| Sen. Kennedy has malignant brain cancer
This kind of cancer usually takes lives within six months. Here is what is being said:
A glioma is a brain tumor that arises from glial cells, the structural cells that surround and support the neurons that do the actual work of the brain. Aggressive gliomas, also called glioblastomas, of the type suffered by Sen. Edward M. Kennedy strike about 9,000 Americans every year, accounting for just under a third of all primary brain tumors.
With standard treatments, the median survival is 15 months, according to Dr. Keith L. Black, chairman of the department of neurosurgery at Cedars-Sinai Medical Center in Los Angeles. Two years after diagnosis, about 8% of patients are still alive. "Age is a very strong predictor of prognosis," Black said, and because Kennedy is 76, his outlook is not as good as that of someone who is younger.
The standard treatment involves surgery, radiation and chemotherapy. Surgery involves physical removal of the tumor, but that may not be a good option for Kennedy because his tumor is on the left parietal lobe, which controls language functions, such as the ability to comprehend and understand speech.
Such a tumor may sometimes cross the corpus callosum to the opposite side of the brain, making surgery even more difficult, Black said.
If the tumor is in the language areas of the brain, he said, surgeons will sometimes undertake its removal while the patient is awake so that they can monitor speech functions during the procedure.
Radiation is similar to having a brain X-ray and is given once a day, five days a week, for seven weeks.
Chemotherapy usually involves the drug Temodar, which is given orally and which is well-tolerated.
New treatments are also being studied. One experimental approach is to use the drug Avastin, which blocks the formation of new blood vessels that supply the tumor with nutrients. The drug has so far been approved only to treat colon cancer.
According to Black, about 60% of glioma patients who receive Avastin show a benefit on an MRI scan. "We believe it improves survival, and it definitely improves the quality of life," he said.
Another approach, originally developed by Black, involves the use of therapeutic vaccines. Gliomas are not recognized by the patient's immune system, so the body never mounts a defense against them.
Black developed a technique to remove proteins from the tumor and attach them to a form of white blood cell called an antigen-presenting cell, which is then injected back into the patient to activate the immune system.
In phase II studies of the vaccine, which are nearly complete, survival at two years increased from 8% to 42%, he said. Oncologists at Massachusetts General Hospital have a protocol from producing the vaccine, he added. | 
