascinating interplay. We’ll define the intriguing abscopal and bystander effects, discuss how tumors try to evade our immune defenses, and identify the key immune cells that are our allies and those that can be foes in the fight against cancer. Crucially, we'll break down the PD-1/PD-L1 and CTLA-4 immune checkpoint pathways and then dive into the rationale and mechanisms for combining radiation with immune checkpoint inhibitors, including the concept of immunogenic cell death and Damage-Associated Molecular Patterns, or DAMPs. Finally, we'll list some of the checkpoint inhibitor drugs you're likely to encounter.

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