Low energy contact X-ray brachytherapy (CXB)
Topic Status Complete
Low energy contact X-ray brachytherapy (CXB) for the treatment of early stage rectal cancer
Outcome of the appraisal
The evidence supports the routine adoption of contact x-ray brachytherapy (CXB) in addition to chemoradiotherapy for people with early-stage rectal cancer who are suitable for surgery.
The use of CXB boost increases treatment response rates and organ preservation and reduces the need for subsequent surgery compared with external beam radiotherapy boost.
Economic modelling suggests that CXB boost is cost effective compared with external beam boost, with an ICER of £4,463 per QALY gained.
Why was this topic appraised?
Rectal cancer accounts for about a third of colorectal cancers, which is one of the most common cancers in Wales. It is usually treated with surgery and chemoradiotherapy. Surgery can result in the need for a stoma, which has a significant long-term impact on a person’s quality of life. Interest in non-operative management of early-stage rectal cancer is increasing.
One option being explored is the use of contact x-ray brachytherapy (CXB), which is a form of locally delivered radiotherapy that is administered via a tube inserted into the rectum. This treatment can be given in early-stage rectal cancer as a local radiotherapy boost alongside standard chemoradiotherapy and, it is hoped, will avoid the need for surgery and stoma. If this is the case, then treatment could significantly improve quality of life and reduce the costs of surgical interventions and long-term care for people who otherwise require stomas.
The topic was proposed by a consultant clinical oncologist from Swansea University Health Board.
Plain language summary
Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably, leading to a tumour, or a large build-up of cells. The cancerous cells can invade and destroy surrounding healthy tissue, including organs. Rectal cancer is a cancer that starts in the rectum, or the lower part of the large intestine that connects to the colon.
Rectal cancer is usually treated with surgery. Chemoradiotherapy (the combination of chemotherapy and radiotherapy) can be given before or after surgery. Chemotherapy is medicine that can be taken as a tablet or into the veins through an IV in hospital. Radiotherapy uses radiation to either kill or control the growth of cancerous cells. Surgery can result in the need for a stoma. A stoma is when the body’s waste is removed from the colon through an opening made in the abdomen, or tummy, wall. The body’s waste passes through the stoma into a round or oval-shaped bag worn at the end. A stoma can be temporary or permanent. Having a stoma can have a significant impact on a person’s daily life and wellbeing.
Low energy contact x-ray brachytherapy (CXB) is a form of radiotherapy that can be given alongside standard chemoradiotherapy as a radiotherapy ‘boost’. For early-stage rectal cancer, having CXB may improve the chemoradiotherapy outcomes enough that surgery – and its side effects, like a stoma – may not be needed.
Health Technology Wales looked for evidence on the use of CXB for early-stage rectal cancer. The evidence supports the routine adoption of contact x-ray brachytherapy (CXB) in addition to chemoradiotherapy for people with early-stage rectal cancer who are suitable for surgery.
Topic Exploration Report
TER419 04.2023
Evidence Appraisal Review
EAR053 11.2023
Guidance
GUI053 11.2023
