Memantine in Preventing Side Effects in Patients Undergoing Whole-Brain Radiation Therapy for Brain Metastases From Solid Tumors
- Conditions
- Cognitive/Functional EffectsMetastatic CancerNeurotoxicityUnspecified Adult Solid Tumor, Protocol Specific
- Interventions
- Registration Number
- NCT00566852
- Lead Sponsor
- Radiation Therapy Oncology Group
- Brief Summary
RATIONALE: Memantine may be able to decrease side effects caused by whole-brain radiation therapy. It is not yet known if memantine is effective in preventing side effects caused by whole-brain radiation therapy.
PURPOSE: This randomized phase III trial is studying memantine to see how well it works compared to a placebo in preventing side effects caused by whole-brain radiation therapy in patients with brain metastases from solid tumors.
- Detailed Description
OBJECTIVES:
Primary
* Determine whether the addition of memantine hydrochloride to whole-brain radiotherapy (WBRT) preserves cognitive function, specifically memory, as measured by the Hopkins Verbal Learning Test for delayed recall (HVLT-delayed recall), over that of placebo and WBRT in patients with brain metastases at 24 weeks from the start of drug treatment.
Secondary
* Determine whether the addition of memantine hydrochloride preserves cognitive function, specifically memory, as measured by the HVLT-delayed recall at 8 weeks, 16 weeks, and 12 months from the start of drug treatment.
* Determine whether the addition of memantine hydrochloride increases time to neurocognitive failure as measured by cognitive decline on a battery of tests including the HVLT for free recall, delayed recall, and delayed recognition; the Controlled Word Association Test (COWAT); the Trail Making Test Parts A and B (TMT); the Medical Outcomes Scale-Cognitive Functioning Subscale (MOS); and the Mini-Mental Status Examination (MMSE).
* Evaluate the potential benefit of memantine hydrochloride in change and overall quality of life, as measured by the Functional Assessment of Cancer Therapy-Brain (FACT-Br) subscale.
* Determine whether the addition of memantine hydrochloride increases progression-free survival.
* Determine whether the addition of memantine hydrochloride increases overall survival.
* Compare adverse events between the treatment arms according to the CTCAE v3.0 criteria.
* Collect serum, plasma, buffy coat cells, urine, and cerebrospinal fluid (CSF) for future translational research analyses.
OUTLINE: This is a multicenter study. Patients are stratified according to recursive partitioning analysis (RPA) prognostic class (class I vs class II with controlled systemic disease) and prior surgical therapy (none vs radiosurgery or surgical resection). Patients are randomized to 1 of 2 treatment arms.
* Arm I: Patients undergo whole-brain radiotherapy (WBRT) 5 days a week for 3 weeks (15 fractions). Patients also receive oral memantine hydrochloride once daily beginning on day 1 of WBRT and continuing for 24 weeks.
* Arm II: Patients undergo WBRT as in arm I. Patients also receive oral placebo once daily beginning on day 1 of WBRT and continuing for 24 weeks.
After completion of study treatment, patients are followed at 6 months, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 554
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description WBRT+Memantine Whole brain radiation therapy Whole brain radiation therapy (WBRT) and memantine WBRT+Placebo Placebo Whole brain radiation therapy (WBRT) and placebo WBRT+Placebo Whole brain radiation therapy Whole brain radiation therapy (WBRT) and placebo WBRT+Memantine Memantine Whole brain radiation therapy (WBRT) and memantine
- Primary Outcome Measures
Name Time Method Change in the Hopkins Verbal Learning Test - Revised for Delayed Recall (HVLT-R-delayed Recall) at 24 Weeks Baseline and 24 weeks from the start of drug treatment The HVLT-R consists of 3 parts. Free call has a range of 0 to 36, delayed recall has a range from 0 to 12, and delayed recognition has a range of -12 to 12. Higher scores indicating better function in all 3 parts. Standardized scores are used by calculating an average standardized z score for each part of the HVLT-R. Change is calculated by subtracting baseline value from 24-week value. Imputation methods were used to determine values for all alive patients missing the 24 week assessment. This tool is being used to measure cognitive function, specifically memory.
