In 2018, the UMCG Proton Therapy Center officially opened its doors. With this, Groningen had the first proton center in the Netherlands and, at the same time, the first center in the country where children can go for this innovative cancer treatment. At the cradle was Prof. Dr. Hans Langendijk, whose research not only laid the foundation for the center's arrival, but also provides world firsts in the field of medical innovations.
Recently, the UMC Groningen Cancer Center, of which the proton center is a part, was recognized as a Comprehensive Cancer Center by the European Organization of Cancer Institutes (OECI). As a result, the UMCG now belongs to a select group of Europe's leading cancer centers. The Proton Therapy Center is one of three centers in the Netherlands and now offers more than 500 cancer patients annually an alternative to regular radiation therapy.
With proton therapy, you can irradiate much more precisely and there is much less chance of damage to healthy tissue or surrounding organs.
Prof. Dr. Hans Langendijk
Photons and protons
But what makes this form of radiation so innovative? 'Regular radiotherapy is done with photons,' Langendijk explains. 'The aim of radiotherapy is to kill cancer cells, but in doing so the healthy cells must be spared as much as possible. That is only difficult in some cases, for example if a tumor is close to vulnerable organs. With proton therapy, you can irradiate much more precisely and the chance of damage to healthy tissue or surrounding organs is much smaller.'
That, according to Langendijk, is also where the greatest benefit of proton therapy lies: "Depending on where you irradiate, this kind of damage to surrounding tissue can cause long-term problems with swallowing after irradiation for throat cancer, or a heart attack after irradiation for breast cancer. But also cognitive problems, or even dementia, after radiation for brain tumors. Side effects of radiation can occur acutely, but sometimes really years later. Especially in children, you want to prevent that as much as possible, so you can offer them a healthy life after successful treatment, without limitations.'
Despite the therapy's potential, there was also criticism. In late 2021, various media reported that the expected annual number of 1,600 patients treated was far from being reached. It ended up being about 1,000, of which 480 patients were treated in Groningen. Critics felt that the expectations were far too optimistic and ultimately outweighed the costs of building the centers and the treatments themselves, which are some 2.5 times more expensive than photon radiation.
But that is really a distorted picture of reality, says Langendijk: "First of all, that number of 1,600 is not an expectation, but an authorization for the maximum number of patients who can now be treated nationwide per year. That this number has not been reached has nothing to do with a lack of need, but rather with scaling up. Specialists, physicists and lab technicians must first gain experience, treatment protocols must be created for each new indication, and the administrative process of patient referrals must be properly arranged. This takes time and is a learning process. Our capacity is now being optimally utilized and with about 520 patients per year we are already almost at our maximum.'
Langendijk also says the criticism that the new treatment is 2.5 times more expensive than the regular one is too short-sighted. 'It is true that it is more expensive per treatment, but we already see that the number of acute side effects and complications is less. That already saves a lot of costs on other care. In addition, thanks to new methods we will soon be able to irradiate more intensively, so the number of treatments per patient can be reduced, for example from 35 to 20, or in some cases even to 5. That also makes it much more cost efficient.'
Proton therapy will only become more important in the future. According to a recently published study by the Integral Cancer Center of the Netherlands, the number of patients with cancer in the Netherlands will increase sharply over the next decade. Whereas today about 800,000 people have or have had cancer, by 2032 it is expected to be 1.4 million.
'This is largely due to the aging population,' Langendijk explains. 'The good news is that cure rates are increasingly higher these days, but on balance that also means more patients who may experience side effects and complications from treatments. An aging population puts even more pressure on our healthcare system, so it's even more important to reduce those side effects as much as possible.'
Recently, the UMCG Proton Therapy Center irradiated the first patient with an artificial intelligence-based treatment plan for proton therapy. This happened for the first time ever in the world, which is unique. To create a manual treatment plan, a planning lab needs an average of 1-2 days, but it can now be done in about 2.5 hours. 'In addition, during the course of next year we will also be the first in the world to start Proton Arc Therapy for head and neck cancer,' says Langendijk. 'This is a new technique that allows us to deliver even more targeted radiation.'
Although proton therapy is still a relatively new method, the first results are already promising. 'The acute side effects are already much less,' says Langendijk. 'We are carefully charting all the data and we are also cooperating in this with the other proton centers in the Netherlands and in the rest of the world. It is a continuous learning process and I am therefore also very proud of our team. They are the people who make the technology possible and it is incredible what they have achieved in such a relatively short time.'
IFG: our role is finished
As one of the partners, Investment Fund Groningen was involved in funding the construction and realization of the proton center. After all, such a project has some ground to cover. 'The arrival of a proton therapy center first means an enormous contribution to the survival chances of a specific group of cancer patients,' says fund manager Jan Martin Timmer. 'In addition, it also supports the position of the UMCG and Groningen as a leading oncology center. Sufficient reasons, therefore, for the UMCG to want to realize the construction.'
'But of course that came with a risk,' Timmer continues. 'And that's not a risk you want to bear alone as a hospital, because then the healthcare provision for an entire region is at stake if it does go wrong. That's why we set up the funding together with Triade, the Province of Groningen and Proton International. This way you not only spread the risk, but it also acts as a lever, so that you can persuade other parties such as a bank. The idea of this construction was that we would stay on board for the first few years. So not only for the construction, but also after, so that you can also be sure that the equipment is working properly, the treatments can be performed properly and with certainty, and no problems arise in the process.'
Timmer looks back on the collaboration with pride. 'It was really impressive with how much precision the entire project ran. Normally there is always some delay in construction or the costs are slightly higher. This was not the case. And not a single problem with the equipment either. Everything worked just fine. We had a modest role and it's on now. And we are really very proud of what we have achieved.'