Gemcitabine With or Without Radiation Therapy in Treating Patients With Pancreatic Cancer
- Conditions
- Pancreatic Cancer
- Interventions
- Radiation: radiation therapy
- Registration Number
- NCT00057876
- Lead Sponsor
- Eastern Cooperative Oncology Group
- Brief Summary
RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known whether gemcitabine is more effective with or without radiation therapy in treating pancreatic cancer.
PURPOSE: Randomized phase III trial to study the effectiveness of gemcitabine with or without radiation therapy in treating patients who have locally advanced, unresectable pancreatic cancer.
- Detailed Description
OBJECTIVES:
* Compare the overall survival and progression-free of patients with locally advanced, unresectable pancreatic cancer treated with gemcitabine with or without radiotherapy.
* Compare the objective response rate in patients treated with these regimens.
* Compare the toxicity of these regimens in these patients.
* Compare the quality of life (QOL) of patients treated with these regimens.
* Determine the effect of gemcitabine and radiotherapy on the QOL of patients with improved objective response rate and progression-free and overall survival.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to performance status (0 vs. 1) and weight loss within the past 6 months (less than 10% vs. 10% or more). Patients are randomized to 1 of 2 treatment arms.
Arm I (Gemcitabine alone):
* Induction: Patients receive gemcitabine intravenously (IV) over 30-60 minutes once weekly for 6 weeks followed by 1 week of rest.
* Consolidation: After the 1 week of rest, patients receive gemcitabine IV once weekly for 3 weeks. Treatment repeats every 4 weeks for 5 courses in the absence of disease progression or unacceptable toxicity.
Arm II (Gemcitabine with radiotherapy):
* Induction: Patients receive gemcitabine IV over 30-60 minutes once weekly for 6 weeks beginning on day 1. Patients also undergo concurrent radiotherapy 5 days a week for 5.5 weeks beginning on day 1.
* Consolidation: Approximately 4 weeks after completion of radiotherapy, patients receive gemcitabine IV over 30-60 minutes once weekly for 3 weeks. Treatment repeats every 4 weeks for 5 courses in the absence of disease progression or unacceptable toxicity.
Quality of life is assessed at baseline, week 6, week 15 (for arm II), week 16 (for arm I), and 9 months.
Patients are followed every 3 months for 2 years and then every 6 months for 1 year. Patients who receive treatment beyond 3 years are followed for survival.
ACCRUAL: 74 patients were accrued for this study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 74
-
Histologically or cytologically confirmed adenocarcinoma of the pancreas
- Locally advanced or regional (encompassable within the same radiotherapy portals)
- Adenosquamous cancers are allowed
-
Unresectable disease
-
Measurable and/or non-measurable disease as determined by computed tomography (CT) scan or magnetic resonance imaging (MRI), which must be performed within 4 weeks prior to randomization.
-
Age>=18
-
ECOG Performance status of 0-1
-
Life expectancy >= 12 weeks
-
Adequate bone marrow reserve,liver and renal function within 2 weeks of randomization:
- Absolute granulocyte count at least 2,000/mm^3
- Platelet count at least 100,000/mm^3
- Bilirubin less than 3 mg/dL (unless secondary to biliary obstruction or cholangitis)
- Serum glutamic-oxaloacetic (AST) less than 5 times upper limit of normal (ULN)
- Albumin greater than 2.5 g/dL
- Creatinine no greater than 1.5 times ULN
-
Fertile patients must use effective contraception
-
Willing and able to attend follow-up visits
-
Concurrent enrollment on protocol ECOG-E1Y03 allowed
-
More than 4 weeks since prior investigational agents
- Candidate for surgical excision based on local extent of disease (e.g., T3, N1, M0)
- Stage M1 disease
- Small cell, mucinous cystadenocarcinoma, islet cell or papillary cystic histology
- Pregnant or nursing
- Active infection within within 4 weeks of randomization
- Malignancy within the past 5 years except nonmelanoma skin cancer, carcinoma in situ of the cervix, or organ-confined prostate cancer (Gleason score no greater than 7)
- History of active collagen vascular disease (i.e., systemic lupus erythematosus, rheumatoid arthritis, or scleroderma)
- Signs or symptoms of peptic or duodenal ulcer disease
- Concurrent serious systemic disorders that are incompatible with study participation
- Prior chemotherapy for pancreatic cancer
- Prior radiotherapy
- Concurrent intensity modulated radiotherapy
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Gemcitabine + Radiation radiation therapy - Gemcitabine Gemcitabine -
- Primary Outcome Measures
Name Time Method Overall Survival Time assessed every 3 months for 2 years, then every 6 months for year 3 Overall survival was defined as the time from randomization (registration) to death from any cause. Patients alive at last follow-up were censored. Patients were followed every 3 months for 2 years and then every 6 months for year 3. Patients received treatment beyond 3 years were also followed for survival.
