Could you please tell us about the role that radiation therapy plays in oncology treatment in the United States? As you know, there are three main treatment methods for tumor treatment, one is surgery, one is chemotherapy, and one is radiation therapy. Among all tumor treatments in the United States, about 70% of patients need radiation therapy in their treatment; and 70% of them are radical or involved in radical treatment, including playing a major or adjuvant role in radical treatment; and among these 70% of radical (involved in radical) treatment, 70% of patients are cured; that is, radiation therapy cures/participates in curing 35% of tumors. of tumors. In the United States, the cure rate for tumors is approximately 60-70%, which means that half or more of the tumors are cured by or with the involvement of radiation therapy. Furthermore, according to the US Federal Medical Agency, less than 5% of all oncology treatment costs are spent on radiation therapy, which means that we are curing/involved in curing 35% of oncology patients with less than 5% of society’s resources, not to mention its role in other areas such as palliative care. It can be said that radiotherapy is one of the treatments with the highest efficacy ratio when the indications are met. To your knowledge, what are the differences between radiology departments in domestic hospitals and the United States? In the US, one machine receives 30-40 patients per day, while in China, one machine receives 100 or more patients per day, so it is really difficult to do. In the United States, a radiotherapist is a four-year university graduate, a four-year doctorate, a five-year radiotherapy direction, and finally a radiotherapist, compared to the domestic training period is much shorter. So there is indeed a gap here. In the U.S., the best students in college enroll in medical school and the best students in medical school enroll in radiation therapy, so the overall quality of radiation therapists is very high, which is one of the reasons why radiation therapists in the U.S. have a higher clinical and academic status. Do you know what misconceptions there are about radiation therapy? Prof. Zhang: Some people think that radiation “causes” cancer, not “cures” cancer; they are afraid of radiation damaging normal cells and think it will cause cancer. In fact, at present (doctors, patients) are very well protected, there will not be such a situation. In fact, radiation is not terrible, we are exposed to radioactive substances every day in our daily life, for example, one day of CT radiation is actually equivalent to the amount of radiation we must receive in a year. However, from the perspective of tumor treatment, the significance of this dose to tumor treatment is much greater compared with the possible side effects. The second misconception is that people think radiation equipment is more expensive. It is true that its initial investment is very expensive, but generally radiation equipment is a one-time investment, and after the equipment is started, patients can be admitted and treated every day as long as they are plugged in, and the cost can be recovered. Compared to chemotherapy, many imported drugs for chemotherapy and targeted therapy, the annual investment is more than 100,000 to 200,000, or even dollars, which accumulates to a much larger investment than radiation equipment, so from the hospital investor’s point of view, its efficiency-to-price ratio is also relatively high. What do you think is the room for development of radiotherapy in China? Prof. Zhang: I think first of all, we need to change the perception of hospitals, national policies and the public about radiation therapy, such as the idea that radiation therapy is only a palliative treatment and surgery is the only radical cure; secondly, we need to change people’s fear of radiation therapy. In fact, everything has side effects, drinking water can choke, driving will also crash, side effects are not afraid, the main thing is that we need to know how to apply, how to avoid. In fact, there are many data showing that in the treatment of early stage lung cancer, the cure rate and survival of stereotactic radiation therapy is no different from that of surgical resection, and there are even data published in some major journals showing that in some cases, the effect of radiation therapy is even better than surgical resection. For example, lung cancer patients who die from surgical complications within 30 days of surgery have a 5% mortality rate, and 5 out of 100 patients may die from complications, but in comparison, radiation therapy in the early stages of lung cancer treatment does not say that they die from radiation therapy within 30 days. It is understandable that people are more receptive to traditional surgical methods because surgical treatment has existed for 100 years, and it is more difficult to accept new treatment methods, but there is an intellectual handover, so that people can accept the new treatment and know that in some cases, the treatment effect is the same as that of surgical treatment, and even some things that cannot be done by surgical treatment can be done. I would be happy to do some handover to the domestic radiotherapy community, the oncology community and the public. In fact, through my personal contact, many Chinese patients have already given up surgery and received radiation therapy, especially in some early stage, older patients with poor lung function, and received stereotactic therapy, the effect is also very obvious. Can you tell us about the progress of stereotactic therapy at MD Anderson Cancer Center so far? Prof. Zhang: My center has treated nearly 2,000 cases of early-stage lung cancer with stereotactic therapy so far, and the disease control rate is 98.5%, which means that only 2 out of 100 patients have recurred, and this number could not be better. I am not saying that radiotherapy can cure all patients or that all patients need radiotherapy, but under the right circumstances and with good enough quality control and technology, it has many functions that are much better than people currently think.