“Seize every moment, cherish hope and celebrate life.”
After prostate cancer surgery, followed by precision radiation therapy with Elekta Unity MR-Linac, Cees Peeters says he’s feeling good and wants to live to be 100
For years, the construction company where Cees Peeters worked offered its employees free prostate cancer screenings. Cees got used to having his prostate-specific antigen (PSA) regularly tested, so when he retired, he continued the simple, quick check-ups. The tests took little time away from his hobbies of gardening around his home near Eindhoven, the Netherlands, restoring vintage cars, spending time with his two children and three beloved grandchildren, or traveling Europe and overseas with his wife.
In 2019, when he was 73 years old, Cees learned there was a slight increase in his PSA value. It took almost a year with more tests, doctors’ visits and a consultation with a urologist before he received a diagnosis of prostate cancer. The urologist was hopeful, however, and Cees followed his doctor’s advice to have his prostate removed together with almost 30 lymph nodes. Nevertheless, after just a few months, new PSA values indicated that the cancer was still in his body and subsequent scans showed it had metastasized to a lymph node next to the rectum and one in the hip socket. Now the urologist was less hopeful, but Cees had no intention of giving up.
“I was offered conventional radiation therapy in a nearby hospital, but while I was lying on the linear accelerator (linac) couch, the radiation oncologist realized that the location of the target area of one of the tumors was too risky because it was very close to my rectum,” Cees explains.
In radiation therapy the aim is to irradiate the tumor with a high dose of radiation but spare the surrounding healthy tissue to avoid side effects such as diarrhea or bleeding. In Cees’s situation, the highest degree of precision radiation delivery was essential to avoid harmful dose to his rectum.
Most modern linacs, like the one Cees almost received treatment on, use a technology called cone beam computed tomography (CBCT) to view the tumor and surrounding tissue prior to treatment. This is often good enough, however, compared to magnetic resonance imaging (MRI), the soft tissue contrast is not as well defined. This means that a larger area must be irradiated to ensure the whole tumor is being treated, which risks radiating nearby healthy organs at risk, such as the rectum and intestine. This is why Cees’s radiation oncologist felt he would be a good candidate to receive Magnetic Resonance guided Radiation Therapy (or MRgRT) treatment on an Elekta Unity MR-Linac.
“I knew very little about MR-guided radiation therapy, but I knew I was in good hands with Dr. Westhoff. My hope was restored.”
Unity combines an MRI scanner with a linear accelerator, which allows clinicians to visualize tumors in real-time during radiation therapy with unprecedented clarity. This lets clinicians more precisely target the tumor, thereby reducing the risk of side effects. Cees was referred to the Radboud University Medical Center in Nijmegen, home to one of the Netherlands’ nine Elekta Unity systems, and radiation oncologist Dr. Paulien Westhoff. Cees says: “I knew very little about MR-guided radiation therapy, but I knew I was in good hands with Dr. Westhoff. My hope was restored.” He received five treatments and before each session, the treatment plan was adapted to the location of the tumors – both the lymph node near the rectum and the one in the hip socket – and organs at risk at that moment to ensure the utmost precision in treatment.
“I didn't feel anything at all,” he says. “And I wasn't uncomfortable in the MR-Linac device. I could listen to the radio and had contact with the treatment team via the intercom. To make sure I remained still, in the same position, I was neatly wrapped on the table using a vacuum mattress. What I really liked was that I could go home straight after each treatment. A taxi picked me up before lunch and I was back home in the afternoon.
“I responded very well to the treatment sessions and didn’t notice any side effects at all.”
“My last Unity treatment was just before Christmas, on December 23, 2020. I responded very well to the treatment sessions and didn’t notice any side effects at all. This was a great way to end an intense year and recover from everything.”
Dr. Westhoff says: “Our team is very happy that Cees has benefited so much from the treatments on Elekta Unity. We will continue to monitor him and, if necessary, he can always come to us for any follow-up treatments.” Since his last radiation treatment, Cees' health has been closely monitored via blood tests every three months with additional scans if necessary. He continues to do well. “I feel good, and I want to live to be a 100,” says Cees. In the meanwhile, he promotes early screening, noting that he encouraged his brothers to get checked and each of them was diagnosed with prostate cancer. They have both been treated and are feeling fine.
In addition to testing, he urges people to seize every moment, cherish hope and celebrate life. “The past three years are a bonus, no one can take them away from me. But if the cancer does come back,” says Cees wistfully, “I’ll choose the Elekta Unity MR-Linac here in Radboud again. Now that I know Dr. Westhoff and the treatment team, I feel very comfortable here.”