In some patients, radiotherapy and chemotherapy can be used before, during or after surgery in an attempt to decrease the chances of local recurrence and metastatic disease. The most common type of radiotherapy used is external-beam radiation therapy. This is typically 5 weeks of daily (M-F) treatments.

Another way to deliver the treatment is preoperative high dose rate brachytherapy. This can be used before surgery in patients with cancer in the middle or lower third of the rectum. The aim is to help shrink (down-stage) the tumor, which may make anal-preservation surgery more feasible for some patients.

Endorectal high dose rate brachytherapy is usually carried out as an outpatient procedure. Before treatment, the size, stage and position of the tumor are determined using imaging CT scan. At the radiation oncology suite, catheters in endorectal plastic applicator are placed in the rectum. Catheters are loaded selectively with the radioactive sources, thus a conformal radiation dose can be delivered to the tumor within the rectum, sparing the rest of the rectum walls and internal organs.

Dr. Ghaly utilizes a treatment protocol which requires four daily treatments over four consecutive days. The treatment is given on an outpatient basis.

Once the treatment is completed, the patient is scheduled for surgery, usually a few weeks after the final brachytherapy treatment.