473 Background: The role of pelvic radiation (RT) remains undefined in the management of patients with resectable SLMRC. A retrospective study of patients with SLMRC treated with and without pelvic RT was performed to determine recurrence patterns (distant vs. pelvic) and survival. Methods: Data from consecutive patients with SLMRC (disease free interval ≤ 12 months) undergoing complete resection of the rectal primary and liver metastases between 1990 and 2008 were identified from a prospective database. Demographics, tumor and treatment related variables were correlated with recurrence patterns. Competing risks analysis was used to determine the risk of pelvic and extra pelvic recurrence. Results: A total of 185 patients underwent complete resection of a rectal primary and liver metastases. One hundred eighty (97%) received CH during their treatment course and 91 patients (49%) received pelvic RT either before (65, 71.4%) or after (26, 28.6%) rectal resection. The 5-year disease-specific survival was 51% for the entire cohort with a median follow-up of 44 months for survivors. Survival was associated with negative liver margin (p<0.001), absence of LVI (p<0.01), and favorable clinical risk score (p=0.001). Overall, 130 patients (70%) recurred; 18 (10%) having pelvic recurrence as any part of their relapse and 7 (4%) having isolated pelvic recurrence. Recurrence pattern did not correlate with survival. Competing risks analysis demonstrated that the risk of any pelvic recurrence was significantly lower than extra pelvic recurrence (p<0.001), independent of the use of RT (Table). Conclusions: Pelvic recurrence after complete resection of SLMRC is uncommon and significantly exceeded by extra pelvic failures. Given the low pelvic recurrence risk in the cohort of patients who did not undergo pelvic RT, these data suggest that with proper patient selection, CH and surgical resection without pelvic RT is appropriate for patients with known SLMRC. [Table: see text] No significant financial relationships to disclose.