What is Papillon?
With the introduction of the bowel cancer screening programme in the UK more patients are being diagnosed with early rectal cancer. The UK population is ageing and not all patients diagnosed with early rectal cancer are suitable for surgery.
For early rectal tumours radiotherapy is accepted as an alternative if the patients are not suitable for surgery. However, for more advanced tumours, this is not a standard of care in the UK.
Papillon is a form of radiotherapy which is also known as contact X-ray brachytherapy. It uses very low energy X-rays applied directly to the tumour. With each treatment, cancer cells are killed off layer by layer. Low energy X-rays are used, reducing the amount of radiation damage to healthy surrounding tissues.
Professor Papillon from Lyon in France, made the treatment technique popular for clinical use. For this reason the treatment has been named after him. Thousands of patients have been treated around the world over the past eighty years and an overview of the results suggest a long-term cure may be possible for rectal cancer.
In 1992 Professor Sun Myint led the team from Clatterbridge and started the first facility in the UK. Clatterbridge Centre for Oncology* is now the leading international centre for Papillon treatment. Clatterbridge Centre now trains consultants, physicists, radiographers and surgeons from other hospitals who are looking to offer Papillon treatment.
Papillon has become standard treatment for early smaller tumours (less than 3cm) in patients who are not suitable for surgery. However, for more advanced tumours, the accepted standard of care is surgery. If the patient is not suitable for surgery, there is a need to start with external beam radiotherapy to shrink the tumour. If there is a good response with significant shrinkage of the tumour, then Papillon treatment can be considered. Currently, research is being done to establish the safety and outcomes of this approach to treating rectal cancer.
Professor Sun Myint and team talk about Papillon Radiotherapy and the background to the 25th anniversary of Papillon Radiotherapy treatment at Clatterbridge Cancer Centre in UK.
Papillon Plus treatment machine 2021
(see video opposite)
ELIGIBILITY FOR PAPILLON TREATMENT
Early rectal cancers, cT1*
Small tumours, less than 3cm
Tumours which are well / moderately differentiated
Mobile polyp cancer
No spread into the lymph nodes
No spread to distant sites, i.e. liver, lungs etc.
Not suitable for:
cT2 or cT3 tumours* but may be used for patients who are not fit for surgery
*illustration of rectal tumour staging
Note: In patients with advanced rectal tumours who are not suitable for surgery, external beam radiotherapy (with or without chemotherapy) is usually initially offered. If the tumour responds well, and there is a small residual cancer (< 3 cm) Papillon therapy can be considered as an option. Advice should be taken from your local colorectal team or your GP.
It is important to understand that complete cure may not be possible for all patients treated with Papillon. If there is a residual or recurrent cancer following Papillon treatment , surgery may be necessary. This may be either Total Mesorectal Excision (TME) or, local excision - Transanal Endoscopic Microsurgery (TEMS ) - if you are fit enough for surgery and are agreeable to it. These procedures may not necessarily require a permanent stoma.
For more information please follow the link to Clatterbridge Centre for Oncology:
Click here https://www.clatterbridgecc.nhs.uk/application/files/7615/2145/5183/Contact_x-ray_brachytherapy_for_rectal_Cancer__-_v5_a5.pdf to download the Papillon Patient Booklet