Sen. Edward M. Kennedy Dies at 77

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, Aug. 26 (HealthDay News) -- Sen. Edward M. Kennedy, the last surviving brother in a unique American political dynasty and one of the most influential senators in history, died late Tuesday night at his summer home on Cape Cod after a 15-month battle with brain cancer. He was 77.

The Massachusetts lawmaker had continued to follow the current battle to reform health care in the United States -- the centerpiece of his legislative ambitions -- from his sickbed until his death, according to published reports.

There was no immediate word on funeral arrangements.

Kennedy was diagnosed with a malignant glioma in the parietal lobe of his brain in May 2008, after suffering a seizure. By the time of his death, he had met and, by many accounts, exceeded medical expectations.

"He's at about the median survival which, for his age, is pretty good. He's at or exceeded expectations," Dr. Tara Morrison, head of neuro-oncology at Fox Chase Cancer Center in Philadelphia, said shortly before Kennedy's death.

It was not revealed what type of tumor was found last year, but specialists speculated that it appeared likely to be a glioblastoma multiforme, which is more aggressive and more common in older people. With the most aggressive treatment, patients can be expected to live a median of about a year.

Soon after the diagnosis, Kennedy underwent surgery to remove part of the tumor. Partial removals are common when it's not possible to remove the entire tumor, according to Dr. Deepa Subramaniam, director of the brain tumor center at Georgetown University's Lombardi Comprehensive Cancer Center.

Being able to have surgery was the first good sign for Kennedy, as some patients aren't candidates at all.

"I believe doctors initially thought they weren't going to be able to perform surgery because it was a tumor on the left side that could potentially affect speech centers, but they were able to do it," Morrison said. "It is generally known that if the tumor can be resected [removed], patients do tend to do better, and the more that can be removed the better because there's less actual tumor cells that can come back."

After surgery, Kennedy was reported to have undergone chemotherapy and radiation, which is standard procedure for this type of cancer. Specifically, the senator was said to have received proton therapy, which is a form of radiation. "It's a slightly different means of delivering radiation, just a different type of beam," Morrison explained.

Kennedy most likely underwent chemotherapy with temozolomide (Temodar), which has been used since the early part of the decade and became the standard care in about 2005, Morrison said.

The addition of Temodar to the medical armamentarium against brain cancer was the first in four decades.

"Before that, the last big breakthrough was the addition of radiation 40 years ago," Morrison said. "There have not been big steps made in the treatment of brain tumors. There's been a lot of work, but the breakthroughs haven't been coming fast and furious like in many other cancers."

Experts are hopeful that glioblastoma vaccines currently under development will one day yield benefits.

One vaccine being developed at Duke University reported median progression-free survival in patients receiving the vaccine plus chemotherapy of 16.6 months, compared to only 6.4 months of recurrence-free survival in those not taking the treatment.

"There's always great hope that one of the vaccine trials will turn out to be the next big thing," Morrison said. "Chemotherapies have significant side effects and make the patients pretty sick, and we don't want to do that. Therapies that go just to the brain won't make people sick."

But even if new regimens have not drastically improved survival, they have enhanced quality of life for glioblastoma patients, Subramaniam said recently.

"The main quality-of-life issue for these patients, especially with a relapse, is brain swelling which can cause a decline in general alertness. Depending on the location of the tumor, it can cause seizures or problems with speech or vision or weakness in one side of the body," she noted.

Kennedy did collapse at President Barack Obama's inaugural luncheon in January, but that was the result of "simple fatigue," his doctors said at the time.