With the increasing popularity of the Internet, many patients will search for their conditions, symptoms, treatments, etc. on the Internet after listening to the views of several doctors, but in many cases, they will also be confused by multiple statements on the Internet. Recently, I met a patient who was found to be suffering from esophageal cancer during a physical examination. Some of them told him to have surgery first and then use traditional Chinese medicine to regulate his body; another doctor told him to go for chemotherapy after surgery; in addition, some of them told him to have radiotherapy before surgery, so he was very troubled and didn’t know what to do. In the opinion of our radiation oncologists, preoperative radiotherapy is possible for esophageal cancer, and there are clinical studies proving that preoperative radiotherapy can reduce the size of the tumor, reduce the possibility of cancer metastasis, reduce the risk of postoperative spread, and thus improve the survival rate. There are many reports of preoperative radiotherapy combined with comprehensive surgery for esophageal cancer. According to statistics, preoperative radiotherapy improves the five-year survival rate by 10% and the ten-year survival rate by 7%. The effect of preoperative radiotherapy combined with comprehensive treatment is also significantly better than surgery alone. Is it possible to have surgery first? Of course, but it depends on each patient’s specific situation. The 5-year survival rate of esophageal cancer treated by surgery alone is about 15%-20%, while radiotherapy can completely kill cancer cells, forming a complementary relationship between the two. Therefore, in order to improve the efficacy of surgery, a combination of treatments is generally required depending on the situation. Although there are still controversies about preoperative radiotherapy for esophageal cancer, it is certain that preoperative radiotherapy can indeed shrink the tumor and increase the radical resection rate of surgery. Secondly, preoperative radiotherapy reduces the rate of lymph node metastasis, decreasing the chance of metastasis and lymph node metastasis recurrence. Pre-operative radiotherapy will not increase the difficulty and complications of surgery, but can improve the five-year survival rate of patients, especially receiving the most advanced precision radiotherapy represented by TOMO, which is the most advanced in the world, can greatly reduce the side effects of radiotherapy and achieve the best effect of killing cancer cells while ensuring the normal function of organs.