Multiple studies have found that neoadjuvant long-course concurrent chemoradiotherapy and neoadjuvant short-course radiation therapy with immediate surgical resection have equal efficacy as regards local and distant control. However, PCR was better in long-course radiotherapy. The short-course strategy has decreased the incidence of acute radiation toxicities more than conventional chemoradiotherapy. Short-course radiotherapy is also less expensive plus more practical, particularly in busy oncology centers. There are significant benefits to postponing surgery after preoperative rectal cancer treatment. This concern progresses to the short-course radiotherapy approach with subsequent chemotherapy prior to surgical resection aiming to improve complete pathological response rates with less radiation toxicities. Whether neoadjuvant short-course irradiation with delayed resection or neoadjuvant conventional concurrent chemoradiotherapy is the best strategy is still being debated.