If the patient is being managed with curative intent (i.e. there is a plan for surgical resection of both the rectal and liver tumors), then preoperative pelvic chemoRT is reasonable for the same reasons it's indicated in the non-metastatic setting. This is a scenario where we often entertain short-...

Depending on the response of liver disease with systemic therapy, we do sometime treat with neoadjuvant RT prior to surgery. For low lying tumors, we prefer concurrent ChemoRT, but for mid or upper rectum one could do hypofractionation of 5x5 without concurrent chemo.