Some cancer patients are often hesitant to undergo radiotherapy after radical surgery. Will radiotherapy lead to recurrence and metastasis? In this article, we will talk about this issue. Patients have this question: “I have undergone radical surgery and the lesions have been removed. Since there are no more lesions, do I still need to do radiotherapy or chemotherapy?” This is because most of the malignant tumors are infiltrative growth, just like tree roots spreading underground. Surgery can remove the bulk of tumors visible to the naked eye, but there are some subclinical lesions that need microscope to be found, which are sometimes difficult to be cut out by surgery, thus becoming a source of recurrence. In contrast, postoperative radiotherapy can prevent local recurrence at the lesion site to the maximum extent, and systemic chemotherapy can reduce the risk of distant metastasis. In other words, cancer cells in the body can be eliminated within a certain range to achieve the goal of “eliminating the evil”. Some patients may ask, “Why do some patients not need radiotherapy after surgery but I need it? Some patients only need chemotherapy, but I need radiation therapy?” The need for post-operative radiotherapy is determined by the site of the tumor and the post-operative pathology, staging, and physical condition. Generally speaking, the earlier the stage (e.g. stage I and some stage II patients), the less likely you need to receive radiotherapy after surgery; the later the stage (e.g. some stage II and III patients), the more likely you need to receive postoperative treatment. As an example, the postoperative pathology of a rectal cancer patient was reported as follows: (rectal) hypofractionated adenocarcinoma with cancerous tissue penetrating the lamina propria to the subplasma membrane (pT3), cancer emboli visible in the vasculature, no cancer involvement in the severed end, and cancer metastasis visible in the mesenteric lymph nodes (3/20). If distant metastases were excluded, this patient’s postoperative diagnosis was stage IIIB of pT3N1M0 hypofractionated adenocarcinoma of the rectum. According to international clinical practice guidelines, patients with this stage require postoperative radiotherapy and chemotherapy. Receiving regular and adequate courses of postoperative radiotherapy and chemotherapy can minimize the risk of recurrence and metastasis. In the same stage IIIB, if the lesion is found in the colon, radiotherapy is not recommended, and only sufficient courses of chemotherapy are needed. This is because rectal cancer is more prone to local recurrence and the colon can move location with intestinal peristalsis, making it difficult to locate accurately. After the postoperative radiotherapy and chemotherapy, which mostly start about one month after surgery, patients just recover from the blow of surgery and start to receive treatment again, and when they hear that these treatments will have one or another side effects, they will inevitably be afraid, and some of them will have the idea of giving up treatment, thinking that their physical condition cannot tolerate it. The author would like to advise patients to listen to the advice of oncologists at this time. One month after surgery, you need to have a comprehensive examination, including blood test and imaging test, whether you can tolerate radiotherapy or not, the doctor will give you advice according to your physical condition and examination result, not the decision made by the patient himself. It should be reminded that post-operative adjuvant therapy can reduce the risk of recurrence and metastasis, but it is mostly limited to 3-6 months after surgery, and if radiotherapy is administered beyond 6 months, the effect is greatly reduced, and most adjuvant therapy is no longer recommended. In addition, radiotherapy itself does not lead to recurrence or metastasis, but it is not recommended to destroy the body at the cost of radiotherapy at all costs, and should be done according to the ability to “treat the disease and keep the patient”. Some patients may ask: Can Chinese medicine prevent recurrence and metastasis? Is it possible to replace postoperative adjuvant radiotherapy with Chinese herbal treatment? The correct answer is: for patients who need radiotherapy after surgery, Chinese and Western medicine treatment are two carriages that go hand in hand, or like two legs walking, one cannot be separated from the other. Traditional Chinese medicine has been handed down and used for thousands of years and has proven to be effective in both treatment and prevention of diseases. Chinese medicine treatment can be used throughout the whole process of cancer treatment, including before and after surgery, during radiotherapy, during the discontinuation of drug observation, and even in the late stage of cancer. Post-operative patients are depleted of qi and blood and are weak, so Chinese medicine can be used to replenish qi and nourish blood, support the righteousness and promote the body’s recovery at the fastest speed. Different sites of radiotherapy may cause radioactive oral mucositis, esophagitis, pneumonia, proctitis, etc. Patients manifest as oral ulcers, sore throat, dry mouth, pain behind the sternum after swallowing, diarrhea, etc.; chemotherapy may cause weakness, anorexia, nausea, vomiting, hair loss, numbness of hands and feet, decreased blood picture, etc. At this stage, Chinese medicine can adopt individualized treatment according to different symptoms of patients, through different forms, such as Oral, infusion, topical, acupuncture, etc., to minimize the side effects of radiotherapy, relieve symptoms, ensure the quality of life of patients, and enable radiotherapy to proceed smoothly. In conclusion, for patients who need adjuvant radiotherapy after surgery, it is undesirable to pursue radiotherapy and abandon TCM; or to blindly exaggerate the role of TCM and refuse radiotherapy.