The standard treatment for advanced rectal cancer is preoperative chemoradiotherapy (CRT) followed by standard resection of the rectum. Neoadjuvant CRT allows downsizing and downstaging of the tumour, leading to improved resectability and local control. The clinical question is what to do with good response after CRT. Most surgeons advocate performing a resection on the basis of the status before CRT disregarding the response. However, major pelvic surgery is associated with a high postoperative morbidity rate of 40%-50%. The paradigm shift in treatment is further tailoring of treatment for the good responders after CRT aiming at organ saving treatment options with less morbidity, such as local excision. Although still controversial, a wait-and-see-policy (omission of surgery under close monitoring) is being advocated for the complete responders. This shift in treatment has consequences for radiologists. Our major challenge will be to provide tools that can help in precise selection of these patients. The challenge will not only restrict to an accurate evaluation of the local tumour response but also extend to an accurate evaluation of the nodal response. This lecture will focus on the evidence-based role of EUS and MRI for response evaluation after CRT. Accuracy and limitations of each method will be discussed. The lecture will dwell on potential new techniques (diffusion and perfusion MRI, lymph node-specific contrast enhanced MRI, PET/ CT) that can overcome the limitations of standard imaging. Learning Objectives: 1. To understand the evidence based role of imaging for re-staging locally advanced rectal cancer after chemoradiotherapy.