Sixty-seven patients with primary, apparently inoperable rectal adenocarcinomas were referred for radiotherapy from a defined geographic region in Norway during the period from 1976 to 1981. Fifty-five were without detectable metastasis at referral and were potentially resectable. Patients were given high energy radiation towards abdominal chimney or pelvic fields to a dose of 3150 rads. Resection was attempted after three weeks. Additional radiotherapy was given to both resected and nonresected patients to a NSD (nominal standard dose) of 1400 to 1560 ret (rad equivalent therapy). At full radiation dose, nonresected patients were reexamined, and in some explorative laparotomy with resection was attempted. Twenty patients had radical resections in the pelvis, but five of them had moderately advanced distant metastasis. Nine patients are disease-free at 12+ to 76+ months. Although the overall prognosis for the patients with apparently inoperable rectal adenocarcinomas remains poor (median survival 12 months), some patients can achieve long-term disease-free survival after combined radiotherapy and surgery. Patients with moderately advanced metastasis can enjoy a better of quality of life without local symptoms following the combined treatment.