Important improvements in the treatment of locally advanced rectal cancer have been achieved. In patients with resectable rectal cancer, RT allows better local control, as lower local recurrence rates have been reported. The downstaging and downsizing of neoplasm consequent to radiation therapy should lead to a major number of sphincter-preserving operations. In addition, pre-operative RT has lower toxicity effects vs. post-operative radiation.

The concomitant administration of a chemothera-peutic drug has a synergic effect on local control of the disease and improves the overall survival of patients.

In literature numerous studies with interesting results in terms of downstaging, local recurrence and survival are reported but they are heterogeneous and not comparable as Authors reported different total radiation doses, chemotherapeutic drugs administered, interval from neoadjuvant treatment and surgery, stage of disease, etc.

Improvement of technology in imaging studies, and better acknowledgement of the pathological and molecular characters of neoplasms, allow the correct staging of patients after neoadjuvant treatment.

At the moment we still believe that a radical surgical procedure is a reasonable choice in patients with clinical response to neoadjuvant treatment in rectal cancer (yT0N0). Clinical surveillance is acceptable in cases of refusal of any surgical procedure by patients.

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