Colorectal cancer is one of the common gastrointestinal tumors, for which surgery is the main treatment. However, patients with locally advanced colorectal cancer have lower tolerance to surgery, with high risk for surgery and high possibility of recurrence, and are generally treated by chemotherapy. Preoperative chemoradiotherapy can effectively reduce the tumor size and kill metastatic cells early, thereby providing favorable conditions for further treatment, so it is now widely used in clinical practice. Nevertheless, preoperative chemoradiotherapy is not suitable for all patients with advanced colorectal cancer, and its clinical application should be analyzed individually according to patients’ specific condition, and the sensitivity of the patients to this treatment should be ascertained. Here, the authors address the recent progress in research of application of preoperative chemoradiotherapy in patients with locally advanced rectal cancer and its sensitivity prediction, and discuss the existing problems in the relevant studies in China and abroad as well as new treatment concepts in recent years, so as to provide a reference for its clinical application.