Background: The objective of this study was to perform a non-randomised prospective examination of the efficacy of adjuvant, preoperative chemo-radiotherapy in patients with locally advanced rectal cancer.Methods: Between 1996 and 2001, patients presenting with biopsy-proven, locally advanced, rectal cancers within 12 cm of the anal verge were referred for a long course of adjuvant chemo-radiotherapy prior to their surgery. Locally advanced lesions were defined by either: (i) endoanal ultrasound showing at least full thickness penetration of the rectal wall (i.e. T3, T4); (ii) abdominal computed tomography scan showing infiltration of adjacent structures, or; (iii) clinical examination demonstrating a fixed lesion. All patients were followed through the hospital colorectal unit. A Kaplan-Meier survival analysis was used to determine survival and local recurrence rates.Results: There were 60 patients with a mean age of 61.5 years (range 33-77 years) with a sex distribution of males to females of 1.7-1.0. Curative resections were performed in 81% of these patients. The remainder (n = 12) were found to have either metastatic disease at operation (n = 5), inoperable disease (n = 2), or had positive resection margins on histology (n = 7). The mean follow up was 2.1 years (maximum 5.1 years). The overall 2-year survival rate was 86.1% (95% CI +/-5.4%). In patients undergoing curative resections, the overall 2-year survival rate was 91.4% (95% CI +/-4.8%), and the 2-year disease free survival rate was 85.1% (95% CI +/-6.2%). The 2-year local recurrence rate was 7.5%.Conclusions: The use of adjuvant, preoperative, chemo-radiotherapy in patients with locally advanced rectal cancer is associated with high short-term survival and a low recurrence rate.