WASHINGTON — A malignant glioma — the diagnosis doctors gave Sen. Edward Kennedy — has the lowest rate of long-term survivability.
Malignant gliomas strike almost 9,000 Americans a year. Survival statistics are grim — few live three years and for the worst subtype, half die within a year.
Who lasts longer — and some do — depends on exactly what form of glioma someone has, whether surgeons can cut most of it out, age and some other medical details.
Kennedy’s doctors didn’t mention surgery, which may suggest that may not be possible. Doctors were awaiting further tests before choosing a treatment for Kennedy, but they cited radiation and chemotherapy as the usual approach.
“As a general rule, at 76, without the ability to do a surgical resection, as kind of a ballpark figure you’re probably looking at a survival of less than a year,” said Dr. Keith Black, chairman of neurosurgery at Cedars-Sinai Medical Center.
On the plus side, scientists are studying new approaches, adding a drug called Avastin to standard treatment or even brewing up customized vaccines to help the body fight back. Many glioma experts advise newly diagnosed patients to seek out specialized cancer centers and ask if they’re a good candidate for a research study.
“Considering how poorly they do despite standard treatment, it is always best to seek a clinical trial,” said Dr. Deepa Subramaniam, director of the brain tumor center at Georgetown University’s Lombardi Comprehensive Cancer Center. “They are not likely to do worse.”
Kennedy’s age and the mention of upfront chemotherapy mean the glioma is almost certainly one of the two worst forms: a glioblastoma — the fastest-killing brain tumor, known for claiming entertainer Ethel Merman and Republican political strategist Lee Atwater — or the only somewhat less aggressive anaplastic astrocytoma, Subramaniam said.
Malignant glioma “usually is a synonym for a glioblastoma,” said Dr. Robert Laureno, neurology chairman at Washington Hospital Center in the nation’s capital.
About 40 percent of the time, surgery isn’t an option. The cancer, which digs tentaclelike roots into normal brain tissue, may be too deep or located so closely to critical brain regions.
Moreover, “it doesn’t help to take 50 percent or 60 percent of the tumor out,” Black said.
Standard treatment is about six weeks of fairly high-dose radiation along with a chemotherapy pill named Temodar, and then additional Temodar for at least six months or until the tumor stops responding.
But some people fare much better — especially those with a subtype where another glioma form, called oligodendroglioma, is mixed with the primary tumor, Black said. They generally survive three times as long as people with pure glioblastomas.
The tumor’s size, which also wasn’t revealed, is key, too, added Dr. Lynne Taylor of Seattle’s Virginia Mason Cancer Center and the American Academy of Neurology. An 8-centimeter tumor is pretty big for chemo and radiation to blunt, while a 1-centimeter tumor is easier.
Also, the fairly recent addition of Temodar has brought a slight increase in the number of patients who beat average survival odds, she added.
What symptoms will appear first depends on exactly where in the parietal lobe the tumor sits and “how that individual’s brain is wired,” Laureno said.
Among the possibilities: Loss of sensation on the right side of the body, problems with movement in the right arm and leg, eventual problems speaking or even vision problems in the right eye.
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
