Despite intensive research into biomarkers and prognostic factors for CRC, little is known about the factors influencing the survival of patients with rectal cancer. Although there is overlap with the treatment of colon cancer in the metastatic setting, rectal cancers in the locoregional setting are managed differently from colon cancers . The 1997 Swedish Cancer Trial of patients with resectable rectal cancer showed that preoperative radiotherapy improved both short-term and long-term local recurrence rates and OS compared with surgery alone  , although the authors noted that the use of radiotherapy was associated with side effects . Since then, the benefits of preoperative radiotherapy or chemoradiotherapy have been corroborated in several meta-analyses .