Currently, locoregional recurrence of rectal cancer is rare due to the therapeutic progress of total mesorectal excision and pre-operative radiotherapy. Nevertheless, a curative treatment could be proposed provided that surgical removal is possible and complete. Here, we will discuss the position of both external and intra-operative radiotherapy, and concomitant chemotherapy. Actually, multimodal therapy provides the best results for local control and overall survival. Exclusive external radiotherapy is indicated for palliative treatment of unresectable cases of recurrence.