- Secondary Outcome Measures
Name Time Method Change in the Hopkins Verbal Learning Test - Revised for Delayed Recall (HVLT-R-delayed Recall) at 8, 16, and 52 Weeks Baseline, 8, 16, and 52 weeks from the start of drug treatment The HVLT-R consists of 3 parts. Free call has a range of 0 to 36, delayed recall has a range from 0 to 12, and delayed recognition has a range of -12 to 12. Higher scores indicating better function in all 3 parts. Standardized scores are used by calculating an average standardized z score for each part of the HVLT-R. Change is calculated by subtracting baseline value from the respective later time point value. Imputation methods were used to determine values for all alive patients missing the post-baseline assessments. This tool is being used to measure cognitive function, specifically memory.
Median Time to Neurocognitive Failure Baseline to 12 months from the start of drug treatment Neurocognitive failure is defined as the first cognitive failure on any of the neurocognitive tests: the HVLT-R for immediate recall, delayed recognition, and delayed recall; the Controlled Oral Word Association Test (COWAT); the Trail-Making Test (TMT) Parts A and B. Cognitive failure for each test is defined as a post-treatment score that meets one of the following criteria: follow-up score is at least 2 standard deviations worse than the patient's personal baseline score or the patient's raw score change is greater than the reliable change index. The cumulative incidence approach was used to estimate the median time to neurocognitive failure to account for the competing risks of disease progression and death.
Change in Functional Assessment of Cancer Therapy With Brain Subscale (FACT-Br) at 24 Weeks Baseline and 24 weeks from start of treatment The FACT-Br is a 50-question self-report questionnaire contains the following domains (scales): Physical well-being (7 questions), social/family well-being (7 questions), emotional well-being (6 questions), functional well-being (7 questions) and brain cancer subscale which contains concerns relevant to patients with brain tumors (23 questions). Each question has a value 0-4. For some questions a higher indicates better outcome and others are the opposite. The former are summed as is, the latter are reversed in value before adding, such that each domain ranges from 0 to 4 times the number of questions in the domain, with 0 indicating worst and the highest possible value indicating best outcome. The FACT-Br total is obtained by adding all domains together if the overall question response rate is greater than 80%. Total scores on the FACT-Br range from 0 to 184 with lower scores indicating declining quality of life. Change is calculated as baseline score subtracted from 24-week score.
Median Progression-free Survival Time From randomization to date of progression, death or last follow-up. Analysis occurs at the same time as the primary outcome. Patients are followed until death and all follow-up collected at time of analysis is used. Disease progression is defined as the first of the following events: an increase of at least 50% for lesions less than or equal to 1cm, an increase of least 25% for lesions greater than 1cm, appearance of any new brain metastases. Failure for progression-free survival is disease progression or death. Median progression-free survival was estimated using the Kaplan-Meier method.
Overall Survival From randomization to date of death or last follow-up. Analysis occurs at the same time as the primary outcome. Patients are followed until death and all follow-up collected at time of analysis is used. Failure for overall survival is death from any cause. Median survival was estimated using the Kaplan-Meier method.
