"We recommended surgery, the Duke group recommended surgery, and I believe the UCSF group recommended surgery," said Brem. "There are always differences in opinion as to what the best treatment is.
"The question was what removing more tumor would accomplish. Our data shows that people do best if they have the maximum amount of tumor removed safely."
Brem said patients in similar cases often seek opinions from two or three medical centers before deciding whether to undergo brain surgery.
"Kennedy worked the other way around," said Brem. "Everybody came to him."
The Hopkins neurosurgeon said the arrangement was appropriate because Kennedy "has devoted his whole life to improving health care for this country."
Kennedy is expected to remain at Duke for about a week before returning to Boston, where he will receive further treatment at Massachusetts General.
Friedman, 59, is a professor of surgery and chief of the neurosurgery division at Duke, whose Web site says he is responsible for about 90 percent of tumor resections there.
"He's very highly regarded and is one of the thought leaders in the field," said Dr. Richard North, a neurosurgeon at Sinai Hospital in Baltimore. North was a Duke intern when Friedman was a resident there in the late 1970s, and the two have maintained a friendship over the years.
Kennedy's brain tumor is in the left parietal region of the brain, in the top, rear portion of the skull. The region plays a role in sensation, speech and other faculties, so surgeons must balance the need to remove as much tumor as possible with the need to preserve functions critical to a patient's quality of life.
No matter how much tissue they remove, they cannot eradicate the entire mass because it sends microscopic tentacles into surrounding tissue, North said.
"It has spread beyond what one would see with one's eyes in the operating room," said North, who also worked at Hopkins for many years. "It's spread beyond what one can see on a scan."
The tumor has a high propensity to spread - even to the other side of the brain - because it is so deeply rooted, North said.
Surgeons also have the option of implanting chemotherapy wafers that attack the remaining cancer from within. The wafers were developed at Hopkins, and Duke has used the wafers and published research on their benefits. The hospital has not indicated whether its doctors opted for this.
"It's an intraoperative decision," said Brem.
jonathan.bor@baltsun.com
