Background: Locally advanced rectal adenocarcinoma is typically treated by neoadjuvant chemo-radiotherapy and surgery.We assessed the effect of an additional cycle of capecitabine/oxaliplatin chemotherapy before surgery in 57 patients with rectal cancer.Materials and Methods: Radiotherapy (total dose, 50.4 Gy) was combined with three cycles of chemotherapy (two cycles concomitant with radiotherapy), and each cycle consisted of oxaliplatin (130 mg/m2 on day-l) and capecitabine (825 mg/m2, twice per day from day-1 to day-14) for 21 days.The primary end-point was pathological complete response (pCR).The secondary end-point was change in the pre-treatment and post-treatment tumor and node stages.Results: Eleven patients (19%) experienced complete tumor regression and 23 patients (40%) experienced tumor regression grade (TRG) 3.Tumor down-staging occurred in 31 patients (54.4%), and down-staging of nodes occurred in 25 patients (43.9%).There was a significant difference in tumor stage before treatment and after surgery (p < 0.001).Patients with less advanced N-stages had significantly better recurrence-free survival, but similar metastasis-free survival and overall survival.The TRG grade was not associated with overall survival, recurrence-free survival and metastasis-free survival.The most common adverse events were pulmonary infection (n =6, 10.5%) and intestinal obstruction (n =6, 10.5%).Conclusions: An additional cycle of chemotherapy given after chemo-radiotherapy and before surgery provided good efficacy and had a satisfactory safety profile in patients with rectal cancer.