Trial Locations
- Locations (235)
University Medical Center at Princeton
🇺🇸Princeton, New Jersey, United States
York Cancer Center at Apple Hill Medical Center
🇺🇸York, Pennsylvania, United States
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Central Maryland Oncology Center
🇺🇸Columbia, Maryland, United States
UPMC - Shadyside
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center at Magee-Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center at UPMC Passavant
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center - Upper St. Clair
🇺🇸Pittsburgh, Pennsylvania, United States
CCOP - Virginia Mason Research Center
🇺🇸Seattle, Washington, United States
Community Regional Cancer Care at Community Hospital East
🇺🇸Indianapolis, Indiana, United States
Community Regional Cancer Care at Community Hospital North
🇺🇸Indianapolis, Indiana, United States
Central Indiana Cancer Centers - East
🇺🇸Indianapolis, Indiana, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Charles M. Barrett Cancer Center at University Hospital
🇺🇸Cincinnati, Ohio, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Methodist Estabrook Cancer Center
🇺🇸Omaha, Nebraska, United States
Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Oklahoma University Cancer Institute
🇺🇸Oklahoma City, Oklahoma, United States
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
Arizona Oncology Services Foundation
🇺🇸Phoenix, Arizona, United States
Auburn Radiation Oncology
🇺🇸Auburn, California, United States
Mercy Cancer Center at Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States
Rebecca and John Moores UCSD Cancer Center
🇺🇸La Jolla, California, United States
USC/Norris Comprehensive Cancer Center and Hospital
🇺🇸Los Angeles, California, United States
Radiation Oncology Center - Roseville
🇺🇸Roseville, California, United States
St. Joseph Hospital Regional Cancer Center - Orange
🇺🇸Orange, California, United States
Stanford Cancer Center
🇺🇸Stanford, California, United States
Integrated Community Oncology Network at Southside Cancer Center
🇺🇸Jacksonville, Florida, United States
Florida Cancer Center - Palatka
🇺🇸Palatka, Florida, United States
Flagler Cancer Center
🇺🇸Saint Augustine, Florida, United States
John B. Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Center for Cancer Care at Goshen General Hospital
🇺🇸Goshen, Indiana, United States
Methodist Cancer Center at Methodist Hospital
🇺🇸Indianapolis, Indiana, United States
Holden Comprehensive Cancer Center at University of Iowa
🇺🇸Iowa City, Iowa, United States
Kansas City Cancer Centers - Southwest
🇺🇸Overland Park, Kansas, United States
CCOP - Northern Indiana CR Consortium
🇺🇸South Bend, Indiana, United States
Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center
🇺🇸Baltimore, Maryland, United States
Good Samaritan Hospital of Maryland
🇺🇸Baltimore, Maryland, United States
St. Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
William Beaumont Hospital - Royal Oak Campus
🇺🇸Royal Oak, Michigan, United States
Albert Lea Cancer Center at Albert Lea Medical Center
🇺🇸Albert Lea, Minnesota, United States
CentraCare Clinic - River Campus
🇺🇸Saint Cloud, Minnesota, United States
Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸Robbinsdale, Minnesota, United States
Minnesota Oncology Hematology, PA - Maplewood
🇺🇸Maplewood, Minnesota, United States
CCOP - St. Louis-Cape Girardeau
🇺🇸Saint Louis, Missouri, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸Springfield, Missouri, United States
CCOP - Nevada Cancer Research Foundation
🇺🇸Las Vegas, Nevada, United States
New York Methodist Hospital
🇺🇸Brooklyn, New York, United States
New Hanover Radiation Oncology, PA
🇺🇸Wilmington, North Carolina, United States
McDowell Cancer Center at Akron General Medical Center
🇺🇸Akron, Ohio, United States
Barberton Citizens Hospital
🇺🇸Barberton, Ohio, United States
Mission Hospitals - Memorial Campus
🇺🇸Asheville, North Carolina, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸Cleveland, Ohio, United States
Willamette Valley Cancer Center - Eugene
🇺🇸Eugene, Oregon, United States
Providence Cancer Center at PMCC
🇺🇸Medford, Oregon, United States
Northeast Radiation Oncology Center
