| Chicago Tribune Despite the generally discouraging medical outlook for patients like Sen. Edward Kennedy, D-Mass., who have malignant brain cancer, several experts said the veteran lawmaker's best chance may be to keep fighting. SAVE MONEY ON TRAVEL DEALS The most common variety of Kennedy's type of cancer carries a median survival time of about 12 to 15 months, though his doctors at Massachusetts General Hospital did not release enough details for other experts to give a precise assessment of Kennedy's condition. Yet survival for such patients can vary from just a few months up to five years or more in unusual cases. Kennedy's progress depends on such unknowable factors as how his tumor will respond to radiation treatment and chemotherapy. That's a major reason why the senator and his well-wishers should not give up hope, said Dr. Henry Brem, director of neurosurgery at Johns Hopkins School of Medicine. "People who fight tend to do better", Brem said. "Sometimes, these patients outlive their doctors." It's difficult if not impossible to cure Kennedy's type of cancer, identified as malignant glioma. Glioma is a broad term that includes about 42 percent of all brain tumors. About 13,000 Americans die each year from malignant tumors of the brain or spinal cord, accounting for 2.2 percent of all cancer-related deaths, according to the American Cancer Society. Even with the best treatment, only 25 percent of patients with the most common form of malignant glioma survive as long as two years. At three years, the survival rate drops to about 5 percent. Experts say survival has improved in the last 10 years thanks in part to new drugs such as temozolomide, which is now a standard addition to radiation therapy. A 2005 study in the New England Journal of Medicine found that patients with serious brain tumors who took the drug along with radiation survived an average of 14.6 months, compared with 12.1 months for those who got radiation alone. The fact that notable survival gains are measured in months indicates the serious nature of Kennedy's diagnosis, experts said. "Basically it's an incurable disease", said Dr. Lorenzo Munoz, a neurosurgeon at Rush University Medical Center. "You need to ask what realistically you're trying to achieve. The treatment is not a cure. You're trying to prolong life." Malignant brain tumors are difficult to treat in part because there is often no clear boundary between the cancer and essential brain tissue. Munoz compared the problem to plucking crab grass from a patch of normal grass. It's nearly impossible to remove all of the cancerous tissue, he said. "Even in cases where you can remove all of the tumor that you can see, there are almost always tumor cells interspersed with normal brain tissue", said Dr. Jeff Raizer, director of medical neuro-oncology at Northwestern Memorial Hospital. In many cases, the tumor's position in critical brain areas makes it impossible to remove surgically. Kennedy's doctors said his tumor is in his left parietal lobe, which experts said raises the question of whether removing it would affect his brain's language center, which is located nearby. In their statement Tuesday, Kennedy's doctors said the usual course of treatment would include radiation and chemotherapy, but they did not mention treating him with surgery. Doctors never determine the cause of most brain tumors. Aside from a few unusual genetic syndromes, the tendency to get such tumors does not run in families, and the cancer usually is not traceable to causes in the environment. Experts believe most gliomas begin with genetic changes in brain cells, though the source of those changes is also mysterious. Age may be working against Kennedy, who is 76. Older patients with malignant brain tumors tend to have a worse outlook than younger ones, said Dr. Maciej Lesniak, a neurosurgeon at the University of Chicago Medical Center. A typical course of radiation therapy for Kennedy's type of tumor would include treatments five days a week, lasting about seven weeks, in addition to chemotherapy. "I've had plenty of patients in their seventies who have tolerated this treatment well", said Dr. Nina Paleologos, director of the neuro-oncology program at Evanston Northwestern Healthcare.
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