Rombouts AJM, et al. - Whether primary pelvic cancer irradiation increases the incidence of rectal cancer was determined by analyzing data from original articles that reported on secondary rectal cancer after previous radiation therapy (RT) for a primary pelvic cancer. These articles were identified from the PubMed and EMBASE libraries. By correcting for low number of events, high risk of bias, and outlying results, sensitivity analyses were carried out. As per the findings, patients who received RT to the pelvic region were at modestly increased risk for second primary rectal cancer. For all primary pelvic cancer sites, such a risk could not be corroborated. No data was offered to change guidelines for surveillance for rectal cancer in previously irradiated patients.