Low energy contact X-ray brachytherapy (the Papillon technique) for early stage rectal cancer

The procedure

Low‑energy contact X‑ray brachytherapy (the Papillon technique) aims to cure rectal cancer, or stop it spreading.

Patients usually have low‑energy contact X‑ray brachytherapy as day patients. An enema is given to clear the bowel before treatment starts. With the patient lying face up, face down or curled up, a local anaesthetic and a muscle relaxant are applied to the ring of muscle around the anus. A tube (sigmoidoscope) is inserted through the anus into the bowel to see the size and position of the tumour. An applicator containing an X‑ray tube is placed in contact with the tumour. The X‑rays only penetrate a few millimetres so damage to tissues that are not associated with the cancer is reduced. If the tumour does not shrink after contact X‑ray brachytherapy, or if it comes back after treatment, surgery may be needed, if the person can have it.