Inclusion Criteria:

- Previously untreated and pathologically proven adenocarcinoma of the rectum.

- MRI staged T3 or T4, any N.

- Lower border of tumour must be within 12 cm of anal verge.

- Age greater than or equal to 18 years.

- ECOG Performance Status 0-1 (Appendix 2)

- Absolute neutrophil count greater than or equal to 1.5 x 109/L, haemoglobin greater
than or equal to 90 g/L, and platelets greater than or equal to 100 x 109/L.

- Adequate renal function: GFR greater than or equal to 55 mL/min (derived from serum
creatinine e.g. using the Cockcroft-Gault formula or measured by radioisotopic
techniques).

- Bilirubin and ALT less than or equal to 1.5 x upper limit of normal.

- No symptomatic peripheral neuropathy greater than or equal to grade 2.

- Male or non-pregnant, non-lactating female. Patients on study with reproductive
potential, or female partners with reproductive potential, must use an effective
contraceptive.

- Has provided written informed consent for participation in this trial

Exclusion Criteria:

- Presence of metastatic disease.

- Prior pelvic radiotherapy

- Febrile intercurrent illness or infection.

- Previous history of unstable angina

- Cardiac arrhythmia which in the opinion of the investigator would compromise the safe
delivery of protocol treatment

- Acute coronary syndrome even if controlled with medication

- Myocardial infarction within the last 12 months

- Concurrent treatment with other anti-cancer therapy.

- Significant medical condition which in the opinion of the investigator would
compromise the planned delivery of the chemotherapy and radiotherapy or which may be
potentially exacerbated by these modalities.

- Locally recurrent rectal cancer.