The treatment of early rectal (T1) adenocarcinoma is controversial. Between 1984 and 1985, nine patients underwent local excision of rectal cancer followed by radiation therapy (RT) at the University of Florida. All cancers were exophytic and less than or equal to 3 cm in diameter. Pathologically, all tumors were adenocarcinomas, Broder Grade I or II. Surgical margins were free of tumor in eight of nine (89%) specimens. Eight of nine (89%) cancers were confined to the submucosa and one cancer invaded the muscularis propria. All patients received a minimum 4500 rad with or without a boost of an additional 1000 to 1500 rad. There were no operative deaths and the morbidity was minimal. Follow-up ranged from 24 to 127 months (mean 64). Twelve months following treatment one patient died of pneumonia, with no evidence of disease (NED). Eight patients remain NED (mean 67 months) at the time of this study.