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Treatment on an MR-linac can have obvious clinical benefits for some patients, but has potential downsides. Overall treatment time for example, is longer than on a conventional linac. Several studies suggest tolerance for MR-linac treatment is good. However, no direct comparison between MR-linac and conventional linac is available. In this study we investigated the difference in patients’ experiences on both modalities in our clinic.

We used a validated patient experience questionnaire for patients with prostate cancer. This questionnaire contains 16 questions regarding treatment tolerance, and was scored on a four point Likert scale. Questions 1 - 8 were phrased positively, whereas questions 9 – 16 were phrased negatively. This means for questions 1 - 8, a result of 1 was the least favourable and 4 was the most favourable. For questions 9 - 16, this was the opposite. For analysis, responses to questions 9 to 16 were inverted, so that a score of 1 represents the least favourable response and 4 represents the most favourable. Patients were treated either with 5 fractions on the MR-linac or 5, 20, 25 or 30 fractions on a conventional linac. Patients were asked to fill out the questionnaire after their second and last treatment session. 

A total of 93 questionnaires were obtained from 51 patients (MR-linac N = 17, short-course conventional N = 9, long-course conventional N = 25). The mean score for the total questionnaire was 3,78 for the MR-linac (SD = 0,21), 3,65 for short-course conventional (SD = 0,23) and 3,82 for long-course conventional (SD = 0,22), where 4 is the best possible score (range 1 - 4). Overall, 95,64% of the scores were favourable (score 3 or 4) for the MR-linac and 93,73% for the conventional linac. The highest and lowest ranking questions were the same ones for both modalities (see figure 1). Results scored after fraction 2 and after the last fraction were comparable (3,74 and 3,76, respectively. SD = 0,01). A more unfavourable experience for MR-linac treatment, compared to conventional treatment, was only observed for the item ‘’tingling sensations during treatment’’ (12,5% unfavourable responses for the MR-linac versus 0,0% for conventional linac). 

Patient-reported treatment experience for patients treated on an MR-linac is comparable to treatment experience for patients treated on a conventional linac. A tingling sensation was reported more often for MR-linac treatment compared to conventional treatment. Overall, patient-reported tolerance for MR-linac and conventional linac is high.