Background: The aim of the present study is to assess the response rate and toxicity profile in patients with locally advanced rectal cancer using high dose rate endorectal brachytherapy (HDR-EBT) as a start component of the neoadjuvant treatment. Material and methods: 28 patients with T3-4N0-2M0 rectal adenocarcinoma were included in the study. A novel approach using HDR-EBT is given in 4 fractions (4 Gy per fraction, 2 times a week) in combination with external beam radiotherapy (EBRT) 30,6 Gy (1,8 Gy per fraction). All patients received neoadjuvant chemotherapy during the course of irradiation consisting of Capecitabine 825 mg/m2 per os daily. results: The majority of patients were males (n=16; 57.1%), 12 (42.9%) – were females, their mean age was 60,6 years. All patients had a decrease in tumor size from average of 4,88 cm to 3,14 cm longitudinally. 21 of 28 patients (75%) had sphincter preserving surgery. 17 of 28 patients (60.7%) had a pathologic complete response of their primary tumors. Radiation therapy was well-tolerated. Acute GI and GU toxicity was limited to ≤ Grade 2 for all patients. Local recurrence in the observation group within 2 years was 3.6%. conclusions: The use of HDR-EBT as a start component of the neoadjuvant locally advanced rectal cancer treatment is an acceptable modality with high pathological response rate as well as an acceptable toxicity profile.