Treatment of brain cancer may extend patient's life 5 or 10 years, experts say

April 02, 1991|By Gerri Kobren

The losing battle Lee Atwater fought with brain cancer should not be taken as evidence that the disease is always so quickly terminal, a University of Maryland expert says.

Mr. Atwater, who was general chairman of the Republican National Committee, was diagnosed last March and died Friday at age 40.

According to Dr. Richard Kaplan, head of neuro-oncology at the University of Maryland Medical Center, modern methods of treatment have led to "long-term" survival for some patients in the young-adult age group.

"There really can be people who live five and 10 years after malignant glioma [the kind of tumor Mr. Atwater had]," he says. "Unfortunately, it is not the majority, but it gives us the feeling that if we hone our techniques and develop new techniques, we may increase the number of young survivors and may be able to get some survivors among older patients, too."

Survival time depends greatly on the specific type and grade of malignant tumor, with the shortest survival time expected for cases such as Mr. Atwater's.

His tumor was described by one of his doctors, Dr. Paul L. Kornblith, as "very, very aggressive" and "at the extreme end of malignancy."

Life expectancy also depends on the condition of the patient, according to Dr. Stuart Grossman, director of neuro-oncology at the Johns Hopkins Cancer Center.

"Some patients do not do well, and some do very well. We have some patients who have done much better than expected," he says.

Mr. Atwater's tumor, one of several known as "astrocytomas" because of their star-shaped cells, was of a type that develops in the brain's supportive, or "glial" tissue, rather than in the neurons that govern thought, speech, movement, perception and emotion. Glial tumors, known as "gliomas," are the most common kind of brain cancer, and astrocytomas are the most common kind of glioma.

Astrocytomas are also the most difficult type to treat; they're usually invasive, with roots and edges that infiltrate other brain tissue. "These tumors are virtually never completely excised," Dr. Grossman says.

With any kind of brain tumor, the first symptoms might be blackouts or seizures. Or the person might have problems with movement,speech or memory.

"They might not be able to move an arm or leg, or they're not thinking the way they usually do, or they're very sleepy, or have severe headaches with nausea and vomiting," Dr. Grossman says.

"People generally go to the doctor and get evaluated when that kind of thing happens."

National statistics show a dramatic rise in recent years in the number of brain cancers diagnosed in people aged 75 and older. No one knows why, and experts are not sure whether the numbers reflect an upswing in disease or a greater frequency of diagnosis.

Dr. Grossman believes the increase is real. But while Dr. Kaplan suspects "a small increase among the older age group," he also points out that the increased reports "coincide precisely" with the period during which computerized axial tomography scans and magnetic resonance imaging have enabled doctors to recognize brain cancers in people who might have been diagnosed in the past as stroke or Alzheimer's patients.

According to the National Cancer Institute, 15,000 Americans per year are diagnosed with "primary" brain cancer -- meaning cancer that begins in the brain, as distinguished from "secondary" tumors that metastasize from somewhere else. And, according to the Association for Brain Tumor Research, brain tumors are also the second most common cancer killer in children, after leukemia, and the third most common cancer killer in males aged 15 to 34.

Not all brain tumors are cancers, though any abnormal growth within the bony confines of the skull can damage or destroy vital brain tissue. Within the category of malignant tu

mors, those classified "grade 1" grow slowly, while "grade 4s" grow rapidly and send cells out to other parts of the brain.

While CAT scans and MRI can show the mass, they cannot determine its type or grade; a biopsy, in which a piece of the tumor is removed and examined under the microscope, is usually the next step in diagnosis, after which treatment is planned.

In some cases, brain tumors may not be considered operable, except for diagnostic purposes.

"If you've got a patient with a tumor in a critical area, so you can't take out the adjacent tissue without damage, or if it had already spread to the other side of the brain, you might leave behind considerable tumor," Dr. Grossman says. "In that case, surgery might not be worthwhile."

Chemotherapy is usually only partially effective too, according to Dr. Kaplan. While drugs can attack the abnormal core of the tumor, the "blood-brain barrier" -- designed by nature to keep toxins out of the brain -- will also keep these therapeutic agents away from the tumor's invasive edges.

Radiation is, therefore, the third prong in aggressive treatment and in most medical institutions is accomplished in the conventional way, by external beam.

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