*3.2.3 Contact radiotherapy/Brachytherapy*

Local radiotherapy (brachytherapy or Papillon, CXB) is effective in some instances [44], and as standalone treatment. It was first popularised by Jean Papillon in France in

### **Figure 4.**

*TEMs (upper left) versus TAMIS (upper right) setup at the anus. While TEMs offers binocular and near 3D views,TAMIS via a less rigid platform allows greater freedom of movement and transferability of minimally invasive skills and tools. Using standard laparoscopic instruments via the GelPOINT Path™ platform (lower left image), a full thickness resection of the ERC is achieved (lower images second and third from left) and the rectal wall defect is sutured with a continuous absorbable, such as a 3–0 PDS suture (lower right).*

the 1950s and has gained recent popularity. This strategy can be considered in patients with exophytic, mobile cancers under 3 cm. It is a curative, non-operative approach for some T1 cancers, however primarily suitable for elderly or frail patients unfit for major resections. Its main disadvantage is the lack of histological specimen and failure to treat the mesorectum, unless combined with external beam radiotherapy (EBR). Overall, the complete clinical response rate ranges between 10 and 30% when combined with chemotherapy. Professor Sun Myint et al. outline the criteria for ERCs suitable for CXB that may successfully result in a complete response as follows [45]:

• Inclusion criteria for CXB alone for ERCs with curative intent.

1.mobile exophytic ERC (cT1).

2.well to moderately differentiated adenocarcinoma.

3. tumour size <3 cm.

4.no evidence of suspicious lymph nodes.

5.no evidence of distant metastases.

6. tumour within 12 cm of the anal verge.

7.patient suitable for long-term follow-up.

• Exclusion criteria.

1.poorly differentiated adenocarcinoma.

2.presence of lymphatic or vascular invasion.

3.bulky rectal cancer involving more than half the circumference (> 3 cm).

4. fixed rectal adenocarcinoma with deep ulceration (cT3, cT4).

The described regimen involves two weekly outpatient treatments, in which 30 Grey of 50KV is delivered to the target area through a rigid applicator. Standard dosage is 60 Grey in 2 fractions over 2 weeks.
