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Sen. Edward M. Kennedy Dies at 77
Date:8/26/2009

Diagnosed with brain tumor last year, his relentless optimism, new therapies helped him exceed expectations, experts say

WEDNESDAY, Aug. 26 (HealthDay News) -- Sen. Edward M. Kennedy, the last surviving brother in a unique American political dynasty and one of the most influential senators in history, died late Tuesday night at his summer home on Cape Cod after a 15-month battle with brain cancer. He was 77.

The Massachusetts lawmaker had continued to follow the current battle to reform health care in the United States -- the centerpiece of his legislative ambitions -- from his sickbed until his death, according to published reports.

There was no immediate word on funeral arrangements.

Kennedy was diagnosed with a malignant glioma in the parietal lobe of his brain in May 2008, after suffering a seizure. By the time of his death, he had met and, by many accounts, exceeded medical expectations.

"He's at about the median survival which, for his age, is pretty good. He's at or exceeded expectations," Dr. Tara Morrison, head of neuro-oncology at Fox Chase Cancer Center in Philadelphia, said shortly before Kennedy's death.

It was not revealed what type of tumor was found last year, but specialists speculated that it appeared likely to be a glioblastoma multiforme, which is more aggressive and more common in older people. With the most aggressive treatment, patients can be expected to live a median of about a year.

Soon after the diagnosis, Kennedy underwent surgery to remove part of the tumor. Partial removals are common when it's not possible to remove the entire tumor, according to Dr. Deepa Subramaniam, director of the brain tumor center at Georgetown University's Lombardi Comprehensive Cancer Center.

Being able to have surgery was the first good sign for Kennedy, as some patients aren't candidates at all.

"I believe doctors initially thought they weren't going to be able to perform surgery because it was a tumor on the left side that could potentially affect speech centers, but they were able to do it," Morrison said. "It is generally known that if the tumor can be resected [removed], patients do tend to do better, and the more that can be removed the better because there's less actual tumor cells that can come back."

After surgery, Kennedy was reported to have undergone chemotherapy and radiation, which is standard procedure for this type of cancer. Specifically, the senator was said to have received proton therapy, which is a form of radiation. "It's a slightly different means of delivering radiation, just a different type of beam," Morrison explained.

Kennedy most likely underwent chemotherapy with temozolomide (Temodar), which has been used since the early part of the decade and became the standard care in about 2005, Morrison said.

The addition of Temodar to the medical armamentarium against brain cancer was the first in four decades.

"Before that, the last big breakthrough was the addition of radiation 40 years ago," Morrison said. "There have not been big steps made in the treatment of brain tumors. There's been a lot of work, but the breakthroughs haven't been coming fast and furious like in many other cancers."

Experts are hopeful that glioblastoma vaccines currently under development will one day yield benefits.

One vaccine being developed at Duke University reported median progression-free survival in patients receiving the vaccine plus chemotherapy of 16.6 months, compared to only 6.4 months of recurrence-free survival in those not taking the treatment.

"There's always great hope that one of the vaccine trials will turn out to be the next big thing," Morrison said. "Chemotherapies have significant side effects and make the patients pretty sick, and we don't want to do that. Therapies that go just to the brain won't make people sick."

But even if new regimens have not drastically improved survival, they have enhanced quality of life for glioblastoma patients, Subramaniam said recently.

"The main quality-of-life issue for these patients, especially with a relapse, is brain swelling which can cause a decline in general alertness. Depending on the location of the tumor, it can cause seizures or problems with speech or vision or weakness in one side of the body," she noted.

Kennedy did collapse at President Barack Obama's inaugural luncheon in January, but that was the result of "simple fatigue," his doctors said at the time.

Kennedy's relentlessly positive attitude was also a factor in his longer-than-usual survival, experts said.

"He's always been a fighter and I think attitude is something that's quite important in trying to deal with every little setback in a very positive way, to take two steps forward for every one step back," Subramaniam said.

"I generally find that patients who are upbeat and positive do better than patients who get depressed and down," Morrison added. "A negative attitude is carried through in the prognosis and that's in all elements of disease, not just gliomas or brain tumors."

But in a sign that Kennedy knew his time was growing short, the senator last week privately asked Mass. Gov. Deval L. Patrick and state legislative leaders to change the succession law to ensure that Massachusetts would have a Senate vote when his seat became vacant, especially if the health-care reform debate came to a head, the Boston Globe reported.

Kennedy asked that Patrick, a fellow Democrat, be given authority to appoint someone to the seat temporarily before voters choose a new senator in a special election. Although Kennedy didn't specifically mention his illness or the health-care debate, he was clearly trying to make sure that the leading cause of his political career -- better health coverage for all Americans -- advance should he die, the newspaper reported.

The American Cancer Society estimates that nearly 22,000 malignant tumors of the brain or spinal cord will be diagnosed this year in the United States. Approximately 13,070 people -- 7,420 men and 5,650 women -- will die from these tumors. The cancers account for about 1.3 percent of all cancers and 2.2 percent of all cancer-related deaths in the United States.

Kennedy was the youngest of nine children, and became a U.S. senator in 1962. His older brother, President John F. Kennedy, was assassinated in 1963. Another brother, Robert Kennedy, who was also a U.S. senator, was assassinated in 1968 during his presidential campaign.

His sister, Eunice Kennedy Shriver, who founded the Special Olympics, died earlier this month.

More information

Harvard Medical School has a patient guide to gliomas.



SOURCES: Tara Morrison, M.D., director, neuro-oncology, Fox Chase Cancer Center, Philadelphia; Deepa Subramaniam, M.D., director, brain tumor center, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C.


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