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Dosimetric gain (if any) is mostly for 3D CRT (i.e. 4-field box)

Irritation of the anal canal (hemorroids) Cho KJMS 2009

Complex procedure: may require frequent adjustments to avoid systematic

errors or deformations (Jones Med Phys 2012, Miralbell IJROBP 2010)

Increases treatment time

Rectal balloons disadvantages

Management of intrafraction motion

Mixed experience, complex and invasive procedure with

questionable benefit.