Headlines
As reported by the Danbury News-Times, May 21, 2008.
Local Experts Say Kennedy's Brain Cancer Is Worst Kind
By Robert Miller
The first line of defense in treating cancer is surgery. In brain cancer, that's not an option.
"You can't just go into the brain willy-nilly and chop away," said Dr. Robert Dowsett, director of radiation oncology at the University of Connecticut Medical Center in Farmington.
"With say, a breast cancer, you can go in, remove the tumor and some tissue surrounding it," said Dr. John Pezzimenti, director of the Praxair Cancer Center at Danbury Hospital. "Remove too much of the brain, and you've got a patient who can't move his arms or remember his name."
That is why doctors were not optimistic when discussing the fate of U.S. Sen. Edward M. Kennedy of Massachusetts, the 76-year-old liberal lion of the Senate.
On Tuesday, Kennedy's doctors revealed he has a malignant brain tumor.
It is a primary brain tumor -- a cancer that originated in the brain, rather than spreading there from another malignancy elsewhere in the body.
Pezzimenti, Dowsett and Dr. Joachim Beahring, director of the Brain Tumor Center at the Yale Cancer Center in New Haven, said Tuesday they cannot diagnose Kennedy's cancer without knowing his full case history.
Beahring said the most common type of malignant brain tumor -- a glioblastoma -- also is the most aggressive.
"If that's the case, it's pretty grave," Beahring said.
However, Beahring said other types of brain cancers -- such as anaplastic gliomas or oigodendrogliomas are slow-growing.
"If it's one of those, his chances could be profoundly better," Beahring said.
Kennedy's doctors said the senator's cancer was a malignant glioma -- an especially lethal type -- in the left parietal lobe of the brain.
Beahring said this section of the brain controls sensory coordination.
"If it's on the left side, it could cause numbness on the right side," he said. Beahring added the tumor is near sections of the brain controlling mathematical abilities, strength, coordination and language.
Pezzimenti, of Danbury Hospital, said Kennedy's doctors never mentioned surgery as part of his treatment.
"It doesn't look like it's operable," he said.
That leaves radiation and chemotherapy. These treatments sometimes can slow the growth of the cancer, but doctors said they do not represent a cure. Depending on the type of cancer, survival rates are as low as a year or less, or as long as three or four years.
Dowsett, of UConn, said today, the most advanced form of radiation used on malignant gliomas would probably be IMRT -- intensity-modulated radiation therapy. It uses 3-D computer modeling to deliver the optimal dosage of radiation to the tumor, while causing less damage to surrounding brain cells.
"It gives us the ability to better shape the dosage," he said.
A new drug on the market, Temodar, or temozolomide, also has proved effective when used with radiation.
"It's like having a left hook with a right jab," Dowsett said of the one-two effectiveness of the two treatments.
Patients tolerate this regimen well, he said, with fatigue, hair loss and nausea the worst symptoms.
But again, the best results of this treatment have been for patients to live three or four years, instead of only one.
"We see partial remissions," Beahring said. "It's rare to see a full remission."
Brain tumors often can't be diagnosed until the cancer is advanced. Kennedy was unaware he was ill until he suffered a seizure over the weekend.
Beahring also said because of the nature of brain cell tissue, malignant brain tumors tend to disperse more easily through the brain. In comparison, cancers in other parts of the body tend to be better defined and more easily treated by surgery, he said.
Because of the nature of the brain itself, it's also harder to operate without damaging a patient's ability to perceive the world or respond to it.
Because of all these problems, the treatment of brain tumors still has a way to go.
"Progress has been slow," Pezzimenti said. "It's the nature of these tumors."
Brain Cancer
200,000 people in the United States are diagnosed annually with a primary or metastatic brain tumor.
Primary brain tumors -- those originating in the brain -- account for about 40,000 tumors.
Brain tumors are the leading cause of solid tumor cancer death in people under the age of 20; the second-leading cause of cancer death in men age 20 to 29; and the fifth-leading cause of cancer death in women age 20 to 39.
Primary brain tumors generally do not metastasize to other parts of the body.
There are over 120 different types of brain tumors. Standard treatments include surgery, radiation therapy, and chemotherapy, used individually or in combination.
Brain tumors in children are different from those in adults and consequently are treated differently. As many as 69 percent of children will survive.
Survival rates decline with age. At 65 years old and older, less than five percent of brain cancer patients survive for five years.
The cure rate for most brain tumors is significantly lower than that for many other types of cancer.
There are currently no known causes of brain tumors.
Source: The Brain Tumor Society