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:

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

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

Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.

PURPOSE: Conventional wisdom has rendered patients with brain metastases ineligible for clinical trials for fear that poor survival could mask the benefit of otherwise promising treatments. Our group previously published the diagnosis-specific Graded Prognostic Assessment (GPA). Updates with larger contemporary cohorts using molecular markers and newly identified prognostic factors have been published. The purposes of this work are to present all the updated indices in a single report to guide treatment choice, stratify research, and define an eligibility quotient to expand eligibility. METHODS: A multi-institutional database of 6,984 patients with newly diagnosed brain metastases underwent multivariable analyses of prognostic factors and treatments associated with survival for each primary site. Significant factors were used to define the updated GPA. GPAs of 4.0 and 0.0 correlate with the best and worst prognoses, respectively. RESULTS: Significant prognostic factors varied by diagnosis and new prognostic factors were identified. Those factors were incorporated into the updated GPA with robust separation (P < .01) between subgroups. Survival has improved, but varies widely by GPA for patients with non-small-cell lung, breast, melanoma, GI, and renal cancer with brain metastases from 7-47 months, 3-36 months, 5-34 months, 3-17 months, and 4-35 months, respectively. CONCLUSION: Median survival varies widely and our ability to estimate survival for patients with brain metastases has improved. The updated GPA (available free at brainmetgpa.com) provides an accurate tool with which to estimate survival, individualize treatment, and stratify clinical trials. Instead of excluding patients with brain metastases, enrollment should be encouraged and those trials should be stratified by the GPA to ensure those trials make appropriate comparisons. Furthermore, we recommend the expansion of eligibility to allow for the enrollment of patients with previously treated brain metastases who have a 50% or greater probability of an additional year of survival (eligibility quotient > 0.50).
Authors
Sperduto, PW; Mesko, S; Li, J; Cagney, D; Aizer, A; Lin, NU; Nesbit, E; Kruser, TJ; Chan, J; Braunstein, S; Lee, J; Kirkpatrick, JP; Breen, W; Brown, PD; Shi, D; Shih, HA; Soliman, H; Sahgal, A; Shanley, R; Sperduto, WA; Lou, E; Everett, A; Boggs, DH; Masucci, L; Roberge, D; Remick, J; Plichta, K; Buatti, JM; Jain, S; Gaspar, LE; Wu, C-C; Wang, TJC; Bryant, J; Chuong, M; An, Y; Chiang, V; Nakano, T; Aoyama, H; Mehta, MP
MLA Citation
Sperduto, Paul W., et al. “Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.J Clin Oncol, vol. 38, no. 32, Nov. 2020, pp. 3773–84. Pubmed, doi:10.1200/JCO.20.01255.
URI
https://scholars.duke.edu/individual/pub1460755
PMID
32931399
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
38
Published Date
Start Page
3773
End Page
3784
DOI
10.1200/JCO.20.01255

Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases.

OBJECTIVE: Stereotactic body radiation therapy (SBRT) offers efficient, noninvasive treatment of spinal neoplasms. Single-fraction (SF) high-dose SBRT has a relatively narrow therapeutic window, while hypofractionated delivery of SBRT may have an improved safety profile with similar efficacy. Because the optimal approach of delivery is unknown, the authors examined whether hypofractionated SBRT improves pain and/or functional outcomes and results in better tumor control compared with SF-SBRT. METHODS: This is a single-institution retrospective study of adult patients with spinal metastases treated with SF- or three-fraction (3F) SBRT from 2008 to 2019. Demographics and baseline characteristics, radiographic data, and posttreatment outcomes at a minimum follow-up of 3 months are reported. RESULTS: Of the 156 patients included in the study, 70 (44.9%) underwent SF-SBRT (median total dose 1700 cGy) and 86 (55.1%) underwent 3F-SBRT (median total dose 2100 cGy). At baseline, a higher proportion of patients in the 3F-SBRT group had a worse baseline profile, including severity of pain (p < 0.05), average use of pain medication (p < 0.001), and functional scores (p < 0.05) compared with the SF-SBRT cohort. At the 3-month follow-up, the 3F-SBRT cohort experienced a greater frequency of improvement in pain compared with the SF-SBRT group (p < 0.05). Furthermore, patients treated with 3F-SBRT demonstrated a higher frequency of improved Karnofsky Performance Scale (KPS) scores (p < 0.05) compared with those treated with SF-SBRT, with no significant difference in the frequency of improvement in modified Rankin Scale scores. Local tumor control did not differ significantly between the two cohorts. CONCLUSIONS: Patients who received spinal 3F-SBRT more frequently achieved significant pain relief and an increased frequency of improvement in KPS compared with those treated with SF-SBRT. Local tumor control was similar in the two groups. Future work is needed to establish the relationship between fractionation schedule and clinical outcomes.
Authors
Park, C; Howell, EP; Mehta, VA; Ramirez, L; Price, MJ; Floyd, SR; Kirkpatrick, JP; Torok, J; Abd-El-Barr, MM; Karikari, IO; Goodwin, CR
MLA Citation
Park, Christine, et al. “Patient outcomes and tumor control in single-fraction versus hypofractionated stereotactic body radiation therapy for spinal metastases.J Neurosurg Spine, Nov. 2020, pp. 1–10. Pubmed, doi:10.3171/2020.6.SPINE20349.
URI
https://scholars.duke.edu/individual/pub1464435
PMID
33157523
Source
pubmed
Published In
J Neurosurg Spine
Published Date
Start Page
1
End Page
10
DOI
10.3171/2020.6.SPINE20349