🇺🇸Dunmore, Pennsylvania, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Texas Oncology, PA at Texas Oncology Cancer Center Sugar Land
🇺🇸Sugar Land, Texas, United States
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
🇺🇸Dallas, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
West Texas Cancer Center
🇺🇸Odessa, Texas, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Franciscan Skemp Healthcare - La Crosse Campus
🇺🇸La Crosse, Wisconsin, United States
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Huntsman Cancer Institute at University of Utah
🇺🇸Salt Lake City, Utah, United States
Dixie Regional Medical Center - East Campus
🇺🇸Saint George, Utah, United States
Fletcher Allen Health Care - University Health Center Campus
🇺🇸Burlington, Vermont, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸Seneca, Pennsylvania, United States
Longview Cancer Center
🇺🇸Longview, Texas, United States
Texas Oncology, PA at Texas Cancer Center Dallas Southwest
🇺🇸Dallas, Texas, United States
Utah Cancer Specialists at UCS Cancer Center
🇺🇸Salt Lake City, Utah, United States
Washington Hospital Cancer Center
🇺🇸Washington, Pennsylvania, United States
Hopital Notre-Dame du CHUM
🇨🇦Montreal, Quebec, Canada
Texas Oncology, PA at Texas Cancer Center - Sherman
🇺🇸Sherman, Texas, United States
Texas Oncology, PA at Texas Cancer Center - Arlington South
🇺🇸Arlington, Texas, United States
McGill Cancer Centre at McGill University
🇨🇦Montreal, Quebec, Canada
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
CCOP - Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Integrated Community Oncology Network
🇺🇸Jacksonville Beach, Florida, United States
Baptist Cancer Institute - Jacksonville
🇺🇸Jacksonville, Florida, United States
St. Luke's Cancer Network at St. Luke's Hospital
🇺🇸Bethlehem, Pennsylvania, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Cancer Center at Clarion Hospital
🇺🇸Clarion, Pennsylvania, United States
Geisinger Cancer Institute at Geisinger Health
🇺🇸Danville, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸McKeesport, Pennsylvania, United States
UPMC Cancer Center - Natrona Heights
🇺🇸Natrona Heights, Pennsylvania, United States
Penn State Cancer Institute at Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Glendale Adventist Medical Center
🇺🇸Glendale, California, United States
Parkview Regional Cancer Center at Parkview Health
🇺🇸Fort Wayne, Indiana, United States
Cancer Center at Ball Memorial Hospital
🇺🇸Muncie, Indiana, United States
Summa Center for Cancer Care at Akron City Hospital
🇺🇸Akron, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸Maumee, Ohio, United States
Hillcrest Cancer Center at Hillcrest Hospital
🇺🇸Mayfield Heights, Ohio, United States
St. Charles Mercy Hospital
🇺🇸Oregon, Ohio, United States
Flower Hospital Cancer Center
🇺🇸Sylvania, Ohio, United States
Precision Radiotherapy at University Pointe
🇺🇸West Chester, Ohio, United States
Cancer Treatment Center
🇺🇸Wooster, Ohio, United States
Cleveland Clinic - Wooster
🇺🇸Wooster, Ohio, United States
Three Rivers Community Hospital
🇺🇸Grants Pass, Oregon, United States
Enloe Cancer Center at Enloe Medical Center
🇺🇸Chico, California, United States
Cancer Care Center, Incorporated
🇺🇸Salem, Ohio, United States
Rosenfeld Cancer Center at Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
Radiation Oncology Associates Southwest
🇺🇸Fort Wayne, Indiana, United States
John Muir/Mt. Diablo Comprehensive Cancer Center
🇺🇸Walnut Creek, California, United States
Mayo Clinic Scottsdale
🇺🇸Scottsdale, Arizona, United States
UPMC Cancer Center at the John P. Murtha Pavilion
🇺🇸Johnstown, Pennsylvania, United States
Cancer Institute at St. John's Hospital
🇺🇸Springfield, Illinois, United States
CCOP - Upstate Carolina
🇺🇸Spartanburg, South Carolina, United States
All Saints Cancer Center at Wheaton Franciscan Healthcare
🇺🇸Racine, Wisconsin, United States
CCOP - Toledo Community Hospital
🇺🇸Toledo, Ohio, United States
MBCCOP - Gulf Coast
🇺🇸Mobile, Alabama, United States
Providence Cancer Center at Providence Hospital
🇺🇸Mobile, Alabama, United States
Arizona Cancer Center at University of Arizona Health Sciences Center
