With the progression of multidisciplinary approaches for the treatment of locally advanced rectal cancer (LARC), chemoradiation therapy (CRT) followed by total mesorectal excision (TME) has been widely adopted as a standard treatment for LARC.[1] This treatment strategy provides a better outcome regarding sphincter preservation rates, the probability of curative resection, and reducing local recurrence rates. Undoubtedly, the primary endpoint of preoperative CRT is the achievement of pathologic complete response (pCR) prior to surgery. pCR, which is obtained in 8.0% to 24.0% of patients receiving preoperative CRT, is strongly associated with good long-term outcomes, and has been suggested as a prognostic indicator.[2–6] In contrast, the majority of patients who received preoperative CRT showed significant residual disease, and these patients showed significantly poorer outcomes compared with patients with good tumor responses.[3] Although pathologic response information can serve as a prognostic indicator, it may not be available before surgical removal of the tumor. Under these circumstances, preoperative prediction of pathologic response to preoperative CRT could enable development of personalized treatment protocols, reducing unnecessary exposure of patients to extensive surgery, and subsequently improving quality of life.