OBJECTIVE The aim of the study was to find out whether pre-operative radiochemotherapy had any survival advantage over postoperative radiochemotherapy for rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis. METHODS Between January 1998 and December 2003, 51 rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis were randomly divided into pre-operative (PRE) and postoperative (POST) radiochemotherapy groups. Twenty-six were assigned to the PRE group and were operated on 5 to 8 weeks after the completion of radiotherapy. The other 25 patients were operated on immediately and received radiotherapy postoperatively 2 to 4 weeks after surgery. The patients were followed up for between 4 to 51 months. RESULTS In the PRE group the rates of disease-free survival were 92%, 70%, 56% and 56% at the end of the 1t, 2d, 3"r and 4th years, respectively. In the POST group those percentages were 83%, 68%, 51% and 51% at the 1S", 2nd, 3r and 4th years, respectively (p = 0.707). One-year and 4-year overall survival rates in the PRE group were 100% and 86% respectively and 100% and 60% in the POST group (p = 0.520). CONCLUSIONS No statistical difference was found between the survival rates of the rectal carcinoma patients receiving radiotherapy either pre-operatively or postoperatively. However, the disease-free survival rates of the PRE group were higher than the POST group's during each year and overall survival rates were higher after the third and fourth years. We conclude that pre-operative radiotherapy is at least as effective as postoperative radiotherapy.