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From: sheder1 on 29 Jul 2008 10:44

Elite cancer panel guided Kennedy

By THE NEW YORK TIMES
July 29, 2008

When Sen. Edward M. Kennedy disclosed on May 20 that he had brain
cancer, three days after suffering a seizure, doctors did not list
surgery as a possibility. A news release from Massachusetts General
Hospital in Boston left the impression that radiation and chemotherapy
were the main options for his pernicious type of cancer.

Two weeks later, Kennedy, 76, flew to Durham, N.C. There, at Duke
University on June 2, neurosurgeons operated for 3½ hours and declared
the procedure "successful," though they did not specify their
criteria.

Precisely why Kennedy's treatment course changed is not known; he and
his doctors are not talking to reporters.

What is known is that a few days after Kennedy learned he had a
malignant brain tumor in the left parietal lobe, he invited a group of
national experts to discuss his case.

The meeting on May 30 was extraordinary in at least two ways.

One was the ability of a powerful patient — in this case, a scion of a
legendary political family and the chairman of the Senate's health
committee — to summon noted consultants to learn about the latest
therapy and research findings.

The second was his efficiency in quickly convening more than a dozen
experts from at least six academic centers. Some flew to Boston.
Others participated by telephone after receiving pertinent test
results and other medical records.

Except for the circumstances, telephone participation and the number
of invited experts, the meeting resembled the tumor board meetings
that specialists regularly hold in their hospitals.

For Kennedy, the scene was all too familiar. It resembled those he had
convened to map the care for two of his children when they had cancer
years earlier.

A son, Edward Jr., who is now 46, had part of his right leg amputated
in 1973 for bone cancer. Kennedy invited a group of experts to his
home to discuss follow-up care for the boy, who then received
radiation and two years of an experimental form of chemotherapy.

A daughter, Kara Kennedy Allen, had lung cancer in 2003. After some
surgeons deemed the cancer inoperable, bolder surgeons operated. Allen
is doing well five years later.

Kennedy is hoping for similar success as he completes about six weeks
of radiation, with chemotherapy expected to continue for a year.

The initial news release about his brain tumor called it a glioma
without specifying the type. A meeting participant described it as a
glioblastoma, the deadliest form of brain cancer. Patients live, on
average, about a year after it is detected.

In the meeting, experts spoke about surgery, radiation and
chemotherapy, said the participant, Dr. Raymond Sawaya, chairman of
neurosurgery at Baylor College of Medicine and the M.D. Anderson
Cancer Center in Houston.

Opinion about the benefit of surgery for Kennedy was divided. Some
neurosurgeons strongly favored it; two did not, Sawaya said, including
himself, largely because the cancer was not a discrete nodule but was
spread over a large area, making it unlikely that most of it could be
removed.

Chances for success are somewhat proportional to the amount of tumor
removed, although experts disagree about precisely how much visible
tumor must be removed for the best chances.

Whether the surgery was justified or not, that Kennedy had it at Duke
embarrassed the Massachusetts General Hospital, a Harvard teaching
institution. The change in venue strongly suggests that the meeting
somehow led to the more aggressive surgical approach.

In declaring the operation successful, Duke doctors did not define
their criteria, like whether they had removed all visible cancer or
spared him complications like loss of speech.

A week later, Kennedy returned to the Boston hospital for continuing
outpatient care and has released sparse information about his cancer
and progress. Although he is learning to cope with fatigue, "the news
is really all positive and encouraging," his wife, Victoria, told
friends in an e-mail message this month.

On July 9, Kennedy flew in virtual secrecy to Washington to make a
surprising and dramatic appearance in the Senate, stirring the
normally staid chamber to a rousing ovation and moving many colleagues
to tears. He looked steady. But his cheeks were puffy, a telltale sign
of heavy steroid treatment, as he voted, delivering Democrats a
decisive victory on a signature health care issue.

Kennedy can tap leading doctors for answers in a way few patients
could. His celebrity status aside, he has spent a career promoting
insurance and other ways to improve the health of Americans.

Several doctors not connected with Kennedy's case said in interviews
that they admired his resourcefulness in getting more opinions
simultaneously. At the same time, these doctors said many average
patients gained competent advice, without a command performance, by
sending pertinent records to experts for their opinions.

Outcomes of surgery for glioblastomas have not improved significantly
in recent decades, several doctors say, so they tend to recommend a
wait-and-see approach — reserving surgery for palliation if it is
needed later in the course of therapy.

These doctors said the concept of reducing the amount of cancer so
radiation and chemotherapy could interact more effectively made a lot
of sense theoretically, but in a practical sense, had not panned out.

Some experts said they favored a more aggressive surgical approach,
when it can be performed safely, because it offers the best chance of
longer survival, particularly when combined with various forms of
radiation and chemotherapy. The experts say that even if surgery
cannot prolong life many years, it can offer more quality for the time
that is left.

The experts also contend that newer techniques like functional brain
imaging and mapping are improving the safety and outcomes of brain
surgery for glioblastomas. Neurosurgeons can test tiny areas of the
brain to map functions controlled by the specific areas. Because these
areas vary in anatomic location with the individual, mapping helps the
surgeon avoid cutting into vital areas and damaging areas that control
vital motor and cognitive functions.

Even when neurosurgeons do sophisticated imaging testing before
surgery, they enter the operating room somewhat uncertainly. Long-term
survival, an uncommon outcome, is considered to be three years or
longer, and most such survivors have had aggressive brain surgery to
remove the tumor, experts say. Long-term success also depends in part
on a patient's age and other ailments.

The uncertainty of what to do in each glioblastoma case shows that
doctors have much to learn about brain cancers. That knowledge gap
makes philosophy an important part of the decision process for
patients and doctors.

