Introduction:In recent years, the approach to adjuvant therapy for rectal cancer in the United States and Europe has been shifting toward preoperative therapy to promote sphincter-preserving surgery and decrease acute and late bowel toxicity.
Patients&Methods:This study will be a phase II trial to study the effectiveness of combining chemotherapy (Gemcitabine) and external – beam radiotherapy followed by surgery in treating patients who have locally advanced rectal cancer , It is carried on Sohag University Hospital & Sohag NCI since( October 2014- December2017),the dose of radiotherapy 5040 cGy /28ttt,and chemotherapy dose is 45mg/m2 given twice weekly during radiotherapy sessions only,  the study included 30 patients (age 18 and over), having rectal cancer with the following eligibility criteria:histologically proven ,previously untreated rectal carcinoma , every patient in the study was subjected to the following:history & physical examination,laboratory investigations, radiological studies.
 Results:Thirty patients were included in the study,13 females (43.3%) and 17 male( 56.6%)     mean of the age was 49 years. (range24-65year), most of them had adenocarcinoma of the rectum, the main presenting symptom was bleeding per rectum(56.7%), as regard to the response to the neoadjuvant treatmen 12/30 patients (40%) achieved Partial response,  8/30patients(27.6%) achieved complete  response and 10/30 patients (33%) had no response, abdomino - perineal resection was performed in 19 patients(63.3%)  and 11 patients (36.7%)  underwent sphincter preservation operation, about the toxicity in this study,for chemotherapy diarrhea was the most common manifestation which seen in 25 patients(83%),followed by loss of appetite seen in 9 patients(63.3%), for radiotherapy 19 patients (63%) developed wet desquamation. the  rate of Overall Survival of  the 2-years study is (80%),the Disease free survival is (63%)while the progression free survival is (72%),N stage was the only significant factor affecting the disease free survival and overall survival.
Conclusion: Pre-operative chemo-radiotherapy in dose and fractionation schedule used is safe, effective and well tolerated, allowed sphincter preservation which performed in (36.7%) of patients