Radiation oncologists at Huntington Hospital are using a new approach to treat patients with cancer in the middle or lower third of the rectum – one that studies have shown doubles the
chance of undergoing anal preservation surgery and reduces the odds of the patient requiring a permanent colostomy. The treatment also minimizes the side effects of traditional external beam radiation.

“Patients with these cancers can be treated with radiotherapy and chemotherapy before surgery in an attempt to shrink the tumor, which may make anal preservation surgery more feasible,” said attending radiation oncologist Maged Ghaly, MD.

The new treatment, called endorectal brachytherapy, is usually an outpatient procedure. During the treatment radiation is delivered via a plastic applicator which is placed in the rectum. The applicator is scored with channels. Only those channels that will be in direct contact with the tumor are loaded with radiation to deliver the maximum dose to the cancer
while sparing the rectum walls and other internal organs.

Typically, only four daily reatments over four consecutive days are required, according to Dr. Ghaly.

“Because we are treating only the tumor, and largely sparing the healthy surrounding tissue, we are able to deliver a higher dose of radiation to the tumor,” explained Dr. Ghaly. A higher radiation dose translates to a higher tumor response.

In contrast, external beam radiation typically given over five weeks of daily treatments exposes the entire circumference of the rectum and internal organs to radiation and often results in uncomfortable side effects.

This new treatment is performed prior to surgery for patients with locally advanced rectal cancer. Its goal is to significantly shrink the tumor so that less extensive surgery will be required to remove the cancer.

“The concept of endorectal brachytherapy is appealing because it allows delivery of high radiation doses over a shorter overall treatment time, which is highly effective,” Dr. Ghaly noted.

Colorectal cancer is the third most common cancer in both men and women in the United States, and the second leading cause of cancer deaths, according to the American Cancer Society. Approximately 150,000 new cases are diagnosed each year. Treatment is most
successful for cases diagnosed early, and survival rates are improving.

“The good news is that the most recent statistics show that the incidence of colon cancer has decreased by six percent, according to the National Institutes of Health,” said Scott Ingber, MD, Chief of Gastroenterology at Huntington. He attributes this drop to the widespread adoption of screening, which detects polyps before they become cancerous.


Colorectal cancers are most common in adults over the age of 50. However, they do sometimes occur in younger adults.

“Unfortunately, because colorectal cancer is relatively uncommon in younger people, symptoms among that age group are sometimes overlooked,” said attending gastroenterologist Noah Zinkin, MD. Consequently, by the time younger people are diagnosed their cancer has often spread.

“This technique is very beneficial for patients of any age,” said Dr. Ghaly. “Patients are very appreciative of the impact on their quality of life that can be realized by avoiding a permanent colostomy.”