Benefits and risks

Information for the public

NICE decided that more evidence is needed about how well low‑energy contact X‑ray brachytherapy works. The 10 studies that NICE looked at involved a total of 1149 patients.

When given with another type of radiotherapy (external‑beam radiotherapy) low‑energy contact X‑ray brachytherapy had the following benefits:

Rates of survival, disease recurrence and disease spread were similar to those in patients who had external‑beam radiotherapy alone.
More patients who had both types of radiotherapy treatment needed less extensive surgery to remove the cancer than after external‑beam radiotherapy alone.

When low‑energy contact X‑ray brachytherapy was given with or without other types of brachytherapy:

Between 85% and 92% of people had tumours that responded to treatment after 1–2 months.
At 5 years 83% of people were still alive and at 8 years 63% were still alive.
A permanent colostomy (when 1 end of the large intestine is brought out through an opening made in the abdominal wall) was needed in 3% of patients.

The studies showed that the risks of the procedure when given with or without other types of radiotherapy were:

Bleeding from the rectum between 6 months and 3 years after treatment in about 38% of people. One patient needed occasional blood transfusions.
Problems with the skin around the rectum and anus in 19% of people, sometimes with soiling and needing to go to the toilet urgently. The skin problems healed within 3 to 6 months.
Ulcers (which healed) inside the lining of the rectum in 27% of people.
Slight inflammation of the anus and rectum in 10% of people.
A constant feeling of needing to open their bowels, urgency of bowel movement or diarrhoea, in about 15% of people.

NICE was also told about some other possible risks: a hole developing in the bowel wall, narrowing of the rectum, an abnormal connection between the vagina and rectum, inability to control bowel movements.

If you want to know more about the studies, see the guidance. Ask your health professional to explain anything you don't understand.