Patients who have received prior pelvic radiotherapy Prior pelvic radiotherapy or prostatectomy Previous pelvic radiotherapy Histological or cytological confirmation of locally recurrent or metastatic rectal adenocarcinoma\r\n* Note: Patients with locally recurrent/persistent disease within the pelvis after primary therapy (chemotherapy, surgery, and/or radiotherapy) are eligible\r\n* Note: Patients who have had prior pelvic radiotherapy with a total dose of =< Gy are eligible\r\n* Note: Patients with or without metastatic disease (excluding untreated central nervous system [CNS] metastasis), with primary pelvic disease or pelvic recurrence are eligible\r\n* Note: Patients with pelvic disease that is potentially resectable or unresectable are eligible No prior pelvic radiotherapy, chemotherapy, immunotherapy, or other anti-cancer treatment for rectal cancer Prior pelvic radiotherapy Patients with any prior chemotherapy or radiotherapy for pelvic malignancy Candidate for pelvic or pelvic-inguinal radiotherapy and concurrent chemotherapy; patients undergoing preoperative chemoradiotherapy are excluded Patient with any prior chemotherapy or radiotherapy for pelvic malignancy Patient with any prior chemotherapy or radiotherapy for pelvic malignancy Completion of pelvic radiotherapy treatment for this current rectal cancer or any prior pelvic radiotherapy (e.g., prior prostate or cervical cancer therapy). Pelvic radiotherapy administered within less than months prior to enrollment. Subjects who received radiotherapy ? months prior to enrollment must demonstrate no cystoscopic evidence or symptoms of radiation cystitis. Prior pelvic radiotherapy No prior pelvic radiotherapy Any previous pelvic radiotherapy Patients must not have received pelvic radiotherapy as treatment for primary or recurrent disease within year of the first dose of study treatment. Patients must be planned to receive whole pelvic radiotherapy to a total dose of Gy or greater Patients who received prior pelvic radiotherapy for any indication History of any major rectal or pelvic surgery or radiotherapy Previous pelvic radiotherapy Prior history of pelvic radiotherapy E . Prior isotope therapy, whole pelvic radiotherapy, or radiotherapy to >% of bone marrow. Patients with a history of pelvic or abdominal radiotherapy; Has received and completed a course of pelvic radiotherapy ? months prior to LAR surgery (Day ). Candidate for pelvic, pelvic-inguinal, or extended field radiotherapy with or without concurrent chemotherapy; patients undergoing preoperative or adjuvant chemotherapy are excluded Prior breast, chest or pelvic radiotherapy Pelvic radiotherapy administered within less than months prior to enrollment. Subjects who received radiotherapy ? months prior to enrollment must demonstrate no cystoscopic evidence or symptoms of radiation cystitis. Willingness to undergo pelvic radiotherapy No prior pelvic radiotherapy Prior history of pelvic radiotherapy Past history of pelvic radiotherapy subjects with any contraindication to pelvic radiotherapy including, but not limited to, previous pelvic radiotherapy or brachytherapy