Background: Clinical trials have studied the efficacy and safety of neoadjuvant chemotherapy (CT) and CRT in PRRC. Chau published his data on PRRC studied with MRI: tumors within 1 mm of mesorectal fascia, T3 at or below levators, tumors extending > 5 mm into perirectal fat, T4 and T1-4N2 tumors (JCO 2006; 24: 668-674). Following this strategy, we present the data from our center. Methods: Since February 2006-December 2015 we treated 54 patients (PT) with MRI-defined PRRC with CAPOX x 4 cycles, Capecitabine-radiotherapy, surgery and capecitabine 4 cycles (Chau strategy). Results: Our sample includes 27 men and 27 women, median age 58 (range 31-79). A patient died after the first CAPOX due to a hemorrhagic stroke. 51 PT had symptomatic improvement with CT (94%; IC 95%: 88-100), without identifying progression. 52 were resected, 49 had R0 resection, R1 in 2 patients, 1 lost. On an intent-to-treat analysis, pathological complete responses was achieved in 12 (pCR: 22%; IC 95%: 11-33%) of 54 patients. The median lymph nodes examined was 10. Compared with baseline MRI, 42 (80%) of 52 patients had downstaging in T only (n = 4), N only (n = 14), or both T+N (n = 24) staging. In the first month post-surgery a patient died due to sepsis. 38 patients (70%) started CT post-surgery. With a median follow up of 40 months, the 3-years DFS was 71% (IC 95%: 59 –86%), 5 local and 14 distant recurrences. The 3-years OS was 87% (IC 95%: 77-97%). Conclusions: Our data support the rutine use of CAPOX and following CRT prior to surgery on PT with PRRC, with promising results consistent with published trial data.