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    Table 1. Abbreviations

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    Appendix A: Methods and literature search strategy

    NICE has identified studies and reviews relevant to Low-energy contact X-ray brachytherapy (the Papillon technique) for rectal cancer.

    Search strategy design and peer review

    This search report is informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S).

    A NICE information specialist ran the literature searches on 20 January 2025. See the search strategy history for the full search strategy for each database. Relevant published studies identified during consultation or resolution that are published after this date may also be considered for inclusion.

    The principal search strategy was developed in MEDLINE ALL (Ovid interface). It was adapted for use in each of the databases listed in table 4a, taking into account the database's size, search functionality and subject coverage. The MEDLINE ALL strategy was quality assured by a NICE senior information specialist. All translated search strategies were peer reviewed to ensure their accuracy. The quality assurance and peer review procedures were adapted from the Peer Review of Electronic Search Strategies (PRESS) 2015 evidence-based checklist.

    Review management

    The search results were managed in EPPI‑Reviewer version 5 (EPPI‑R5). Duplicates were removed in EPPI‑R5 using a 2‑step process. First, automated deduplication was done using a high-value algorithm. Second, manual deduplication was used to assess low-probability matches. All decisions about inclusion, exclusion and deduplication were recorded and stored.

    Limits and restrictions

    The CENTRAL database search removed trial registry records and conference material. The Embase search excluded conference material.

    English language limits were applied to the search in adherence to standard NICE practice for review topics.

    The search was limited from 01 January 2000 to 31 January 2025. The date limit was included to update searches undertaken for an earlier version of this guidance.

    The limit to remove animal studies in the searches is standard NICE practice, which has been adapted from Dickersin K, Scherer R, Lefebvre C (1994) Systematic Reviews: Identifying relevant studies for systematic reviews. BMJ 309(6964): 1286.

    Search strategy history

    MEDLINE ALL search strategy

    1, *rectal neoplasms/ or *anus neoplasms/, 49,685

    2, *Colorectal Neoplasms/, 108,846

    3, *Colonic Neoplasms/, 62,426

    4, ((rect* or anus or anal or colorect* or colon* or bowel*) adj4 (neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or metasta*)).tw., 319,543

    5, or/1-4, 348,591

    6, Brachytherapy/, 22,494

    7, brachytherap*.tw., 21,528

    8, ((internal* or interstitial* or intracavit* or contact*) adj4 (radiotherap* or ((radiation or irradiation) adj4 therap*))).tw., 2,844

    9, ((radiotherap* or ((radiation or irradiation) adj4 therap*)) adj4 (endorect* or endocavit* or Intraluminal* or transluminal*)).tw., 227

    10, (curietherapy or endocurietherapy).tw., 446

    11, (implant* adj4 therap*).tw., 9,975

    12, (surface* adj4 therap*).tw., 2,180

    13, (endorect* adj4 (applicat* or catheter* or needle)).tw., 23

    14, papillon.tw., 692

    15, CXB.tw., 318

    16, plaque therapy.tw., 142

    17, radio* plaque therapy.tw., 20

    18, or/6-17, 44,287

    19, 5 and 18, 1,365

    20, Animals/ not Humans/, 5,263,238

    21, 19 not 20, 1,338

    22, limit 21 to ed=20000101-20250131, 860

    23, limit 22 to english language, 772

    Embase search strategy

    1 , *rectum cancer/ , 29,772

    2 , *anus tumor/ , 1,311

    3 , *colorectal tumor/ , 18,894

    4 , *colon tumor/ , 13,690

    5 , ((rect* or anus or anal or colorect* or colon* or bowel*) adj4 (neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or metasta*)).tw. , 461,587

    6 , or/1-5 , 469,726

    7 , brachytherapy/ , 47,733

    8 , brachytherap*.tw. , 38,315

    9 , ((internal* or interstitial* or intracavit* or contact*) adj4 (radiotherap* or ((radiation or irradiation) adj4 therap*))).tw. , 4,379

    10 , ((radiotherap* or ((radiation or irradiation) adj4 therap*)) adj4 (endorect* or endocavit* or Intraluminal* or transluminal*)).tw. , 296

