Dirk can cast his fishing rod again after successful treatment on Elekta Unity
Retired IT specialist Dirk Lub, now 72-years-old, first encountered radiotherapy and Elekta Unity a little over a year ago. After an initial diagnosis of renal cell carcinoma in 2013 and subsequent regression, the cancer unfortunately returned at the end of 2023.
Dirk and his wife Doety live in Ommen, the Netherlands, and they have two sons. He is an avid fisherman and windsurfer and enjoys boating with their own boat and relaxing at the campsite. Dirk worked for 42 years at a mail-order company as an IT employee and witnessed the transition from paper catalogs to a fully automated warehouse – he was at the forefront of online sales.
In early 2024, Dirk was successfully treated with the Elekta Unity MR-Linac at Radiotherapiegroep Deventer in the Netherlands. Radiotherapiegroep, with locations in Deventer, Arnhem, Ede and Apeldoorn, is among the world’s first non-academic hospitals to have this advanced technology. The MR-Linac integrates an advanced diagnostic MRI scanner and a radiation therapy system in a single device, allowing an MRI scan to be taken just before and during each radiation session. Because the MRI accurately images the tumor and surrounding tissue, the lesion can be targeted very precisely, allowing a higher dose per radiation session. Precise radiation delivery ensures that the surrounding healthy tissue is better spared, resulting in the potential for fewer patient side effects. Moreover, the treatment is less burdensome for patients, as the higher dose means fewer radiation sessions are needed.
Diagnosis and treatment
In 2012, Dirk was diagnosed with clear cell renal cell carcinoma, after which his left kidney was surgically removed at Isala Hospital in Zwolle in 2013. After six years of check-ins and control scans without irregularities, metastases were discovered in his lungs and lymph nodes in 2019. These metastases, however, spontaneously regressed; a very small spot remained on the tail of the pancreas, for which no further treatment was needed at that time.
When this tumor showed minimal growth during a control scan in 2023, the treating physician in Zwolle recommended MR-guided radiation therapy (MRgRT) with Elekta Unity, for which Dirk was referred to Radiotherapiegroep Deventer. The radiation with the MR-Linac took place in February 2024, in 7 Gy fractions. Thanks to the precise imaging, the tumor could be targeted with minimal damage to the surrounding tissue. Surgery was technically also an option, but this would have involved a much longer recovery plus the risk of complications. For this reason, treatment on the MR-Linac was the best choice.
Dirk’s experience with MRgRT
Dirk was well-prepared for the treatment and found the process very manageable. He drove to Deventer just five times, and the treatment times were short. During the therapy sessions, a compression belt was used to reduce the movement of the abdominal organs during breathing. He especially appreciated the friendly staff and the relaxed atmosphere during the treatments.
“I was not anxious, nor did I feel claustrophobic in the rather wide tunnel you lie in… I could also listen to music and had to force myself not to fall asleep, I was very relaxed.”
“The hospital here is really cozy, informal, and small-scale,” Dirk recalls. “They pay a lot of attention to patients and their families. For example, there are jigsaw puzzles in the waiting rooms. My wife also likes to do puzzles at home, and sometimes I hide a piece to tease her. “The treatment was actually as I had imagined,” he continues. “I was not anxious, nor did I feel claustrophobic in the rather wide tunnel you lie in. The only thing I found annoying was the beeping and noise of the MRI scanner, but I understand that comes with it. I could also listen to music and had to force myself not to fall asleep, I was very relaxed.”
The beeping sounds come from the MRI scanner in Elekta Unity, which very accurately registers any movement in the body, such as a gas bubble. Dirk rates the comfort level of the treatment a 5 on a scale of 1 to 5.
“The staff present is super important; it was almost fun. And having a good doctor you trust and have good contact with is very valuable,” Dirk adds. He experienced no side effects and was able to resume his favorite hobby of fishing immediately after the treatments.
“I actually had a very boring file, and in the afternoons after treatment, I was often already back at the water,” he beams.
Expanding treatment possibilities with Elekta Unity
The largest group of people currently being treated on the MR-Linac in Deventer are patients with prostate cancer, according to radiation oncologist Paul Jeene, MD, PhD.
“Patients with tumors in the upper abdomen were previously not eligible for radiation – it’s incredibly important that the MR-Linac has changed this,” he says. “It’s because everything moves in the upper abdomen – which is not visible on a regular radiation device but seen very well on the MR-Linac. We are very happy with the referral from Zwolle and that we were able to treat Dirk so well.
“Because we can see everything well, we can apply hypofractionation, which means fewer radiation sessions but with a higher radiation dose each time.”
“Because we can see everything well, we can apply hypofractionation, which means fewer radiation sessions but with a higher radiation dose each time,” Dr. Jeene adds. “There is hardly any risk of complications because we see everything. Consultations with patients are pleasant because there is very little risk.”
He adds that before his center acquired Elekta Unity, the team gave many more fractions, usually 25, with a total dose that was still too low because they had to account for the surrounding healthy tissue.
“Since we could not see the target area as well, we were forced to irradiate a larger area, resulting in more radiation to the surrounding healthy tissue and thus more side effects,” he explains.
Radiotherapiegroep is working hard to expand the treatment possibilities of the MR-Linac for new indications and patient groups. In the short term, Radiotherapiegroep will participate in a national study investigating whether radiation therapy on the MR-Linac can be an alternative to surgery for a certain group of patients with rectal cancer.
Additionally, it is being investigated whether patients with metastases in a lymph node can be treated with a single radiation session. With these studies, they aim not only to provide more patient-friendly treatments but also to contribute to keeping healthcare accessible and affordable.
“Radiotherapiegroep is part of the international MR-Linac Consortium,” Dr. Jeene says. “Together, we are committed to improving treatment with the MR-Linac. We conduct research to evaluate and optimize treatments on the MR-Linac because care can always be better.”
Adapting to change with motion management
Radiotherapiegroep’s MR-Linac now also has Comprehensive Motion Management (CMM). This is an advanced technique in which the shape and size of the tumor, as well as movement caused by breathing, for example, are closely monitored, and the radiation beam is automatically adjusted.
“With CMM, we continuously have an even better view of the tumor and can actually adjust the radiation beam during treatment, if necessary.”
“With CMM, we continuously have an even better view of the tumor and can actually adjust the radiation beam during treatment, if necessary,” he says. “This makes the radiation area smaller and thus even more precise. For smaller tumors, we can even proceed to a single radiation session.”
Back to a normal life
Thanks to the treatment with the innovative Elekta Unity MR-Linac and the careful approach of Radiotherapiegroep Deventer, Dirk can once again fully enjoy life, his family, and hobbies such as fishing and boating. He would certainly recommend this treatment to other patients with a similar diagnosis.
Dirk’s life motto is: “Do as much as I enjoy and what I can do right now, don’t postpone.” He advises others: “Make sure to stay healthy, take care of your body, drink little alcohol, don’t smoke, and watch your weight.”
Learn more about what MRgRT with Elekta Unity is like.
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