Kennedy has 'successful' surgery
3-hour procedure at Duke Medical Center targets tumor; doctor says goals achieved
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 yesterday that his hand-picked neurosurgeon declared a success.
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.
Friedman said in a statement 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
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 yesterday.
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 yesterday 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 yesterday.
Gregory B. Craig, a friend and former aide, also spoke to Kennedy Sunday."He seemed in great spirits," Craig said yesterday. "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 yesterday. His daughter, Kara, a survivor of lung cancer, was expected to join him last 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 yesterday.
Stephen Smith of the Globe staff contributed to this report.
