John Kirkpatrick

Overview:

Malignant and benign tumors of the brain, spine and base of skull. Mathematical modelling of tumor metabolism, mass transfer and the response to ionizing radiation. Enhancing clinical outcome in stereotactic radiosurgery, fractionated stereotactic radiotherapy and stereotactic body radiotherapy.

Positions:

Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Professor in Neurosurgery

Neurosurgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1978

Rice University

M.D. 1999

University of Texas Health Science Center San Antonio

Grants:

Validation of Novel Therapeutic Approach for Leptomeningeal Metastases

Administered By
Neurosurgery
Role
Investigator
Start Date
End Date

BMX-001 AS A THERAPEUTIC AGENT FOR TREATMENT OF MULTIPLE BRAIN METASTASES

Administered By
Radiation Oncology
Role
Principal Investigator
Start Date
End Date

Publications:

Hippocampal Avoidance in Multitarget Radiosurgery.

Brain metastases are a common complication for patients diagnosed with cancer. As stereotactic radiosurgery (SRS) becomes a more prevalent treatment option for patients with many brain metastases, further research is required to better characterize the ability of SRS to treat large numbers of metastases (≥4) and the impact on normal brain tissue and, ultimately, neurocognition and quality of life (QOL). This study serves first as an evaluation of the feasibility of hippocampal avoidance for SRS patients, specifically receiving single-isocenter multitarget treatments (SIMT) planned with volumetric modulated arc therapy (VMAT). Second, this study analyzes the effects of standard-definition (SD) multileaf collimators (MLCs) (5 mm width) on plan quality and hippocampal avoidance. The 40 patients enrolled in this Institutional Review Board (IRB)-approved study had between four and 10 brain metastases and were treated with SIMT using VMAT. From the initial 40 patients, eight hippocampi across seven patients had hippocampal doses exceeding the maximum biologically effective dose (BED) constraint given by RTOG 0933. With the addition of upper constraints in the optimization objectives and one arc angle adjustment in one patient plan, four out of seven patient plans were able to meet the maximum hippocampal BED constraint, avoiding five out of eight total hippocampi at risk. High-definition (HD) MLCs allowed for an average decrease of 29% ± 23% (p = 0.007) in the maximum BED delivered to all eight hippocampi at risk. The ability to meet dose constraints depended on the distance between the hippocampus and the nearest planning target volume (PTV). Meeting the maximum hippocampal BED constraint in re-optimized plans was equally likely with the use of SD-MLCs (five out of eight hippocampi at risk were avoided) but resulted in increased dose to normal tissue volumes (23.67% ± 16.3% increase in V50%[cc] of normal brain tissue, i.e., brain volume subtracted by the total PTV) when compared to the HD-MLC re-optimized plans. Comparing the effects of SD-MLCs on plans not optimized for hippocampal avoidance resulted in increases of 48.2% ± 32.2% (p = 0.0056), 31.5% ± 16.3% (p = 0.024), and 16.7% ± 8.5% (p = 0.022) in V20%[cc], V50%[cc], and V75%[cc], respectively, compared to the use of HD-MLCs. The conformity index changed significantly neither when plans were optimized for hippocampal avoidance nor when SD-MLC leaves were used for treatment. In plans not optimized for hippocampal avoidance, mean hippocampal dose increased with the use of SD-MLCs by 38.0% ± 37.5% (p = 0.01). However, the use of SD-MLCs did not result in an increased number of hippocampi at risk.
Authors
Gude, Z; Adamson, J; Kirkpatrick, JP; Giles, W
MLA Citation
Gude, Zachary, et al. “Hippocampal Avoidance in Multitarget Radiosurgery.Cureus, vol. 13, no. 6, June 2021, p. e15399. Pubmed, doi:10.7759/cureus.15399.
URI
https://scholars.duke.edu/individual/pub1488949
PMID
34249548
Source
pubmed
Published In
Cureus
Volume
13
Published Date
Start Page
e15399
DOI
10.7759/cureus.15399

Arteriovenous Malformation: A Real Can of Worms.

Authors
Trotter, JW; Kirkpatrick, JP
MLA Citation
Trotter, Jacob W., and John P. Kirkpatrick. “Arteriovenous Malformation: A Real Can of Worms.Int J Radiat Oncol Biol Phys, vol. 111, no. 4, Nov. 2021, pp. 851–53. Pubmed, doi:10.1016/j.ijrobp.2018.08.068.
URI
https://scholars.duke.edu/individual/pub1499729
PMID
34655559
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
111
Published Date
Start Page
851
End Page
853
DOI
10.1016/j.ijrobp.2018.08.068

Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis.

