Papillon
Tackling cancer directly
LANDMARK APPROVAL NICE Recommendations [13th November 2025]
Papillon CXB - brachytherapy for rectal cancer.
About Papillon
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 a standard treatment for early smaller tumours (less than 3cm) and advanced tumours in patients who are not suitable for surgery and who refuse surgery. If the tumour is more than 3cm there is a need to start with external beam radiotherapy to shrink the tumour. If there is a good response with significant shrinkage (less than 3 cm ) then, Papillon treatment can be considered. [ see NICE guidance link].
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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
Suitable for:
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Rectal cancers, cT1, cT2, cT3a-b/ cN0-cN1[up to 3 lymph nodes*
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*illustration of rectal tumour staging
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Small tumours, less than 3cm can start with Papillon
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Larger tumours greater than 3 cm should start with external beam radiotherapy and when downsized to less than 3 cm then this can be followed by Papillon CXB
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Tumours which are well / moderately differentiated
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Mobile polyp cancer
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Papillon can be offered to patients with up to 3 lymph nodes affected
Not suitable for:
patients with spread to distant sites, i.e. liver, lungs etc.
Download the Papillon Patient Booklet
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.
More Information:
All cases of rectal cancer should be discussed at your local hospital colorectal MDT. All patients should be given an option to decline or elect for surgery. If you decline surgery, and the tumour size is lees than 3cm, then you can start your treatment with Papillon Therapy (organ preservation 93%@ five years - ref: OPERA Trial 2025).
Short video explanation of treatment procedure to expect: