Sen. Edward Kennedy Diagnosed With Malignant Glioma

Susan Jeffrey

May 23, 2008

May 23, 2008 — Sen. Edward Kennedy went home from the hospital Wednesday after receiving a diagnosis of malignant glioma earlier this week. He was hospitalized last weekend after suffering a seizure and underwent diagnostic testing at Massachusetts General Hospital, in Boston.

In a joint statement issued May 20, Lee Schwamm, MD, vice-chair of the department of neurology at Mass General, and primary care physician Larry Ronan, MD, confirmed Sen. Kennedy's condition. "Some of the tests we had performed were inconclusive, particularly in light of the fact that the senator had severe narrowing of the left carotid artery and underwent surgery just 6 months ago," they write. "However, preliminary results from a biopsy of the brain identified the cause of a seizure as a malignant glioma in the left parietal lobe."

The usual course of treatment includes combinations of various forms of radiation and chemotherapy, they add. "Decisions regarding the best course of treatment for Sen. Kennedy will be determined after further testing and analysis."

Wednesday night, news outlets featured coverage of Sen. Kennedy's return home after hospital discharge, showing him smiling and waving to crowds of well-wishers and then heading straight out for a sail with his wife, Victoria, and his dogs.

A Clinical Trial Candidate?

Both the American Academy of Neurology (AAN) and the American Association of Neurological Surgeons (AANS) acknowledged the news about Sen. Kennedy's diagnosis and provided resources for those wanting information about glioblastomas.

The AAN posted a number of resources on its website, including information on antiangiogenic therapy for glioblastomas, neuroimaging in the emergency patient presenting with a seizure, and anticonvulsant prophylaxis in patients with newly diagnosed brain tumors.

Lynne Taylor, MD, director of neuro-oncology at the Virginia Mason Medical Center, in Seattle, Washington, wrote a question-and-answer article on glioma that was also posted on the AAN site.

The incidence is approximately 18,500 new cases in the United States per year, or 7.4 cases per 100,000 person-years, Dr. Taylor writes. Age plays a role. "The older the patient, the more likely that their primary brain tumor is going to be classified as a glioblastoma multiforme [GBM]," she notes.

The current standard treatment is as aggressive surgical removal as possible while maintaining the best neurologic function for the patients, Dr. Taylor notes, followed by radiation and chemotherapy. The use of temozolomide (Temodar, Schering) to sensitize tumors to the effects of chemotherapy has increased long-term survival from 10% to 27% at 2 years.

Like most newly diagnosed patients, 1 decision Sen. Kennedy will have to make is whether he would consider participation in a clinical trial "to do 2 things," she told Medscape Neurology & Neurosurgery. "One, hopefully to get a new agent that wouldn't be available to him outside of a clinical trial, and number 2, to actually increase our knowledge about how to treat brain tumors, so he'd be doing a public service . . . which as a politician and a public figure might be compelling to him."

For patients with newly diagnosed tumors, she uses the National Cancer Institute's "Find a Clinical Trial" function to search out trials for which they may potentially be candidates. By entering their zip code, the site narrows down locally available trials, since most patients will want to be close to family and friends during this time and may not have the resources to travel long distances often for treatment, she said.

Of 4 such trials available in Sen. Kennedy's area for which he might be a candidate, most are antiangiogenic strategies — for example, vandetanib (Zactima, ZD6474; AstraZeneca), a product that blocks vascular endothelial growth factor. "It points out the explosive interest in the whole field of angiogenesis in brain tumors," she noted.

She said it was unlikely that surgery will be an available option for Sen. Kennedy, since the left parietal lobe is close to the parietal-temporal lobe, where expressive and receptive language resides. Most brain tumors do not reside in 1 lobe but cross over into multiple lobes, she said. "Because it's in his left parietal lobe, and depending how large it is, the likelihood that he'd be rendered aphasic would be fairly high, and that probably would be unacceptable to someone in his profession."

A Challenge for Complete Resection

A statement from the AANS describes glioma as the most prevalent type of adult brain tumor. There are a number of types of glial tumors, its statement notes, including astrocytomas, ependymomas, and GBM. GBM is the most invasive type of glial tumor, growing rapidly and spreading to other tissue, with a poor prognosis; 5-year survival is only about 3%. GBM is more common in people aged 50 to 70 years and in men than women, its statement notes.

Treatment includes surgery, radiation, or chemotherapy, but the AANS statement notes, "Gliomas can present a challenge for complete surgical resection because they have roots and tentacles. While it is true that radiation and chemotherapy are more often used for malignant, residual, or recurrent tumors, decisions as to what treatment to use are made on a case-by-case basis and depend on a number of factors. There are risks and side effects associated with each type of treatment."

A Sense of Reassurance

In a feature article Thursday, New York Times writer Carl Hulse talks to Sen. Kennedy's colleagues on Capitol Hill, where word of his "grave medical condition shook the Senate this week."

"What is it about the idea of Mr. Kennedy never again thundering from the floor, lumbering down the hallway, or joking in the corridor that was so disturbing to lawmakers no matter what their party?" Mr. Hulse writes. "The potential answers are many, but the question could come down to just one fundamental truth: Mr. Kennedy, love him or loathe him, personifies stability and continuity. He somehow provides a sense of reassurance that political tumult is transitory while serious achievement is not.

"His colleagues hope their days of jousting and joshing with Mr. Kennedy are not at an end," Mr. Hulse writes. "They say they want him back in good health for his sake and their own."

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