Chapter 3 50 The retrospective character of this study also leads to heterogeneity regarding oncological history and manifestation of the local recurrence of the patients included in this study. This study is however a good representation of the clinical practice and is, to our knowledge, the largest series to date of patients treated with induction chemotherapy and subsequent chemo(re)irradiation for locally recurrent rectal cancer. Conclusions This study shows a high pCR rate in patients with LRRC after treatment with induction chemotherapy and chemo(re)irradiation, translating into exceptional outcomes in these patients. In addition, response to neoadjuvant treatment is a powerful predictor of improved oncological outcome, underlining the importance of achieving a good response. To determine whether the addition of induction chemotherapy to chemo(re) irradiation in the treatment of LRRC improves outcomes for curative treatment of LRRC in general, a randomized controlled trial is warranted.