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Cancer of the rectum and sigmoid colon ranks second to lung cancer as the major cause of death in man. Radical surgical treatment has shown no significant improvement in the last 20 years. Radiation therapy was first utilized in the treatment as early as 1914 and has been explored by numerous investigators, either as an adjuvant to surgical resection or for palliation. There is a sound radiobiologic basis for the combined use of preoperative radiation therapy and surgery in the treatment of resectable carcinoma of the rectum. This program of management must be of the highest quality in planning and delivery, with proper attention to the limits of tolerance of the gastrointestinal viscera. The Veterans Administration Surgical Adjuvant Cancer Study Group reported a significant reduction in the finding of positive lymph nodes in patients pre‐operatively irradiated (27%) compared with the control treated by surgery alone (40%). The 5‐year survival for the preoperatively irradiated group was 40% vs. 27.5% for the surgical group. These data have been confirmed by other investigators. The Radiation Therapy Oncology Group and the Central Oncology Group have initiated a national joint program to evaluate preoperative radiation therapy in patients with carcinoma of the rectum and rectosigmoid. The objectives are to determine the efficacy of preoperative adjuvant radiation therapy, the rate of recurrence, the time of recurrence, and survival in patients treated surgically for this disease.

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