http://www.boston.com/news/local/articles/2008/06/04/chasing_down_bra...

CHICAGO - When the world's top specialists in removing and treating brain tumors talk about surgery, they never utter the word cure.

That's because a brain tumor is much like a wildfire, always seeking new territory to conquer. An operation can douse the hottest part of the inferno, but doctors know that dangerous embers remain behind.

As a result, patients such as Senator Edward M. Kennedy, whose malignant tumor was excised Monday by physicians at Duke University Medical Center in North Carolina, must endure radiation and chemotherapy in an attempt to neutralize stray cancer cells.

"These tumors are very aggressive," said Dr. Mark Gilbert, a neuro-oncologist at M.D. Anderson Cancer Center in Houston. "They cannot be treated by surgery alone."

A statement released yesterday by Kennedy's office said that the senior senator from Massachusetts had experienced no complications from his operation and "has been walking the hallways, spending time with family, and actively keeping up with the news of the day." The statement predicted he would leave Duke in about a week.

At the same time Kennedy was undergoing surgery Monday, brain tumor specialists here were revealing their latest research at an international scientific meeting of cancer doctors, showing modest progress in treating brain cancer and advances in understanding its underlying biology. Specialists debate how much surgery can extend patients' lives, but studies presented this week and previously have shown that a three-year-old form of chemotherapy, when combined with surgery and radiation, adds at least several months to the lives of patients.

Once the surgeon's work is finished, follow-up treatment proceeds on two fronts: in the region where the tumor once sat and in more distant corners of the brain.

Radiation, carefully calibrated and narrowly targeted, aims at the tumor bed and, usually, a 2-centimeter ring around it.

"So radiation provides some control of the tumor at and around where the original tumor was, but still there are individual tumor cells that might have migrated much further out" in the brain, said Dr. Deepa Subramaniam, director of the Brain Tumor Center at Georgetown University's Lombardi Comprehensive Cancer Center in Washington. "And it is those cells that are targeted by chemotherapy."

A few weeks after surgery is completed, patients begin receiving radiation and chemotherapy simultaneously. Typically, the course of radiation lasts six weeks, with five treatments each week.

Patients also start a daily dose of chemotherapy called temozolomide, which comes in a pill. Once radiation is finished, patients continue taking the pills for at least the next six months. The doses become less frequent, with pills taken on only five consecutive days in each month.

Unlike some other forms of chemotherapy, temozolomide usually does not cause patients' hair to fall out or severe bouts of nausea. Continued... http://www.boston.com/news/local/articles/2008/06/04/chasing_down_brain_tumor_wi...