A 48-year-old man, who had undergone a low anterior resection for advanced lower rectal cancer on May 27, 2003, was admitted to our hospital with anastomosis recurrence in November 2004. After chemo-radiotherapy (5-FU 250 mg/ body continuous infusion, 5 Gy each 5 fragments), an abdomino-perineal resection was performed on December 1, 2004. A follow-up CT scan showed pelvic local recurrences located dorsal to prostate in January, and the presacral region in July 2006. Because of presence of complication of acute promyelocytic leukemia (APL), this patient had a poor general condition. So radiofrequency ablation (RFA) therapy was performed as a palliative therapy. A presacral relapse was revealed in three months after RFA. As a complication, two weeks after RFA for the presacral region, a vesicoctaneous fistula occurred, and it required a urinary diversion. He died of APL on August 27, 2007. CT-guided radiofrequency ablation is useful for pelvic recurrence from rectal cancer of poor-risk patient.