Northwestern University Feinberg School of Medicine
Robert H. Lurie Comprehensive Cancer Center of Northwestern University
Lou and Jean Malnati Brain Tumor Institute

John A. Kalapurakal, MD

Professor, Radiation Oncology; Feinberg School of Medicine

John A. Kalapurakal, MD

Research Program

Email

j-kalapurakal( at )northwestern.edu

Selected Publications

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Cancer-Focused Research

I am the lead radiation oncologist and director of the Pediatric Radiation Oncology Program at the Robert H. Lurie Comprehensive Cancer Center (Northwestern University) and Lurie?s Children?s Hospital of Chicago. I am also Vice-Chair of the department of radiation oncology and director of the radiosurgery program that includes Gamma Knife and Stereotactic Body Radiotherapy. I am also a consultant radiation oncologist at the Northwestern Proton Center in Warrenville, IL. I first became interested in Wilms tumors (WT) and pediatric radiation oncology during my residency training (1993-1997) at Temple University and St. Christopher Children?s Hospital in Philadelphia. In 1999, towards the end of the NWTS-5 study for primary and relapsed Wilms tumors, I became a member of the National Wilms Tumor Study (NWTS). I am also the consultant radiation oncologist for the NWTS Late Effects Study from 1999 until now. In 2002, the NWTS was succeeded by the Children?s Oncology Group (COG) renal tumors committee. I have since been the vice-chair and radiation oncology chair of this committee. In the COG, I was a member of the radiation oncology steering committee from 2005-2015. In March 2016 I was elected chair of the radiation discipline in the Children?s Oncology Group. Dr. D?Angio and the NWTS group through 5 prospective NWTS clinical trials was able to reduce the abdomen RT dose for children with Wilms tumor from 40Gy to 10Gy (for stage III) and no RT (for stage I and II) with concurrent systemic chemoradiation. This significant NCI-funded effort of the NWTS has not only helped improve survival and quality of survival of children, but also led to the creation of the NWTS LES under the leadership of the late Dr. Norman Breslow. The NWTS LES has enrolled >9000 children between 1969-2002 and this study has played a significant role in promoting our understanding of the incidence and causative factors responsible for late effects after multimodality treatment of Wilms tumor. Indeed, while survival statistics may reveal that the majority of children are ?cured? from their cancer, the unrelenting RT-related late effects always remind them that childhood cancer is a life-long problem. Throughout my tenure in the NWTS and COG, as lead radiation oncologist representing our specialty and our patients, I have maintained an unwavering focus on the beneficial and adverse effects of radiation therapy in children with WT. Whenever I saw an option to improve upon existing RT treatment techniques for children with Wilms tumor using novel technologies, I have performed CT-based dosimetry comparisons with standard techniques before suggesting modifications in clinical practice. I have conducted two such projects at Northwestern: one for cardiac sparing IMRT for whole lung RT and another for renal sparing IMRT for liver irradiation in Wilms tumor (a). Both of these techniques will be implemented group wide in the next generation of COG renal tumor protocols. I have had the honor and unique advantage of working with my mentors ? Dr. D?Angio and the late Dr. Breslow in the NWTS. Together, they have contributed over a century of effort for the cause of the NWTS and WT patients from the late 1960s until today. I am proud to have their continued support and guidance for this late effects dosimetry project that will further increase the relevance and value of the NWTS for decades to come. An important reason among many others for taking up this dosimetry project was the repeated questioning by parents of young girls with Wilms tumor who have asked me about the reproductive potential of their daughters after irradiation. I did not have an answer despite being the lead COG radiation oncologist. The NWTS has never analyzed the reproductive outcomes of these girls. I am hopeful that the results of this dosimetry study will provide radiation oncologists and others evidence based guidelines regarding: i) the importance of gonadal dose estimation and reduction in girls and boys and ii) implementation of measures to prevent or mitigate the effects of radiation therapy on hypogonadism and infertility including oophoropexy, orchiopexy and testicular or ovarian cryopreservation in high risk children. While some of these procedures are currently being dismissed as experimental, as a clinician and a parent, I feel strongly that we should act proactively to help these children be in a position to avail of the future advances in the field of oncofertility that offers them the potential to become parents themselves many decades later. These and many other interventions for other late effects will play a major role in improving the quality of life and overall well-being of childhood cancer survivors. In summary based on my 17 years of experience and accomplishments in the field of Wilms tumor radiation therapy and my leadership in the renal tumor committee and as radiation oncology discipline chair of COG, I am well positioned to lead this novel late effects target organ dosimetry study of patients treated on NWTS protocols.

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