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Radiation therapy has a well-established role in the treatment of locally advanced, clinically node-positive rectal cancer. Radiation therapy has been demonstrated in numerous randomized trials to decrease the rates of local failure. There are two radiation treatment schemas which have been proven to be effective, including standard fractionated chemoradiation and short-course radiation therapy. More recent studies are evaluating the potential impact of omission of radiation therapy and surgical resection, respectively, for favorable-risk locally advanced tumors.