    11 , (curietherapy or endocurietherapy).tw. , 364

    12 , (implant* adj4 therap*).tw. , 14,348

    13 , (surface* adj4 therap*).tw. , 3,057

    14 , (endorect* adj4 (applicat* or catheter* or needle)).tw. , 55

    15 , papillon.tw. , 809

    16 , CXB.tw. , 433

    17 , plaque therapy.tw. , 164

    18 , radio* plaque therapy.tw. , 26

    19 , or/7-18 , 74,009

    20 , 6 and 19 , 2,509

    21 , Nonhuman/ not Human/ , 5,552,183

    22 , 20 not 21 , 2,451

    23 , limit 22 to english language , 2,275

    24 , (conference abstract* or conference review or conference paper or conference proceeding).db,pt,su. , 6,126,811

    25 , 23 not 24 , 1,381

    26 , from 25 keep 1-1381 , 1,381

    27 , limit 26 to dc=20000101-20250131 , 1,176

    Cochrane Library (CDSR and CENTRAL)) search strategy

    #1 MeSH descriptor: [Rectal Neoplasms] this term only 2768

    #2 MeSH descriptor: [Anus Neoplasms] this term only 212

    #3 MeSH descriptor: [Colorectal Neoplasms] explode all trees 13094

    #4 MeSH descriptor: [Colonic Neoplasms] this term only 2530

    #5 ((rect* or anus or anal or colorect* or colon* or bowel*) near/4 (neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or metasta*)) 31303

    #6 #1 or #2 or #3 or #4 or #5 31367

    #7 MeSH descriptor: [Brachytherapy] explode all trees 1084

    #8 brachytherap* 2967

    #9 ((internal* or interstitial* or intracavit* or contact*) near/4 (radiotherap* or ((radiation or irradiation) adj4 therap*))) 3331

    #10 ((radiotherap* or ((radiation or irradiation) near/4 therap*)) near/4 (endorect* or endocavit* or Intraluminal* or transluminal*)) 41

    #11 (curietherapy or endocurietherapy) 8

    #12 (implant* near/4 therap*) 2989

    #13 (surface* near/4 therap*) 1024

    #14 (endorect* near/4 (applicat* or catheter* or needle)) 1

    #15 papillon 34

    #16 CXB 33

    #17 (plaque therapy) 10254

    #18 radio* plaque therapy 1000

    #19 #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 20040

    #20 #6 AND #19 294

    #21 conference:pt or (clinicaltrials or trialsearch or clinicaltrials.gov or www.who.int) 832310

    #22 #20 NOT #21 121

    INAHTA HTA Database search strategy

    1 , "Rectal Neoplasms"[mh] , 35

    2 , "Anus Neoplasms"[mh] , 7

    3 , "Colorectal Neoplasms"[mh] , 323

    4 , "Colonic Neoplasms"[mh] , 26

    5 , ((rect* or anus or anal or colorect* or colon* or bowel*) AND (neoplasm* or cancer* or carcinoma* or adenocarcinom* or tumour* or tumor* or malignan* or metasta*)) , 550

    6 , "Brachytherapy"[mh] , 80

    7 , brachytherap* , 96

    8 , ((internal* or interstitial* or intracavit* or contact*) AND (radiotherap* or ((radiation or irradiation) AND therap*))) , 29

    9 , ((radiotherap* or ((radiation or irradiation) AND therap*)) AND (endorect* or endocavit* or Intraluminal* or transluminal*)) , 3

    10 , (curietherapy or endocurietherapy) , 0

    11 , (implant* AND therap*) , 187

    12 , (surface* AND therap*) , 50

    13 , (endorect* AND (applicat* or catheter* or needle)) , 0

    14 , papillon , 3

    15 , CXB , 1

    16 , (plaque therapy) , 14

    17 , (radio* plaque therapy) , 0

    18 , #17 OR #16 OR #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 , 363

    19 , #5 OR #4 OR #3 OR #2 OR #1 , 586

    20 , #19 AND #18 , 20

    Inclusion criteria

    The following inclusion criteria were applied to the abstracts identified by the literature search.

    • Publication type: clinical studies were included with emphasis on identifying good quality studies. Abstracts were excluded if they did not report clinical outcomes. Reviews, editorials, and laboratory or animal studies, were also excluded and so were conference abstracts, because of the difficulty of appraising study methodology, unless they reported specific adverse events not available in the published literature.

    • People with rectal adenocarcinoma.

    • Intervention or test: CXB.

    • Outcome: articles were retrieved if the abstract contained information relevant to the safety, efficacy, or both.

    If selection criteria could not be determined from the abstracts the full paper was retrieved.