The aim of preoperative radiotherapy for rectal cancer is to improve the local control rate, increase the possibility for sphincter preservation, and improve the survival and the quality of life. Randomized clinical trials have shown that combining radical surgery with preoperative radiochemotherapy is more effective in improving the local control rate as compared with radical surgery or preoperative radiotherapy alone. With introduction of more effective novel chemotherapeutic agents and schemes of their combination, multimodal treatment with preoperative radiochemotherapy will be applied individually to treat selected patients, which is expected to further enhance the therapeutic effect of rectal cancer. This article reviewed the current status and development of preoperative radiochemotherapy for rectal cancer.