We present the updated results of our phase I trial that delivers mild hyperthermia using magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) combined with radiation and chemotherapy in the treatment of locally recurrent rectal cancer. Participation in the study is based on careful consideration of patient and tumor factors. MR-HIFU mild hyperthermia was delivered in three sessions during a 17-day regimen. MR-HIFU mild hyperthermia was successfully delivered and the procedure was well tolerated. No adverse effects have been reported following the combined treatment to date.