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Good responses (ypStage I) after preoperative chemoradiation therapy (CRT) and curative resection for locally advanced rectal cancer are associated with excellent local control and improved disease-free survival. This study was conducted to evaluate whether this population has comparable oncologic outcomes with those for patients with early rectal cancer (pStage I).This prospective study included 123 patients with pathologic stage I rectal cancer that was located less than 7 cm from the anal verge and who underwent radical resection. Of the 123 patients, 30 patients underwent preoperative CRT followed by radical resection, while 93 underwent proctectomy with no preoperative treatment. The oncologic outcomes between the 2 groups were compared.The median follow-up period was 78 months. The pretreatment clinical staging was significantly different between the 2 groups (P < .001). The 10-year overall and disease-free survival rates for the patients who received preoperative CRT were 48% and 75%, respectively, which were different from the rates for those patients who did not undergo preoperative CRT (83%; P = .001 and 93%; P = .001, respectively); however, the 10-year local recurrence rates did not significantly differ between the patients who received preoperative CRT and those who did not receive preoperative CRT (7% vs5%, respectively, P = .381).Good responses after preoperative CRT and curative resection for locally advanced rectal cancer may be associated with local control that is similar to that of the patients with early rectal cancer.