AIM: To develop novel biomarkers of rectal radiotherapy, we measured gene expression profiles on biopsies taken before and during preoperative radiotherapy. METHODS: Six patients presenting with a locally advanced rectal cancer (T>T2, N0/Nx, M0) eligible for preoperative radiotherapy (45 Gy in 25 fractions) were selected in a pilot study. Six tumor and 3 normal tissues biopsies were taken before and during radiotherapy,after a dose of 7.2 Gy at a median time of 1 h following irradiation (0:27-2:12). Tumor or normal tissue purity was assessed by a pathologist prior to RNA extraction. Mean RNA content was 23 μg/biopsy (14-37) before radiotherapy and 22.7 μg/biopsy (12-35) during radiotherapy. After RNA amplification, biopsies were analysed with 54K HG-U133A Plus 2.0 Affymetrix expression micro-arrays. Data were normalized according to MAS5 algorithm. A gene expression ratio was calculated as: (gene expression during radiotherapy-gene expression before radiotherapy)/gene expression before radiotherapy. Were selected genes that showed a ratio higher than ± 0.5 in all 6 patients. RESULTS: Microarray analysis showed that preoperative radiotherapy significantly up-regulated 31 genes and down-regulated 6 genes. According to the Gene Ontology project classification, these genes are involved in protein metabolism (ADAMDEC1 ; AKAP7 ; CAPN5 ; CLIC5 ; CPE ; CREB3L1 ; NEDD4L ; RAB27A), ion transport (AKAP7 ; ATP2A3 ; CCL28 ; CLIC5 ; F2RL2 ; NEDD4L ; SLC6A8), transcription (AKAP7 ; CREB3L1 ; ISX ; PAB-PC1L ; TXNIP), signal transduction (CAPN5 ; F2RL2 ; RA- B27A ; TNFRSF11A), cell adhesion (ADAMDEC1 ; PXDN ; SPON1 ; S100A2), immune response (CCL28 ; PXDN ; TNFRSF11A) and apoptosis (ITM2C ; PDCD4 ; PVT1). Up-regulation of 3 genes (CCL28 ; CLIC5 ; PDCD4) was detected by 2 different probes and up-regulation of 2 genes (RAB27A ; TXNIP) by 3 probes. CONCLUSION: Micro-arrays can efficiently assess early transcriptomic changes during preoperative radiotherapy for rectal cancer, and may help better understand tumor radioresistance. AIM: To develop novel biomarkers of rectal radiotherapy, we measured gene expression profiles on biopsies taken before and during preoperative radiotherapy. METHODS: Six patients presenting with a locally advanced rectal cancer (T> T2, NO / Nx, M0) eligible for preoperative radiotherapy (45 Gy in 25 fractions) were selected in a pilot study. Six tumor and 3 normal tissues biopsies were taken before and during radiotherapy, after a dose of 7.2 Gy at a median time of 1 h following irradiation (0: 27-2: 12). Tumor or normal tissue purity was assessed by a pathologist prior to RNA extraction. Mean RNA content was 23 μg / biopsy (14-37) before radiotherapy and 22.7 μg / biopsy (12-35) during radiotherapy. After RNA amplification, Biopsies were analyzed with 54K HG-U133A Plus 2.0 Affymetrix expression micro-arrays. Data were normalized according to MAS5 algorithm. A gene expression ratio was calculated as: (gene expression during radiotherapy-gene expression before radiotherapy) / gene expression befo Were selected genes that showed a ratio higher than ± 0.5 in all 6 patients. RESULTS: Microarray analysis showed that preoperative radiotherapy significantly up-regulated 31 genes and down-regulated 6 genes. According to the Gene Ontology project classification, these genes is involved in protein metabolism (ADAMDEC1; AKAP7; CAPN5; CLIC5; CPE; CREB3L1; NEDD4L; RAB27A), ion transport (AKAP7; ATP2A3; CCL28; CLIC5; F2RL2; NEDD4L; SLC6A8) (CCL28; PXDN; TNFRSF11A) and apoptosis (ITM2C; PDCD4; PVT1); cell adhesion (ADAMDEC1; Up-regulation of 3 genes (CCL28; CLIC5; PDCD4) was detected by 2 different probes and up-regulation of 2 genes (RAB27A; TXNIP) by 3 probes. CONCLUSION: Micro-arrays could assess assess early transcriptomic changes during preoperative radiotherapy for rectal cancer, and may help better understand tumor radioresistance