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【medical-news】肯尼迪参议员脑手术背后的故事
The Story Behind Kennedy’s Surgery
By LAWRENCE K. ALTMAN, M.D
Published: July 29, 2008
When Senator Edward M. Kennedy disclosed on May 20 that he had brain cancer, three days after suffering a seizure, doctors did not list surgery as a possibility. A news release from Massachusetts General Hospital in Boston left the impression that radiation and chemotherapy were the main options for his pernicious type of cancer.
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Josh Reynolds/Associated Press
CALLING ALL CONSULTANTS Senator Edward M. Kennedy in May, after his diagnosis.
Two weeks later, Mr. Kennedy, 76, flew to Durham, N.C. There, at Duke University on June 2, neurosurgeons operated for three and a half hours and declared the procedure “successful,” though they did not specify their criteria.
Precisely why Mr. Kennedy’s treatment course changed is not known; he and his doctors are not talking to reporters.
What is known is that a few days after Mr. Kennedy learned he had a malignant brain tumor in the left parietal lobe, he invited a group of national experts to discuss his case.
The meeting on May 30 was extraordinary in at least two ways.
One was the ability of a powerful patient — in this case, a scion of a legendary political family and the chairman of the Senate’s health committee — to summon noted consultants to learn about the latest therapy and research findings.
The second was his efficiency in quickly convening more than a dozen experts from at least six academic centers. Some flew to Boston. Others participated by telephone after receiving pertinent test results and other medical records.
Except for the circumstances, telephone participation and the number of invited experts, the meeting resembled the tumor board meetings that specialists regularly hold in their hospitals.
For Mr. Kennedy, the scene was all too familiar. It resembled those he had convened to map the care for two of his children when they had cancer years earlier.
A son, Edward Jr., who is now 46, had part of his right leg amputated in 1973 for bone cancer. Mr. Kennedy invited a group of experts to his home to discuss follow-up care for the boy, who then received radiation and two years of an experimental form of chemotherapy.
A daughter, Kara Kennedy Allen, had lung cancer in 2003. After some surgeons deemed the cancer inoperable, bolder surgeons operated. Ms. Allen is doing well five years later.
Mr. Kennedy is hoping for similar success as he completes about six weeks of radiation, with chemotherapy expected to continue for a year.
The initial news release about his brain tumor called it a glioma without specifying the type. A meeting participant described it as a glioblastoma, the deadliest form of brain cancer. Patients live, on average, about a year after it is detected.
In the meeting, experts spoke about surgery, radiation and chemotherapy, said the participant, Dr. Raymond Sawaya, chairman of neurosurgery at Baylor College of Medicine and the M. D. Anderson Cancer Center in Houston.
Opinion about the benefit of surgery for Mr. Kennedy was divided. Some neurosurgeons strongly favored it; two did not, Dr. Sawaya said, including himself, largely because the cancer was not a discrete nodule, but was spread over a large area, making it unlikely that most of it could be removed.
Chances for success are somewhat proportional to the amount of tumor removed, although experts disagree about precisely how much visible tumor must be removed for the best chances.
Whether the surgery was justified or not, that Mr. Kennedy had it at Duke embarrassed the Massachusetts General Hospital, a Harvard teaching institution. The change in venue strongly suggests that the meeting somehow led to the more aggressive surgical approach.
The urgency of the operation forced Mr. Kennedy, the third-longest-serving senator in history, to cancel his receiving an honorary doctorate from his alma mater, Harvard.
The commencement was scheduled for six days after the consultants’ meeting, and doctors said that was too long to wait, Mr. Kennedy told the Harvard president, Drew Gilpin Faust, in a telephone call, according to a friend who did not want to be identified. When Dr. Faust said Mr. Kennedy would receive the degree in person in the future, the announcement received a standing ovation.
In declaring his operation successful, Duke doctors did not define their criteria, like whether they had removed all visible cancer or spared him complications like loss of speech.
A week later, Mr. Kennedy returned to the Boston hospital for continuing outpatient care and has released sparse information about his cancer and progress. Although he is learning to cope with fatigue, “the news is really all positive and encouraging,” his wife, Victoria, told friends in an e-mail message this month.
On July 9, he flew in virtual secrecy to Washington to make a surprising and dramatic appearance in the Senate, stirring the normally staid chamber to a rousing ovation and moving many colleagues to tears. He looked steady. But his cheeks were puffy, a telltale sign of heavy steroid treatment, as he voted, delivering Democrats a decisive victory on a signature health care issue.
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作者:admin@医学,生命科学 2011-05-06 17:14
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