🇺🇸Tucson, Arizona, United States
Arizona Oncology - Tucson
🇺🇸Tucson, Arizona, United States
Providence Saint Joseph Medical Center - Burbank
🇺🇸Burbank, California, United States
Cancer Care Center at John Muir Health - Concord Campus
🇺🇸Concord, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Radiation Oncology Centers - Cameron Park
🇺🇸Cameron Park, California, United States
Solano Radiation Oncology Center
🇺🇸Vacaville, California, United States
Emanuel Regional Cancer Services at Emanuel Medical Center
🇺🇸Turlock, California, United States
Rocky Mountain Cancer Centers - Colorado Springs
🇺🇸Colorado Springs, Colorado, United States
CCOP - Christiana Care Health Services
🇺🇸Newark, Delaware, United States
Poudre Valley Radiation Oncology
🇺🇸Fort Collins, Colorado, United States
Baptist Medical Center South
🇺🇸Jacksonville, Florida, United States
Integrated Community Oncology Network - Orange Park
🇺🇸Orange Park, Florida, United States
Washington Cancer Institute at Washington Hospital Center
🇺🇸Washington, D.C., District of Columbia, United States
Winship Cancer Institute of Emory University
🇺🇸Atlanta, Georgia, United States
Veterans Affairs Medical Center - Atlanta (Decatur)
🇺🇸Decatur, Georgia, United States
Northwest Community Hospital
🇺🇸Arlington Heights, Illinois, United States
Northeast Georgia Medical Center
🇺🇸Gainesville, Georgia, United States
John H. Stroger, Jr. Hospital of Cook County
🇺🇸Chicago, Illinois, United States
Saint John's Cancer Center at Saint John's Medical Center
🇺🇸Anderson, Indiana, United States
Indiana University Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Bloomington Hospital Regional Cancer Institute
🇺🇸Bloomington, Indiana, United States
Greenebaum Cancer Center at University of Maryland Medical Center
🇺🇸Baltimore, Maryland, United States
St. Agnes Hospital Cancer Center
🇺🇸Baltimore, Maryland, United States
Cancer Institute at St. Joseph Medical Center
🇺🇸Towson, Maryland, United States
Boston University Cancer Research Center
🇺🇸Boston, Massachusetts, United States
Tate Cancer Center at Baltimore Washington Medical Center
🇺🇸Glen Burnie, Maryland, United States
Charach Cancer Center at Huron Valley - Sinai Hospital
🇺🇸Commerce, Michigan, United States
Josephine Ford Cancer Center at Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Great Lakes Cancer Institute at McLaren Regional Medical Center
🇺🇸Flint, Michigan, United States
CCOP - Grand Rapids
🇺🇸Grand Rapids, Michigan, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸Fridley, Minnesota, United States
Immanuel St. Joseph's
🇺🇸Mankato, Minnesota, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Regional Cancer Center at Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Billings Clinic - Downtown
🇺🇸Billings, Montana, United States
Renown Institute for Cancer at Renown Regional Medical Center
🇺🇸Reno, Nevada, United States
Payson Center for Cancer Care at Concord Hospital
🇺🇸Concord, New Hampshire, United States
Elliot Regional Cancer Center at Elliot Hospital
🇺🇸Manchester, New Hampshire, United States
Ocean Medical Center at Meridian Health
🇺🇸Bricktown, New Jersey, United States
Cancer Institute of New Jersey at Cooper University Hospital - Camden
🇺🇸Camden, New Jersey, United States
Trinitas Comprehensive Cancer Center at Trinitas Hospital
🇺🇸Elizabeth, New Jersey, United States
Princeton Radiation Oncology Center
🇺🇸Jamesburg, New Jersey, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
Cancer Institute of New Jersey at Cooper - Voorhees
🇺🇸Voorhees, New Jersey, United States
J. Phillip Citta Regional Cancer Center at Community Medical Center
🇺🇸Toms River, New Jersey, United States
New York Oncology Hematology, PC at Albany Regional Cancer Care
🇺🇸Albany, New York, United States
Veterans Affairs Medical Center - Albany
🇺🇸Albany, New York, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Sands Cancer Center
🇺🇸Canandaigua, New York, United States
Long Island Jewish Medical Center
🇺🇸New Hyde Park, New York, United States
CCOP - North Shore University Hospital
🇺🇸Manhasset, New York, United States
Trinity CancerCare Center
🇺🇸Minot, North Dakota, United States
