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Practical Radiation Oncology senior editor Michael Buckstein, MD, PhD, hosts a discussion on the recently published ASTRO clinical practice guideline on radiation therapy for rectal cancer (https://www.practicalradonc.org/article/S1879-8500(20)30207-1/fulltext). Two of the authors of the guideline, Jennifer Wo, MD of Massachusetts General Hospital and Prajnan Das, MD, MS, MPH of MD Anderson Cancer Center, discuss the development process of the guideline and the evidence for the recommendations included. Brian Czito, MD, of Duke University Medical Center and an author of the associated commentary Emerging Treatment Paradigms in Localized Rectal Cancer (https://www.practicalradonc.org/article/S1879-8500(20)30270-8/fulltext), discusses some of the ongoing and upcoming paradigm shifts in the treatment of rectal cancer.