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

In a randomised controlled trial of 88 patients treated by both low‑energy contact X‑ray brachytherapy (CXB) and external‑beam radiotherapy (EBRT; n=45) or EBRT alone (n=43), overall actuarial survival rates (Kaplan–Meier estimates) were 55% and 56% respectively, at 10‑year follow‑up (p=0.85). In the same study, disease‑free survival rates were 53% and 54% respectively, at 10‑year follow‑up (p=0.99). In a case series of 101 patients treated by low‑energy CXB with or without interstitial brachytherapy boost, overall actuarial survival rates (Kaplan–Meier estimates) were 83% and 63% at 5 and 8 years respectively. In the same study, disease‑specific survival rates were 94% and 89% at 5 and 8 years respectively. Actuarial survival rates for patients with stage T1 and T2 tumours were 68% and 55% respectively, at 8‑year follow‑up (p=0.73). Disease‑specific survival rates for patients with stage T1 and T2 tumours were 91% and 86% respectively, at 8‑year follow‑up (p=0.82).

In a case series of 97 patients treated by low‑energy CXB with or without interstitial brachytherapy boost, a complete response (no definition provided) was reported in 85% (82/97) of patients at a median follow‑up of 39 days. In a case series of 63 patients treated by low‑energy CXB followed by EBRT and interstitial brachytherapy boost, a complete clinical response (no definition provided) was reported in 92% (58/63) of patients at 2‑month follow‑up.

In the randomised controlled trial of 88 patients treated by low‑energy CXB and EBRT (n=45) or EBRT alone (n=43), actuarial local recurrence rates (Kaplan–Meier estimates) were 10% and 15% respectively, at 10‑year follow‑up (p=0.69). Distant recurrence was reported in 27% (12/45) of patients in the low‑energy CXB and EBRT group and 26% (11/43) of patients in the EBRT‑alone group at 10‑year follow‑up (no p value reported).

In the randomised controlled trial of 88 patients treated by low‑energy CXB and EBRT (n=45) or EBRT alone (n=43) all patients had surgery (either sphincter‑saving procedures or abdominoperineal resections) after initial treatment. Sphincter‑saving procedures were possible in 76% (34/45) of patients in the low‑energy CXB and EBRT group and 44% (19/43) of patients in the EBRT‑alone group (no p values reported). Abdominoperineal resections were needed in 24% (11/45) of patients in the low‑energy CXB and EBRT group and 56% (24/43) of patients in the EBRT‑alone group (no p values reported). In the same study, the actuarial colostomy rates (Kaplan–Meier estimates) were 29% in the low‑energy CXB and EBRT group and 63% in the EBRT‑alone group at 10‑year follow‑up (p<0.001).

In a case series of 312 patients treated by low‑energy CXB and interstitial brachytherapy boost, a permanent colostomy was needed in 3% (8/312) of patients.

Specialist advisers listed the following key efficacy outcomes: overall survival, disease‑free survival, clinical response, local control rates, loco‑regional and distant recurrence rates, avoiding a permanent stoma, quality of life, as well as bowel, urinary and sexual function.