WASHINGTON — Senator Kennedy, battling a brain tumor, walked through a wall of applause and into the Senate yesterday and cast a dramatic, decisive vote on long-stalled Medicare legislation.

“Aye,” the 76-year-old Mr. Kennedy said in a loud voice, smiling broadly and making a thumbs-up gesture as he registered his vote.

Spectators in the galleries that overhang the chamber burst into cheers — a violation of decorum that drew no complaints.

“It’s great to be back. I love this place,” he said after his brief visit.

Mr. Kennedy made his way into the Senate on his own power, appearing little the worse for his illness. A patch of scalp was clearly visible through his familiar white hair, although it was not clear whether that was a result of surgery he underwent or the effects of chemotherapy or radiation that are part of his treatment.

He walked into chamber accompanied by Senator Obama of Illinois, his party’s presidential nominee-in-waiting, as well as a fellow Massachusetts senator, John Kerry, Senator Dodd of Connecticut, and Mr. Kennedy’s son, Rep. Patrick Kennedy of Rhode Island.

Democratic senators, who had been tipped to his presence, burst into applause when he entered. Some Republicans looked around quizzically, then quickly joined in the applause when they saw Mr. Kennedy.

“I return to the Senate today to keep a promise to our senior citizens, and that’s to protect Medicare,” the senator said in a statement issued by his office as the vote was unfolding.

“Win, lose or draw, I wanted to be here. I wasn’t going to take the chance that my vote could make the difference.”

Mr. Kennedy’s dramatic return gave Democrats the impetus they needed to free Medicare legislation from gridlock. It had received 59 votes on an earlier test, one short of the 60 needed to advance. Mr. Kennedy made 60, and when Republicans saw the outcome was sealed, several of them joined Democrats to pad the margin. The House already has overwhelmingly approved the measure. Senators Schumer and Clinton of New York also voted to approve the legislation.

Lawmakers are under pressure from doctors and the elderly patients they serve to void a 10.6% pay cut for doctors treating Medicare patients. It kicked in July 1 because of a funding formula that establishes lower reimbursement rates when Medicare spending levels exceed established targets. Some doctors say they’ll quit taking new patients if the cuts stand.

Officials said Mr. Kennedy left Boston immediately after his daily cancer treatment for a flight to Washington. He was returning home immediately, in time for today’s treatment.

One official said Mr. Kennedy has been in regular contact with Majority Leader Harry Reid, and had asked his doctors earlier this week whether he could make a quick trip to Washington. He told Mr. Reid on Tuesday he would be there.

Mr. Kennedy was last in the Senate in mid-May. He was diagnosed with a brain tumor this spring after suffering unexplained symptoms that resulted in his being taken to a hospital on Cape Cod, Mass., and then flown to Boston.

He later underwent surgery at Duke University Medical Center in Durham, N.C.,

Seated in the Senate gallery were Mr. Kennedy’s wife, Vicki, and Caroline, his niece. As the tourists and senators alike rose in a standing ovation, Vicki Kennedy wiped away tears.

So did many of Mr. Kennedy’s colleagues and several Senate clerks.