Prognosis Usually Bleak for Condition, a Glioma

By LAWRENCE K. ALTMAN and ANAHAD O’CONNOR
22 may 2008--The statement that Senator Edward M. Kennedy’s doctors issued on Tuesday made clear that his malignant tumor was a glioma, a cancer that arises in the brain and that often carries a bleak prognosis.
Gliomas occur more frequently with advancing age, and studies have shown that in general patients in their 70s fare less well than those 45 and younger. Still, the statement also said Mr. Kennedy, 76, was in “good spirits and full of energy” and walking around his room at the Massachusetts General Hospital in Boston.
Mr. Kennedy’s glioma is in the parietal area in the upper part of the left side of his brain, above the ear. This area of the brain involves motor control and ability to understand language, among other functions.
Malignant brain tumors rarely spread elsewhere in the body. But like the root of a plant, cancerous brain tumors can invade nearby areas in the brain.
Gliomas are categorized by subtypes and by a numerical gradation based on how aggressive they appear. But the doctors did not provide these details or the tumor’s size, saying only that the diagnosis was made by removing a small piece of the cancer in a biopsy, which followed a series of other tests that began after Mr. Kennedy suffered a seizure on Saturday morning.
The cancer was responsible for that seizure, said Dr. Lee H. Schwamm, vice chairman of the hospital’s department of neurology, and Dr. Larry Ronan, a primary care physician, in their statement. Mr. Kennedy has experienced no further seizures, the doctors said.
Gliomas and other brain tumors are often heralded by seizures and headaches, and are often removed surgically. Imaging techniques are used to make sure that the surgeon removes as much of the cancer as anatomically possible. Then such patients often receive a course of radiation, lasting seven weeks, and chemotherapy.
Precisely how Mr. Kennedy’s glioma will be treated depends on further tests, the doctors said.
But the statement noticeably omitted the option of surgery, suggesting that operating might cause significant damage because of the tumor’s location.
Speaking of brain tumors in general and not of Mr. Kennedy’s case, Dr. Steven S. Rosenfeld, who directs NewYork-Presbyterian/Columbia hospital’s brain tumor center, said: “I do not know what his surgeons are planning, but we certainly find ourselves with malignant gliomas on that side of the brain where we don’t do surgery because of the possibility of damaging speech. And for someone with Senator Kennedy’s profession, that could be particularly disabling.”
According to the American Cancer Society, about 13,070 people in this country will die from brain and nervous system cancers this year, and over all, 21,810 people will develop them.
About 42 percent of all brain tumors, including benign ones, are gliomas, according to Dr. Otis W. Brawley, the cancer society’s chief medical officer. About 77 percent of malignant brain tumors are gliomas.
Most brain cancers have no known cause, result from genetic abnormalities and are not linked to cigarette smoking, Dr. Brawley said.
Statistically, the most common type of glioma is known as an astrocytoma.
It can take four or so days for a pathologist to determine the specific type of glioma. Depending on the type of glioma and the course of treatment, the prognosis, in general, can range widely, from 50 percent survival rate at one year to as much as 40 percent at 10 years, for the least aggressive kind.
But new approaches to treating gliomas with so-called targeted therapies “have offered hope beyond what we have seen in the past,” Dr. Brawley said.
These include drugs and experimental cancer vaccines aimed at the body’s immune system.
Mr. Kennedy underwent surgery seven months ago at the same hospital to restore blood flow through a narrowed carotid artery in his neck and to prevent a possible stroke. He had no symptoms at the time, the hospital said.
As part of the testing for that procedure, Mr. Kennedy very likely had an M.R.I. brain scan, Dr. Keith L. Black, director of neurosurgery at Cedars-Sinai Medical Center in Los Angeles, said in answer to a question. Because gliomas are fast-growing cancers, it is possible that the tumor was too small to show up on the scan. But it is also possible that the doctors did not detect a tumor at that time or dismissed the abnormality as due to something else, Dr. Black said.
Mr. Kennedy’s family has been unusually affected by cancer. Two of his three children and his first wife are cancer survivors. His son, Edward Kennedy Jr., was treated for bone cancer in 1973 at the age of 12. His daughter, Kara Kennedy Allen, was treated for lung cancer in 2003. His first wife, Joan Kennedy, was treated for breast cancer in 2005.