Many patients willingly take the risks of aggressive brain surgery
because they understand that their chances of longer survival are
reduced without an attempt to remove as much of the visible tumor as
possible.

Dr. Mitchel S. Berger, chairman of the department of neurosurgery at
the University of California, San Francisco, flew to Boston to
participate in Kennedy's meeting and care. He spoke only about his
experience in other cases, including the recent one of an 80-year-old
woman. She has a glioblastoma that Berger judged likely to cause her
death in about two months.

If he could remove all visible brain cancer, the operation, combined
with chemotherapy and radiation, could provide three to 15 months of
high-quality life with her family, he said.

"While that may not be a huge amount of time — one-eightieth of her
lifetime — it is a lot of time to say and do many things," he said.
"When people look at it in that context, it becomes a big and
significant piece of time."
From: J on 30 Jul 2008 01:21
sheder1 wrote:

> Elite cancer panel guided Kennedy
>
> By THE NEW YORK TIMES
> July 29, 2008
>
> When Sen. Edward M. Kennedy disclosed on May 20 that he had brain
> cancer, three days after suffering a seizure, doctors did not list
> surgery as a possibility. A news release from Massachusetts General
> Hospital in Boston left the impression that radiation and chemotherapy
> were the main options for his pernicious type of cancer.
>
> Two weeks later, Kennedy, 76, flew to Durham, N.C. There, at Duke
> University on June 2, neurosurgeons operated for 3� hours and declared
> the procedure "successful," though they did not specify their
> criteria.
>
> Precisely why Kennedy's treatment course changed is not known; he and
> his doctors are not talking to reporters.
>
> What is known is that a few days after Kennedy learned he had a
> malignant brain tumor in the left parietal lobe, he invited a group of
> national experts to discuss his case.
>
> The meeting on May 30 was extraordinary in at least two ways.
>
> One was the ability of a powerful patient � in this case, a scion of a
> legendary political family and the chairman of the Senate's health
> committee � to summon noted consultants to learn about the latest
> therapy and research findings.
>
> The second was his efficiency in quickly convening more than a dozen
> experts from at least six academic centers. Some flew to Boston.
> Others participated by telephone after receiving pertinent test
> results and other medical records.
>
> Except for the circumstances, telephone participation and the number
> of invited experts, the meeting resembled the tumor board meetings
> that specialists regularly hold in their hospitals.
>
> For Kennedy, the scene was all too familiar. It resembled those he had
> convened to map the care for two of his children when they had cancer
> years earlier.
>
> A son, Edward Jr., who is now 46, had part of his right leg amputated
> in 1973 for bone cancer. Kennedy invited a group of experts to his
> home to discuss follow-up care for the boy, who then received
> radiation and two years of an experimental form of chemotherapy.
>
> A daughter, Kara Kennedy Allen, had lung cancer in 2003. After some
> surgeons deemed the cancer inoperable, bolder surgeons operated. Allen
> is doing well five years later.
>
> Kennedy is hoping for similar success as he completes about six weeks
> of radiation, with chemotherapy expected to continue for a year.
>
> The initial news release about his brain tumor called it a glioma
> without specifying the type. A meeting participant described it as a
> glioblastoma, the deadliest form of brain cancer. Patients live, on
> average, about a year after it is detected.
>
> In the meeting, experts spoke about surgery, radiation and
> chemotherapy, said the participant, Dr. Raymond Sawaya, chairman of
> neurosurgery at Baylor College of Medicine and the M.D. Anderson
> Cancer Center in Houston.
>
> Opinion about the benefit of surgery for Kennedy was divided. Some
> neurosurgeons strongly favored it; two did not, Sawaya said, including
> himself, largely because the cancer was not a discrete nodule but was
> spread over a large area, making it unlikely that most of it could be
> removed.
>
> Chances for success are somewhat proportional to the amount of tumor
> removed, although experts disagree about precisely how much visible
> tumor must be removed for the best chances.
>
> Whether the surgery was justified or not, that Kennedy had it at Duke
> embarrassed the Massachusetts General Hospital, a Harvard teaching
> institution. The change in venue strongly suggests that the meeting
> somehow led to the more aggressive surgical approach.
>
> In declaring the operation successful, Duke doctors did not define
> their criteria, like whether they had removed all visible cancer or
> spared him complications like loss of speech.

Yes, I think I read that they spared him speech impairment
Not much new there about treatments; This webpage claims...
http://pagingdrgupta.blogs.cnn.com/tag/dr-sanjay-gupta-chief-medical-correspondent/

"Kennedy may have ended up at Duke simply because he really liked the
doctors and felt comfortable in their hands � attitude, such an important
thing for a patient. He may have gone to Duke because he thought they were
the �best.� Finally, it could also be because of a vaccine clinical trial
that is going on there. Just today, researchers at Duke reported on a
small study that found that a cancer vaccine could double the survival
time of people with one of the deadliest brain tumors, from around 14 1/2
months to 33 months."

Another claims it's suprtaentoral, which sounds like a similar location to
Marc's.
http://en.wikipedia.org/wiki/Glioma
" supratentorial: Above the tentorium, in the cerebrum, mostly in adults
(70%). Senator Edward M. Kennedy�s brain tumor, for example was
supratentoral, in the parietal area in the upper part of the left side of
his brain, above the ear.

I think that Mary-anne's husband had all (the visible) tumor removed. I
could be reemembering wrong but I think he lived around 13 or 14 monrths,
so we'll see if Kennedy does better if he joins the vaccine trials.

It's all conjecture of course, since we don't have access to perhaps
important details.
Thanks for this.
I won't make it political, since I don't even know what he does. :)
J

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