Erik van der Heijden, hoogleraar Interventie Longziekten

Erik van der Heijden appointed professor of Interventional Pulmonology

Erik van der Heijden has been appointed Professor of Interventional Pulmonology at Radboud university medical center / Radboud University. His primary focus is to develop technological innovations to improve early diagnosis and treatment of patients with lung cancer. He is also committed to applying this new technology in daily practice.

Detection of early lung cancer is usually a coincidence, when incidental nodules are found on a chest CT, for example, when someone is evaluated in the emergency room after a traffic accident. ‘When we can diagnose these malignant nodules early, we can also start therapy early, with a higher chance of curation’, says pulmonologist Erik van der Heijden. ‘I am working with my team to develop new technology that allows us to better map the route leading to these tumors and evaluate options for local treatments.’

Breadcrumbs

Still, it is difficult to prove whether a suspicious spot is actually lung cancer. ‘Currently, of all the people who receive radiation for early-stage lung cancer, 65% have no evidence that it is actually lung cancer’, says Van der Heijden. The standard diagnosis now is a biopsy of the suspicious area through the chest wall, but that is not always technically feasible or possible due to restraints in pulmonary function if the area lies deep within the lungs. In addition, such a biopsy leads to a pneumothorax in twenty percent of cases. ‘We need better and less invasive diagnostics.’

Van der Heijden therefore developed a new technique: cone beam CT navigation bronchoscopy. The patient lies on a hybrid operating room with a CT scanner. Doctors use a bronchoscope, a flexible catheter, which includes a camera and a light attached to it, to go through the mouth into the lungs to smaller and smaller branches of the trachea. They determine the route to the tumor based on live CT images. 'It is like climbing inside a tree, all the way up to the smallest twig. We put a dot on the computer images at each junction, indicating the right turn. Those dots point lead the way like breadcrumbs.' Once in the tumor, the doctor takes biopsies for a precise diagnosis.

Robotics

This technique should become widely available, Van der Heijden believes: 'We have demonstrated its cost-effectiveness and as of January 1, 2024, health insurance companies will reimburse it. We are training other centers and working in the meantime to improve the technology.' This is done, for example, with smart software that guides the doctor to the tumor like a tomtom. Furthermore, the instruments can be improved. 'We use a catheter with a curved tip, which can be troublesome in taking difficult turns. We are now preparing tests with a better steerable catheter. We could also start steering it with robotic support.'

Doctors currently use CT-guided bronchoscopy for diagnostics. ‘But if we are in that lung with our instruments, we could also directly treat a tumor in the same procedure’, Van der Heijden says. 'For example, injecting immunotherapy directly into a tumor, or heating a tumor locally with microwave radiation. With such techniques at an early stage of disease, you may prevent more invasive and burdensome treatments at a later stage of disease and improve outcomes in lung cancer.'

Career

Erik van der Heijden (Eindhoven, 1965) studied medicine at Radboud University. He received his doctorate for his dissertation entitled 'Effects of β2-adrenoceptor agonists on the diaphragm; functional and morphological studies in animal models'. Part of the research took place at the Mayo Clinic, USA. Van der Heijden trained as a pulmonologist at the Radboud university medical center and became a medical specialist there in 2002. He recently received two large grants: from IHI-EU and from The Dutch Cancer Foundations. The appointment is effective December 1, 2022, for a period of five years.