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Sen. Kennedy Undergoing Surgery for Brain Tumor
Date:6/2/2008

He has a malignant glioma, an especially lethal type of brain tumor

MONDAY, June 2 (HealthDay News) -- Sen. Edward M. Kennedy was undergoing surgery Monday for the malignant brain tumor that was diagnosed last month.

The 76-year-old senator was having the surgery for a malignant glioma, an especially lethal type of brain tumor, at Duke University Medical Center in Durham, N.C. A statement from the Massachusetts Democrat's office said he would be operated on by one of the nation's top neurosurgeons, Dr. Allan Friedman, neurosurgeon-in-chief at Duke, the Boston Globe reported.

The surgery, expected to last approximately six hours, will be followed by weeks and possibly months of chemotherapy and radiation, the newspaper reported.

The surgery is considered the most aggressive approach that Kennedy could select to treat his tumor. The decision to opt for surgery was considered something of a surprise, the Globe said, because Kennedy's doctors did not mention surgery as an option after the tumor diagnosis was announced almost two weeks ago. Instead, Kennedy's doctors said the focus of treatment would be radiation and chemotherapy.

The American Cancer Society estimates that 21,810 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 malignant 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.

A patient's prognosis depends on the "grade" of the tumor, said Dr. Isabelle Germano, co-director of The Radiosurgery Program at Mount Sinai Medical Center in New York City. Five-year survival rates for low-grade (grade 1) tumors can be as high as 95 percent; for grade 4 tumors, five-year survival plummets to about 5 percent, she said.

Dr. Deepa Subramaniam, director of the brain tumor center at Georgetown University's Lombardi Cancer Center in Washington, D.C., said younger people tend to be diagnosed with low-grade tumors while older individuals tend to have more aggressive ones.

The first evidence that a person has a malignant tumor is often a seizure like the one Kennedy suffered last month, or stroke-like symptoms.

The parietal lobe, where Kennedy's tumor is located, governs strength in one-half of the body, Subramaniam said.

Without surgery, patients are left with chemotherapy (only one drug is currently approved for malignant glioma) and radiation, often given concurrently for the first six weeks. If that is well tolerated and if the tumor hasn't grown, patients might receive additional chemotherapy for the next five months or longer, Subramaniam said.

In the most aggressive form of the cancer -- grade 4 -- patients can live for about a year with the full complement of therapies, Subramaniam said. Without treatment, however, the prognosis is usually a few months.

But the outlook isn't always that grim. Subramaniam said she has examples of patients who have lived for two years, "so it's not clear why some patients live so long while others die within a year."

Dr. Jonathan Friedman, director of the Texas Brain and Spine Institute in College Station, said that, given a "diagnosis of malignant glioma, surgery is generally not curative. The primary role of surgery is to biopsy and ascertain the diagnosis and, in some circumstances, there's a role for debulking or removal of a significant volume of tumor. But in some circumstances, that's not possible or not desirable.

"But malignant glioma are infiltrative tumors," added Friedman, who's also an assistant professor of surgery and neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine. "They don't have good margins. They grow into the brain, which makes sense, because they are made out of brain cells. Because of that, they generally cannot be removed in their entirety."

Kennedy, the second-longest serving Democratic senator in Congress, suffered a seizure May 17 while at his family's Hyannisport compound and was taken by helicopter to Boston.

In October 2007, a partially blocked carotid artery in Kennedy's neck was discovered during a routine magnetic resonance imaging (MRI) examination. Doctors cleared the blockage, and Kennedy was released to convalesce in Hyannisport.

Dr. Otis W. Brawley, chief medical officer for the American Cancer Society, last month called Kennedy an "unparalleled leader in the fight against cancer and for access to quality health care for all Americans throughout his distinguished career in the United States Senate. He yields to no one in his accomplishments and in his efforts to bring all the resources of the nation to bear in fighting cancer and other diseases, to reigning in the tobacco industry, and to extending health insurance coverage to all Americans, especially the most vulnerable among us."

Kennedy is 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.

More information

The National Library of Medicine has more on glioma.



SOURCES: Deepa Subramaniam, M.D., director, brain tumor center, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C.; Isabelle M. Germano, M.D., professor of neurosurgery, and director, The Radiosurgery Program, Mount Sinai Medical Center, New York City; Jonathan Friedman, M.D., assistant professor of surgery and neuroscience and experimental therapeutics, Texas A&M Health Science Center College of Medicine, and director, Texas Brain and Spine Institute, College Station; American Cancer Society; Boston Globe


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