A retrospective study of 101 patients with rectal cancer who received chemoradiotherapy (CRT) after surgical resection found that pre-CRT platelet count correlated with venous invasion and tumour size as well as the response rate to therapy. Patients with pre-CRT thrombocytosis had markedly shorter local recurrence-free survival than those patients with normal platelet counts. Platelet count before CRT is a promising biomarker for predicting CRT efficacy and risk of local recurrence in patients with rectal cancer.