Can lattice radiation boost immunotherapy to shrink lung tumors before surgery?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Voluntary agreement to participate and signed written informed consent. * Cytologically or histologically confirmed (via percutaneous lung biopsy, bronchoscopy, mediastinoscopy, etc.) bulky stage III non-small cell lung cancer (NSCLC) per AJCC 9th edition staging, with primary tumor \>5 cm (T3-T4), N0-N2, and no prior chemotherapy, radiotherapy, surgery, or immunotherapy. * Pulmonary lesion considered potentially resectable by a multidisciplinary team (MDT) including a thoracic surgeon. * Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1. * Adequate hematologic and organ function as demonstrated by: Absolute neutrophil count ≥ 1,500 × 10⁹/L. Platelet count ≥ 100 × 10⁹/L. Hemoglobin \> 9.0 g/dL. Serum creatinine ≤ 1.5 × upper limit of normal (ULN) or creatinine clearance (CrCl) ≥ 40 mL/min. AST/ALT ≤ 3 × ULN. Total bilirubin ≤ 1.5 × ULN. FEV1 ≥ 1.2 L or \> 40% of predicted value. INR/APTT within normal limits. -Age 18 to 75 years (inclusive). Exclusion Criteria: * Has or is suspected of having an autoimmune disease. Note: patients with vitiligo, type I diabetes mellitus, or hypothyroidism (Hashimoto's thyroiditis) requiring only hormone replacement therapy may be enrolled if no significant signs of recurrence are present. * Requires systemic corticosteroid therapy (\>10 mg prednisone or equivalent per day) or other immunosuppressive agents within 14 days after enrollment. Note: inhaled or topical corticosteroids, or adrenal hormone replacement therapy (\>10 mg prednisone or equivalent per day) for patients without active autoimmune disease, are permitted. * Prior history of thoracic radiotherapy. * Active bleeding prior to treatment. * Severe cardiac, pulmonary, hepatic, renal, or hematopoietic dysfunction, cachexia, or any condition that would preclude tolerance to radiochemotherapy. * History of diabetes mellitus for \>10 years with poorly controlled blood glucose. * History of interstitial lung disease or non-infectious pneumonitis. * NSCLC with known EGFR-sensitizing mutations, ALK fusion gene, or ROS1 rearrangement. * History of another malignancy (excluding non-melanoma skin cancer and carcinoma in situ of the bladder, stomach, colon, endometrium, cervix, melanoma, or breast) unless the malignancy has been in complete remission for ≥2 years and no additional anti-tumor therapy is required during the study period. * In the investigator's opinion, medically, psychologically, or physically unable to complete the study or to understand the patient information. * Prior treatment with anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4, or other agents targeting T-cell co-stimulation or immune checkpoint pathways. * Active hepatitis B (HBV DNA ≥ 2000 IU/mL or ≥ 10⁴ copies/mL) or hepatitis C (anti-HCV antibody positive and HCV-RNA above the lower limit of detection). * HIV-positive or diagnosed with acquired immunodeficiency syndrome (AIDS). * Known or suspected allergy to the study drugs or to any agent used in this trial. * Pregnant or breastfeeding women.