The outcome of 42 patients who developed locally recurrent rectal carcinoma after initial local excision or electrocoagulation was presented. Five patients received combined surgery and radiotherapy (XRT). The remaining 37 patients were managed by XRT alone. The overall 5 year actuarial survival and local control rates were 21 and 22%, respectively. For patients who received XRT alone, the 5 year actuarial survival and local control rates were 20 and 15%, respectively. The corresponding figures were 35 and 40% for patients who received a total XRT dose of 50 Gy or more. One patient who underwent combined treatment developed rectal and bladder incontinence requiring surgery. For patients with rectal recurrence after initial conservative surgery, XRT is an alternative to abdominoperineal resection if major surgical resection is contraindicated.