By Bill Smith, St. Louis Beacon, May 23, 2008
Despite significant medical advances in dealing with many types of cancers over the past decade, aggressive brain tumors remain extremely difficult to treat successfully.
As a result, Sen. Ted Kennedy and patients like him have a only a slight chance of surviving more than a couple of years.
That is the grim assessment of two of the St. Louis area''s top experts on brain cancer.
"There are always little incremental improvements" in treatment protocols," said Dr. Joshua Dowling, associate professor of neurological surgery at Washington University. "But there has not been anything dramatic. Five-year survival rates do occur, but it is highly unusual."
"Right now, there is nothing out there that is proven" to extend a patient''s life more than a few months, said Dr. Richard Bucholz, director of the division of neurosurgery at St. Louis University. "There is nothing that one would consider a major advance."
Both men said malignant gliomas such as Kennedy''s are usually treated with surgery, radiation and chemotherapy. Reports indicate that Kennedy''s tumor may not be operable because of its location in the left parietal lobe, a region of the brain that governs language, movement and the senses.
If that is the case, both men agree that his chance of longer-term survival is significantly reduced.
Still, Dowling said, "the problem with making predictions is that each of these tumors is unique.
"Some will respond well to radiation and chemotherapy, but others will keep growing aggressively and quickly."
Both men said Kennedy''s age -- he is 76 -- also is a contributing factor. Younger patients tend to survive longer.
Both men also said that another factor to longer term survivability is just how impaired the senator''s functioning already is.
"People who already have a neurological deficit do not do as well," Bucholz said.
Even under ideal circumstances -- in cases where the visible tumor can be removed with surgery, where the patient is young and where the cancer responds well to radiation and chemotherapy -- survival rates rarely exceed three to five years.
About 9,000 people each year are diagnosed with primary brain tumors, making such a diagnosis far less common than lung cancer, colon cancer, breast cancer or prostate cancer.
Dowling said it is so difficult to treat malignant brain tumors because cancer cells invade surrounding tissue.
"Even if you resect (remove in surgery) all of what appears to be a tumor, there are always tens of thousands or hundreds of thousands of cancer cells that have seeped into surrounding brain tissue," Dowling said.
Dowling said a seizure, such as the one experienced by Kennedy, often is the first sign of a brain tumor.
Dowling also said an earlier diagnosis does not make a difference in dramatically extending a patient''s life. "These tumors are not curable, regardless of when they are diagnosed," he said.
He also said science does not know how they are caused. He noticed that despite reports to the contrary, there is no proof that brain cancer is linked to cell phone use.
Typical treatment for a patient where surgery is not an option calls for a six-week course of radiation directed at the tumor area. That is usually followed by a period of several months in which where the patient takes an oral chemotherapy drug called Temodar.
The drug usually has few side effects.
Bucholz said that while current treatment protocols do not significantly increase survivability rates, there "absolutely is hope and research continuing in this area."
He specifically pointed to the thus far experimental use of the drug Avastin, which blocks the formation of new blood vessels that supply the tumor with nutrients.
A story in the Los Angeles Times quotes Dr. Keith L. Black, chairman of the department of neurosurgery at Cedars-Sinai Medical Center in Los Angeles, as saying the use of Avastin may improve survival and "definitely improves the quality of life."
Bucholz also said that there has been some excitement in the medical community over administering an anti-cancer drug directly into a patient''s brain. The drug, he said, has been found to attach itself to cancer cells, destroying them.
But, he said, that process is still in its very earliest stages and "our technology for delivering it (the cancer killing agent) still has a lot to be desired.
Still, though, he said, "Conceivably, this is something that may prolong an individual''s life, maybe significantly longer than figures we have been talking about."