The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on, low energy contact X-ray brachytherapy (the Papillon technique) for early stage rectal cancer in September 2015.
Low-energy contact X-ray brachytherapy (CXB; the Papillion technique) aims to improve local control or cure rectal cancer. The procedure involves inserting an X-ray tube through the anus and placing it in close contact with the tumour, to kill cancer cells and reduce the size of the tumour.
Low-energy CXB for rectal cancer is usually delivered in a day-care setting. The patient is given an enema before treatment, to clear the bowel. With the patient in a knee-to-chest, prone jack-knife or supine position, local anaesthesia and glyceryl trinitrate are applied to the anal sphincter to numb the area and relax the sphincter muscles. A sigmoidoscope is inserted to check the size and position of the tumour. A rigid endorectal treatment applicator is then inserted and placed in contact with the tumour. A contact X-ray tube is introduced into the applicator and treatment commences. The tube emits low-energy X-rays that only penetrate a few millimetres. This minimises damage to deeper tissues that are not involved in the cancer. If the tumour does not respond to low-energy CXB, or recurs after treatment, surgery may be performed.
X65.2 Delivery of a fraction of intracavitary radiotherapy
Y35.4 Introduction of radioactive substance into organ for brachytherapy NOC
In addition the ICD-10 code C20.X Malignant neoplasm of rectum would be recorded.