Rectal Brachytherapy


Papillon Radiotherapy for Rectal Cancer 

Consultants Dr Alex Stewart, Dr Sharadah Essapen

The Royal Surrey County Hospital was the first hospital in the South to offer Papillon treatment for cancer after a major fundraising campaign by local bowel cancer charities BRIGHT & GUTS.

Papillon is a contact radiotherapy treatment suitable for patients with early stage rectal cancer which offers an alternative to major surgery.  The technique may also avoid the need for a lifetime of using a colostomy bag – something which is a major issue for many people.

Bowel cancer is the second most common cancer in the UK and more than 16,000 people die from bowel cancer every year.  There are approximately 8,000 rectal cancers diagnosed each year and up to a third of these tumours might be suitable for the Papillon treatment.

The roll out of the National Bowel Cancer Screening programme (Guildford is the centre for the South of England for testing patients) will find many early stage tumours which are suitable for the Papillon technique.

“If you’ve been diagnosed with early stage bowel cancer, treatment with a Papillon machine is an option everyone should have the chance to explore as it is an alternative to life-changing surgery.  I’m delighted to say that we can now offer patients from across the South of England this option,” said Dr Alexandra Stewart, consultant clinical oncologist at the Royal Surrey County Hospital and chairman of BRIGHT.

Traditionally patients diagnosed with bowel cancer have to undergo major abdominal surgery and, as the operation removes part of the lower bowel, some patients also require a colostomy bag.  With a Papillon machine, treatment is less invasive – it is applied directly to the tumour so there is less damage to the surrounding normal tissue.  Although surgery remains the current gold standard of care, Papillon therapy allows patients who want to explore organ preserving therapy to have an alternative treatment option.

Papillon is delivered as a day case procedure. You will meet with the dieticians in advance who will talk to you about following a special diet for three days before the procedure. When you arrive at the hospital you’ll meet with the specialist radiographers who will talk to you about what is going to happen and answer any questions that you have. You’ll then have some medicine to help you empty your bowels. When you come into the room you’ll be examined and a small metal tube is placed inside your bottom so that the treatment can be delivered. It is removed after treatment delivery. It is a little uncomfortable but we use anaesthetic jelly to make the procedure more tolerable. You can go home after the procedure and can drive yourself if you choose to. Most patients receive 3 or 4 treatments.

Professor Marks, founder of GUTS, added, “Papillon is not a new treatment option – it was developed in Lyons, France during the 1970s.  However, as technology progresses (for example, a new Papillon machine was developed in 2008), it is becoming an important treatment option.  In addition, this technique is especially suitable for early stage bowel cancer which will be detected by screening programme.”

Mr David Macaulay (age 73, from Haslemere, Surrey) was a patient of Dr Stewart’s who travelled to the Clatterbridge Centre for Papillon treatment in 2011.  “I had a small rectal tumour and surgery would have meant a colostomy bag for the rest of my life.  Dr Stewart informed me about the Papillon machine at Clatterbridge and, as I would try anything not to have a colostomy bag, up to Liverpool I went.  I only needed three treatments and it was completely painless and successful.  Papillon allowed me to keep my dignity and I have now been clear of bowel cancer since January 2012.”

More information can also be found at or

If you would like more information about Papillion treatment or to find out if it might be a suitable option for you or someone you know who is suffering from early stage rectal cancer, please contact consultant clinical oncologist Dr Alexandra Stewart at the Royal Surrey County Hospital.

For help or assistance, please contact:

Medical Secretary:
Sue Letherens: 01483 406800 ext 2556

HDR Rectal Brachytherapy

Consultant Dr Alex Stewart

For patients will more advanced rectal cancer that cannot be operated on we offer HDR brachytherapy. This uses a flexible plastic tube that is placed inside the rectum to deliver radiation. It can be used as sole treatment, in combination with EBRT or for patients who have previously had radiotherapy but their cancer has unfortunately grown back and cannot be operated on. This technique is generally used for symptom control but those effects may last for years. Most patients will receive one tube insertion for planning and three more insertions for treatment but a single treatment can be used for very symptomatic patients.

First your gastroenterologist or surgeon will perform a sigmoisoscopy (scope test) to put some small metal clips in the bowel to define the position of the cancer. Eventually these will pass out with a bowel motion so do not be alarmed if you see a small piece of metal in the toilet bowl. Then you will come to St Luke’s Cancer Centre and may be given some medicine to help you clear your bowels. You will then go into the CT scanner and have the plastic tube inserted. After the CT scan, you will transfer to the brachytherapy suite and be connected to the brachytherapy machine. The treatment will be delivered and the tube removed. After that you can go home and you can drive yourself if you choose to.

This treatment is only offered at a few centers in the UK and delivers a highly focused dose of radiation using image guidance to the bowel.

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