In patients for whom surgery is not considered suitable, current evidence on the efficacy and safety of low‑energy contact X‑ray brachytherapy (CXB; the Papillon technique) for early‑stage rectal cancer is adequate to support the use of this procedure, provided that normal arrangements are in place for clinical governance, consent and audit.
In patients for whom surgery is considered suitable, but who choose not to have an operation, the evidence on safety is adequate but the evidence on efficacy is inadequate. Therefore this procedure should only be used for these patients with special arrangements for clinical governance, consent and audit or research.
Clinicians wishing to do low‑energy CXB in patients for whom surgery is considered suitable, but who choose not to have an operation, should take the following actions:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients and their carers understand the alternative options for treatment and the uncertainty about this procedure's efficacy and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Patient selection should be done by a colorectal cancer multidisciplinary team, including a clinical oncologist and a colorectal surgeon with expertise in local excision techniques.
Clinicians should enter details about all patients having low‑energy CXB for early‑stage rectal cancer onto the contact X-ray brachytherapy database. Clinical outcomes should also be reviewed locally.
NICE encourages further research into low‑energy CXB for early‑stage rectal cancer. Research should clearly describe details of patient selection and treatment intent. It should document adjunctive treatments and subsequent procedures. Outcomes should include local recurrence, survival, disease‑free survival and quality of life. NICE may update the guidance on publication of further evidence.