DURHAM, N.C. - US Senator Edward M. Kennedy, moving with
extraordinary
quickness to pursue the most aggressive form of treatment for his
malignant
brain tumor, flew by private jet to North Carolina and underwent
brain
surgery that his hand-picked neurosurgeon declared a success
Monday.
The three-hour operation was performed by Dr. Allan H. Friedman,
chief of
neurosurgery at Duke University Medical Center, who is known for
tackling
surgeries that his colleagues consider too risky because of a
tumor's
proximity to critical areas of the nervous system.
Freidman said in a statement Monday that he was "pleased to
report that
Senator Kennedy's surgery was successful and accomplished our
goals." The
statement said the 76-year-old senator was awake during the
operation and
"should therefore experience no permanent neurological effects
from the
surgery."
Kennedy emerged from his surgery about 2 p.m. and told his wife,
Victoria
Reggie Kennedy: "I feel like a million bucks. I think I'll do that
again
tomorrow." She quoted him in a statement that she e-mailed to
friends.
Kennedy is expected to remain at Duke for about a week and will
then
"begin targeted radiation at Massachusetts General Hospital and
chemotherapy treatment," Friedman said in the statement. Radiation
is
typically given five days a week for up to six weeks. Although more
precise
and powerful than in past years, the treatments leave some patients
fatigued, and some lose hair.
The standard chemotherapy for brain tumors is a pill called
temozolomide,
which has been shown to extend patients' lives by a few months, on
average,
when used with radiation. Doctors say the medication, which is
taken for
six months to a year, is well tolerated by patients, though some
people
experience lowered blood-cell counts, which leave them tired and
susceptible to infections.
Kennedy's decision to undergo surgery was somewhat unexpected
because,
after his diagnosis May 20, his doctors did not mention surgery as
an
option. Rather, they said the typical course of treatment involves
radiation and chemotherapy. But after talking to Friedman, Kennedy
became
convinced that he had found a more aggressive approach and that
there was
no time to waste.
"He personally made the decision: If we're going to do it,
let's do it
quickly," said Gerard Doherty, a close friend and former chairman
of the
Massachusetts Democratic Party. "He's truly a profile in courage.
He
stares straight ahead and does what he has to do."
Kennedy's doctors and relatives declined to provide further
information on
his surgery.
Dr. Michael Lim, a neurosurgeon at Johns Hopkins Hospital in
Baltimore who
is not part of Kennedy's medical team, said success in the
senator's
surgery is typically defined as removal of 90 percent or more of
the tumor.
Dr. Mark Gilbert, a specialist in neuro-oncology at M.D.
Anderson Cancer
Center in Houston, said studies are mixed on the effectiveness of
such
surgeries, which some doctors believe can help patients better
tolerate
radiation and chemotherapy. One study, done at M.D. Anderson, found
that
patients who had at least 98 percent of their tumor removed lived
about
four months longer, on average, than patients whose tumors were not
removed.
As recently as Friday, Kennedy was still weighing his options
for treating
the tumor, known as a malignant glioma. Accompanied by his wife, he
summoned cancer specialists from across the country to
Massachusetts
General Hospital. The group included Friedman, doctors from the
National
Institutes of Health and National Cancer Institute, Kennedy's
personal
physician, Dr. Larry Ronan, and Dr. Lawrence C. Horowitz, a former
aide
whom the senator has enlisted to sort through the medical
literature.
The doctors met privately at first, then with Kennedy and his
wife. The
couple asked "a ton of questions," listened to the doctors lay
out the
various courses of treatment, and then left the room, said a source
familiar with the meeting. Associates said Kennedy seemed to have a
special
rapport with Friedman. After some time alone with his wife, Kennedy
decided
to travel to Duke and place his care in Friedman's hands.
Colleagues said Friedman has three decades of neurosurgery
experience.
Operations that would be rare for other doctors are routine for
him, they
said.
Reynolds Price, an author and English professor at Duke, had an
11-inch
cancerous tumor removed from his spine by Friedman in 1986. He said
he has
been cancer-free since, and was hoping, when he heard about
Kennedy's
tumor, that the senator would seek treatment from Friedman.
"I think Senator Kennedy is in very fine hands, indeed,
unusually fine
hands," Price said.
Kennedy spent Saturday and Sunday at his Hyannis Port compound,
relaxing
and talking to colleagues. He telephoned Senator Harry Reid, the
majority
leader, both to tell him of his plans and to push for two bills:
higher
education reauthorization and mental health parity, Kennedy aides
said.
Kennedy also called Senators Christopher Dodd and Barbara Mikulski
to ask
their help in shepherding the bills through their respective
conference
committees.
After sailing Sunday in Nantucket Sound, Kennedy quietly boarded
a
chartered flight on a Beechcraft Beechjet, leaving Barnstable at
2:40 p.m.
He arrived in Raleigh at 4:25 p.m. and checked into Duke shortly
after.
Only his closest friends and relatives knew he had left the state;
his
Senate office did not issue a statement until Monday morning.
Dodd said that he spoke with Kennedy late Sunday and that he
sounded "very
optimistic and very upbeat" and talked almost entirely about
legislation.
"This is the kind of conversation I'd be having with him even
if he wasn't
in North Carolina," Dodd said Monday.
Gregory B. Craig, a friend and former aide, also spoke to
Kennedy Sunday.
"He seemed in great spirits," Craig said Monday. "He said,
'We have a
plan."'
Removing a brain tumor is a delicate process but surprisingly
painless for
most patients, said Lim, the Johns Hopkins surgeon. At the
beginning of the
operation, patients are sedated and "kept nice and comfortable,"
he said.
Surgeons then remove a piece of the patient's skull large enough
to reach
the tumor and conduct mapping tests, designed to make sure their
work is
not damaging crucial parts of the brain. Once the brain is exposed,
the
patient is brought out of sedation. Because the brain has no pain
fibers,
operating on it typically causes no discomfort.
As surgeons determine how much of the tumor they can safely
remove, they
use sophisticated, real-time snapshots that provide
three-dimensional
images of the patient's brain.
Tiny electrodes are placed on the brain to introduce an
electrical current.
If the electrical charge strikes a region pivotal to speech, "it
will stop
their speech," Lim said. "You know then that's a region you
usually try
to stay away from or preserve while you're doing surgery."
Next, surgeons remove the tumor, usually a soft growth that is
purple in
the center and white around the edges. Because brain tumors are
soft,
doctors at Duke suction out the edges with a thin, fine device,
remove the
core, and use electric tweezers to stop the bleeding.
After the tumor is removed, patients are again sedated so that
the piece of
skull removed at the start of the operation can be reattached. It
is
usually held in place with titanium plates shaped like snowflakes
and with
small screws.
Kennedy's sister Jean and son Patrick, a congressman from Rhode
Island,
were with the senator and his wife at Duke. His daughter, Kara, a
survivor
of lung cancer, was expected to join him Monday night.
Paul G. Kirk, a Kennedy friend, said the senator felt that
surgery was "an
important first step."
"He's a man of uncommon resolve and a positive attitude that
goes with
it," Kirk said.
Stephen Smith of the Globe staff contributed to this report.
c.2008 The Boston Globe