Cleveland Clinic Cancer Center at Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Cleveland Clinic Cancer Center
🇺🇸Independence, Ohio, United States
North Coast Cancer Care, Incorporated
🇺🇸Sandusky, Ohio, United States
St. Anne Mercy Hospital
🇺🇸Toledo, Ohio, United States
Dubs Cancer Center at Rogue Valley Medical Center
🇺🇸Medford, Oregon, United States
UPMC Cancer Center at Jefferson Regional Medical Center
🇺🇸Clairton, Pennsylvania, United States
Delaware County Regional Cancer Center at Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
UPMC Cancer Center - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
Fox Chase Cancer Center - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Jameson Memorial Hospital - North Campus
🇺🇸New Castle, Pennsylvania, United States
UPMC - Moon
🇺🇸Moon, Pennsylvania, United States
Albert Einstein Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
UPMC Cancer Center at UPMC St. Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center - Uniontown
🇺🇸Uniontown, Pennsylvania, United States
Lankenau Cancer Center at Lankenau Hospital
🇺🇸Wynnewood, Pennsylvania, United States
Texas Oncology, PA at Harris Center HEB
🇺🇸Bedford, Texas, United States
Texas Oncology, PA at Texas Cancer Center - Denton South
🇺🇸Denton, Texas, United States
Klabzuba Cancer Center at Harris Methodist Fort Worth Hospital
🇺🇸Fort Worth, Texas, United States
Cancer Care Centers of South Texas - Northeast
🇺🇸San Antonio, Texas, United States
Tyler Cancer Center
🇺🇸Tyler, Texas, United States
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
🇺🇸Murray, Utah, United States
Sentara Cancer Institute at Sentara Norfolk General Hospital
🇺🇸Norfolk, Virginia, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
Schiffler Cancer Center at Wheeling Hospital
🇺🇸Wheeling, West Virginia, United States
Theda Care Cancer Institute
🇺🇸Appleton, Wisconsin, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
Community Memorial Hospital Cancer Care Center
🇺🇸Menomonee Falls, Wisconsin, United States
University of Wisconcin Cancer Center at Aspirus Wausau Hospital
🇺🇸Wausau, Wisconsin, United States
London Regional Cancer Program at London Health Sciences Centre
🇨🇦London, Ontario, Canada
Nova Scotia Cancer Centre
🇨🇦Halifax, Nova Scotia, Canada
West Allis Memorial Hospital
🇺🇸West Allis, Wisconsin, United States
Maisonneuve-Rosemont Hospital
🇨🇦Montreal, Quebec, Canada
Centre Hospitalier Universitaire de Quebec
🇨🇦Quebec City, Quebec, Canada
Rocky Mountain Cancer Centers - Aurora
🇺🇸Aurora, Colorado, United States
Radiological Associates of Sacramento Medical Group, Incorporated
🇺🇸Sacramento, California, United States
Mercy General Hospital
🇺🇸Sacramento, California, United States
University of California Davis Cancer Center
🇺🇸Sacramento, California, United States
UPMC Cancer Center at Beaver Medical Center
🇺🇸Beaver, Pennsylvania, United States
Florida Institute of Research, Medicine and Surgery Cancer Center
🇺🇸Orlando, Florida, United States
Kansas City Cancer Centers - South
🇺🇸Kansas City, Missouri, United States
Yale Cancer Center
🇺🇸New Haven, Connecticut, United States
Norton Suburban Hospital
🇺🇸Louisville, Kentucky, United States
Kansas City Cancer Centers - North
🇺🇸Kansas City, Missouri, United States
Hollings Cancer Center at Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
University of Florida Shands Cancer Center
🇺🇸Gainesville, Florida, United States
Lucille P. Markey Cancer Center at University of Kentucky
🇺🇸Lexington, Kentucky, United States
Lovelace Medical Center - Downtown
🇺🇸Albuquerque, New Mexico, United States
Radiation Oncology Associates, PA
🇺🇸Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Highland Hospital of Rochester
🇺🇸Rochester, New York, United States
Lipson Cancer and Blood Center at Rochester General Hospital
🇺🇸Rochester, New York, United States
University Radiation Oncology at Parkridge Hospital
🇺🇸Rochester, New York, United States
James P. Wilmot Cancer Center at University of Rochester Medical Center
🇺🇸Rochester, New York, United States
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center
🇺🇸Madison, Wisconsin, United States
Medical University of Ohio Cancer Center
🇺🇸Toledo, Ohio, United States