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Myint et al. Mini-invasive Surg 2018;2:34 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.52

Review Open Access

Minimally invasive contact X-ray brachytherapy as an
alternative option in patients with rectal cancer not
suitable for bespoke surgical resection

Arthur Sun Myint , Jean Pierre Gerard 3
1,2
1 Papillon Unit, Clatterbridge Cancer Centre, Wirral CH63 4JY, UK.
2 Translation research Unit, University of Liverpool, Liverpool L 69 3GE, UK.
3 Centre Antoine-Lacassagne, Nice 06189, France.
Correspondence to: Dr. Arthur Sun Myint, Papillon Unit, Clatterbridge Cancer Centre, Wirral CH63 4JY, UK.
E-mail: sun.myint@nhs.net

How to cite this article: Myint AS, Gerard JP. Minimally invasive contact X-ray brachytherapy as an alternative option in
patients with rectal cancer not suitable for bespoke surgical resection. Mini-invasive Surg 2018;2:34.
http://dx.doi.org/10.20517/2574-1225.2018.52
Received: 14 Jul 2018 First Decision: 22 Aug 2018 Revised: 10 Sep 2018 Accepted: 13 Sep 2018 Published: 7 Oct 2018

Science Editor: Gordon N. Buchanan Copy Editor: Cui Yu Production Editor: Zhong-Yu Guo

Abstract
Surgery remains the gold standard treatment for rectal cancer. All published guidelines and most protocols recommend
surgery as the standard of care. However, non-surgical management of rectal cancer is increasingly gaining acceptance
as it avoids extirpative surgery and a stoma. In patients who are not suitable for surgery because of advancing age
or medical comorbidities, and also in a small number of patients who are stoma phobic and refuse surgery, we need
to consider an alternative treatment option to bespoke surgery. External beam radiotherapy is usually offered as an
alternative. However, local regrowth rate is high and contact X-ray brachytherapy (Papillon treatment) boost can be
added to reduce the risk of local regrowth after external beam radiotherapy. Case selection is important to achieve the
best results.

Keywords: Contact X-ray brachytherapy, watch and wait, papillon, rectal cancer patients not suitable for surgery

INTRODUCTION
Surgery remains the gold standard treatment for rectal cancer: all published guidelines and most
[1,2]
protocols recommend surgery as the standard of care . Selection of the best option for care is based on
recommendations made during multidisciplinary team (MDT) meetings, which are now mandated in most
countries to discuss treatment for all patients with rectal cancer. The majority of MDTs still recommend

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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