Isolated pelvic recurrence of rectal carcinoma may occur in up to one third of patients following definitive resection of primary disease. The means by which recurrence is diagnosed, methods by which it may be treated, and reported outcomes are all evolving and improving. Current data indicate that a substantial proportion of patients treated by aggressive multi-modality salvage therapy may be provided with durable survival. This review highlights current concepts in the diagnosis and management of locally recurrent rectal carcinoma.