Recent advances in multimodality therapy and wide acceptance of total mesorectal excision (TME) have significantly improved the care of patients with rectal cancer. [1, 2] Rates of local pelvic failure after primary curative therapy has declined from 20–30%, to only 6–11% in the setting of clinical trials and specialized centers. [3, 4] However, locally recurrent rectal cancer (LRRC) remains a challenging problem. Local pelvic failure not only shortens patient’s life expectancy, but also decreases their quality of life (QOL). [5] Common cancer- related morbidities include severe pelvic pain, bleeding, obstruction, fistula, orchronic pelvic sepsis. [6] While the expected median survival is often measured in months with supportive