Several studies have examined postoperative complications and survival rates with preoperative short-course radiation therapy. A British Columbia study examined 63 patients receiving 25 Gy in 5 fractions over 1 week: 11 patients (17%) had postoperative complications, which included anastomotic leak (n = 3), perineal wound breakdown (n = 3), fecal incontinence (n = 2), rectovaginal fistula (n = 1), bowel obstruction (n = 1), and anastomotic stricture (n = 1). Local recurrence occurred in 3 patients (5%).8 The 5-year recurrence-free survival rate was 83% for stage I, 75% for stage II, and 62% for stage III. Read et al9 evaluated 260 preoperatively irradiated patients with rectal cancer and compared the outcome in patients receiving either short-course irradiation (20 Gy in 5 fractions), long-course irradiation (45 Gy in 25 fractions), or long-course irradiation with concomitant chemotherapy. A complete response (eg, no evidence of residual tumor) was found in 5% of patients receiving short-course irradiation, in 4% of patients receiving long-course irradiation, and in 8% of the combined chemoradiation group. Tumor down-staging occurred in 42% of patients receiving short-course irradiation compared with 45% of long-course patients and 48% of the combined chemoradiation group. Although the complication rates were similar in all groups, chemoradiation patients had the highest rates of toxic side effects (25%) and short-course irradiation patients the lowest (0%). Short-course irradiation appears to have similar clinical efficacy and is associated with fewer adverse effects than long-course irradiation.