Major uncertainties which impact on pre- or postoperative radiotherapy of rectal neoplasms and operational measures taken to lower the risks in prescription, planning, delivery and follow-up of radiotherapy, are examined. In prescription, major problems related with the selection of treatment dose and volumes, are considered. In planning, irradiation techniques and systems for intestinal loop displacement from treatment site, are analyzed. In dose delivery, methods used to ensure treatment reproducibility and support care, are examined. Finally, in follow-up procedures used in the evaluation of disease progress, late side-effects, and life quality, are discussed.