Purpose: To describe our population of primary brain tumor (PBT) patients, a subgroup of cancer patients whose intensive care unit (ICU) outcomes are understudied. Methods: Retrospective analysis of PBT patients admitted to an ICU between 2013 to 2018 for an unplanned need. Using descriptive analyses, we characterized our population and their outcomes. Results: Fifty-nine PBT patients were analyzed. ICU mortality was 19% (11/59). The most common indication for admission was seizures (n = 16, 27%). Conclusion: Our ICU mortality of PBT patients was comparable to other solid tumor patients and the general ICU population and better than patients with hematological malignancies. Further study of a larger population would inform guidelines for triaging PBT patients who would most benefit from ICU-level care.
Authors
Kang, JH; Swisher, CB; Buckley, ED; Herndon, JE; Lipp, ES; Kirkpatrick, JP; Desjardins, A; Friedman, HS; Johnson, MO; Randazzo, DM; Ashley, DM; Peters, KB
MLA Citation
Kang, Jennifer H., et al. “Primary brain tumor patients admitted to a US intensive care unit: a descriptive analysis.Cns Oncol, vol. 10, no. 3, Sept. 2021, p. CNS77. Pubmed, doi:10.2217/cns-2021-0009.
URI
https://scholars.duke.edu/individual/pub1497219
PMID
34545753
Source
pubmed
Published In
Cns Oncology
Volume
10
Published Date
Start Page
CNS77
DOI
10.2217/cns-2021-0009

Adult pilocytic astrocytoma: clinical management and prognostic factors.

158 Objective: The purpose of this study is to analyze adult patients with pilocytic astrocytomas and to identify factors associated with recurrence and survival. Background: Pilocytic astrocytomas (WHO grade I) represent the most common central nervous system tumor in the pediatric population, but is rare in the adult population. Given the rarity of this tumor in the adult population, we sought to understand the clinical behavior of adult pilocytic astrocytoma (PA) patients retrospectively. Design/Methods: Patients at the Preston Robert Tisch Brain Tumor Center at Duke were consented as part of a database registry between 12/31/2004 and 10/12/2016. All cases of adult PA (patients ≥ 18 years of age at time of diagnosis) were identified and data were evaluated retrospectively for demographic information, absence or presence of tumor progression, treatment, and survival outcomes. We estimated progression-free survival and overall survival using Kaplan-Meier methods. Results: There were 42 patients with adult PA identified (age 19–76 yrs, mean = 31.65, sd= 12.26). Of the 42 patients, 20 (47.6%) had tumor progression and 8 (21.4%) passed away. 7 of 8 patients (87.5%) that died experienced tumor progression. Tumor progression was seen in 7 of the 22 (31.8%) patients with gross total resection (GTR), 9 of the 13 (69.2%) patients with subtotal resection (STR), and 4 of the 7 (57.1%) patients with biopsy. Death was seen in 2 of the 22 (9.1%) patients with GTR, compared to 6 of the 20 (30.0%) patients with STR or biopsy. Progression-free 10-year survival was 45% (95% CI: 26.2%, 62.1%) and 10-year overall survival was 79.6% (95% CI: 61.8%, 89.8%). Conclusions: For adults with PA, 10-year progression-free survival was approximately 45%, which emphasizes the importance of long term monitoring. The number of progressions and deaths amongst adult PA patients receiving GTR was less than that among those receiving STR or biopsy.
Authors
Inamullah, O; Kirkpatrick, J; Healy, P; Lipp, E; Johnson, M; Ashley, D; Randazzo, D; Friedman, H; Peters, K
MLA Citation
Inamullah, O., et al. “Adult pilocytic astrocytoma: clinical management and prognostic factors.Neurology, vol. 90, no. 15, American Academy of Neurology, 2018, p. P6.158-P6.158.
URI
https://scholars.duke.edu/individual/pub1460332
Source
manual
Published In
Neurology
Volume
90
Published Date
Start Page
P6.158
End Page
P6.158

Cognitive Outcomes of Phase I Trial of Novel Metalloporphyrin Radioprotectant and Radiosensitizer in Newly Diagnosed High Grade Glioma Patients.

MASCC20-ABS-1534
Authors
Peters, KB; Kirkpatrick, J; Batinic-Haberle, I; Affronti, ML; Woodring, S; Iden, D; Lipp, ES; Healy, P; Herndon, JE; Boyd, K; Hahn, K; Spasojevic, I; Gad, S; Silberstein, D; Johnson, MO; Randazzo, D; Desjardins, A; Friedman, HS; Ashley, D; Crapo, J
MLA Citation
Peters, Katherine B., et al. “Cognitive Outcomes of Phase I Trial of Novel Metalloporphyrin Radioprotectant and Radiosensitizer in Newly Diagnosed High Grade Glioma Patients.Supportive Care in Cancer, Springer (part of Springer Nature), 2020.
URI
https://scholars.duke.edu/individual/pub1458678
Source
manual
Published In
Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer
Published Date