Radiotherapy (RT) is a highly effective anti-cancer therapy delivered to around 50–60% of patients. It is part of therapy for around 40% of cancer patients who are cured of their disease. Until recently, the focus of this anti-tumour efficacy has been on the direct tumour cytotoxicity and RT-induced DNA damage. Recently, the immunomodulatory effects of RT on the tumour microenvironment have increasingly been recognized. There is now intense interest in potentially using RT to induce an anti-tumour immune response, which has led to rethinking into how the efficacy of RT could be further enhanced. Following the breakthrough of immune check point inhibitors (ICIs), a new era of immuno-oncology (IO) agents has emerged and established immunotherapy as a routine part of cancer treatment. Despite ICI improving outcomes in many cancer types, overall durable responses occur in only a minority of patients. The immunostimulatory effects of RT make combinations with ICI attractive to potentially amplify anti-tumour immunity resulting in increased tumour responses and improved outcomes. In contrast, tumours with profoundly immunosuppressive tumour microenvironments, dominated by myeloid-derived cell populations, remain a greater clinical challenge and RT may potentially further enhance the immunosuppression. To harness the full potential of RT and IO agent combinations, further insights are required to enhance our understanding of the role these immunosuppressive myeloid populations play, how RT influences these populations and how they may be therapeutically manipulated in combination with RT to improve outcomes further. These are exciting times with increasing numbers of IO targets being discovered and IO agents undergoing clinical evaluation. Multidisciplinary research collaborations will be required to establish the optimal parameters for delivering RT (target volume, dose and fractionation) in combination with IO agents, including scheduling to achieve maximal therapeutic efficacy.

Objectives To evaluate the utility of staging pelvic lymvariables. Relative to PSA and Gleason score, the patients' age, race and clinical stage were less relevant. phadenectomy and to identify factors associated with nodal metastases in which a node dissection would be Sensitivity analysis determined that combining a PSA of Á20 ng/mL (normal 0-4) and a Gleason score of of clinical benefit. Patients and methods A retrospective analysis Á8 gave a negative predictive value of 92% with a specificity of 99%, a positive predictive value of 67% (1989-1993) was performed on 303 consecutive patients who underwent staging bilateral modified and an overall accuracy of 91% for predicting nodal metastases. pelvic lymph node dissection for clinically localized prostate cancer. Multivariate logistic regression analyConclusion From this data, lymph node metastases are unlikely in patients with clinically localized prostate sis was used to evaluate age, race, clinical stage, prostate-specific antigen (PSA) level and Gleason score cancer who have a PSA of <20 ng/mL and a Gleason score <8, and that a pelvic lymph node dissection as for predicting nodal metastases. Results Twenty-eight patients had nodal metastases, an adjunctive procedure should be avoided in such individuals. giving an overall prevalence of 9.2%. PSA and Gleason score (both P<0.001) were significantly predictive of Keywords Prostate cancer, nodal metastases, laparoscopic pelvic lymph node dissection nodal involvement when combined or as independent identify factors associated with nodal disease and thereby