- Secondary Outcome Measures
Name Time Method Progression-free Survival Time assessed every 3 months for 2 years, then every 6 months for year 3 Time from randomization (registration) to the earlier of disease progression or death. Patients alive and progression-free at last follow-up were censored. Progressive disease was defined as at least a 20% increase in the sum of the longest diameters of target lesions (taking as reference the baseline sum longest diameter), or the appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. Patients were followed every 3 months for 2 years and then every 6 months for year 3. Patients who received treatment beyond 3 years were also followed for survival.
Overall Response assessed at week 8, and every 3 months for 2 years, then every 6 months for year 3 Response was assessed per Response Evaluation Criteria In Solid Tumors (RECIST) by CT. Overall response included complete response (CR) and partial response (PR). CR was defined as the disappearance of all target and non-target lesions. PR was defined as CR of target lesions and persistence of one or more non-target lesions or at least a 30% decrease in the sum of the longest diameters of target lesions and non-progressive disease in the non-target lesions. The 71 eligible, treated participants were included in the analysis.
Trial Locations
- Locations (227)
Emory University Hospital - Atlanta
🇺🇸Atlanta, Georgia, United States
Robert H. Lurie Comprehensive Cancer Center at Northwestern University
🇺🇸Chicago, Illinois, United States
Mercy Hospital and Medical Center
🇺🇸Chicago, Illinois, United States
Swedish Covenant Hospital
🇺🇸Chicago, Illinois, United States
Tufts - New England Medical Center
🇺🇸Boston, Massachusetts, United States
CCOP - Nevada Cancer Research Foundation
🇺🇸Las Vegas, Nevada, United States
Hinsdale Hematology Oncology Associates
🇺🇸Hinsdale, Illinois, United States
Banner Good Samaritan Medical Center
🇺🇸Phoenix, Arizona, United States
Bryan LGH Medical Center West
🇺🇸Lincoln, Nebraska, United States
Saint Joseph's Mercy Cancer Center
🇺🇸Hot Springs, Arkansas, United States
New Britain General Hospital
🇺🇸New Britain, Connecticut, United States
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center
🇺🇸Farmington, Connecticut, United States
Baton Rouge General Regional Cancer Center
🇺🇸Baton Rouge, Louisiana, United States
Mary Bird Perkins Cancer Center - Baton Rouge
🇺🇸Baton Rouge, Louisiana, United States
Cancer Resource Center - Lincoln
🇺🇸Lincoln, Nebraska, United States
Fox Chase Virtua Health Cancer Program - Marlton
🇺🇸Marlton, New Jersey, United States
Booker Cancer Center at Riverview Medical Center
🇺🇸Red Bank, New Jersey, United States
Oncology/Hematology Associates of Central Illinois, P.C.
🇺🇸Peoria, Illinois, United States
Community Cancer Center
🇺🇸Normal, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Medical Oncology and Hematology Associates at Mercy Cancer Center
🇺🇸Des Moines, Iowa, United States
William N. Wishard Memorial Hospital
🇺🇸Indianapolis, Indiana, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Memorial Hospital System
🇺🇸Monroe, Michigan, United States
CCOP - Duluth
🇺🇸Duluth, Minnesota, United States
Lakeland Cancer Care Center at Lakeland Hospital - St. Joseph
🇺🇸Saint Joseph, Michigan, United States
William Beaumont Hospital - Royal Oak Campus
🇺🇸Royal Oak, Michigan, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸Springfield, Missouri, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸Escanaba, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
Green Bay Oncology, Limited - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
St. Mary's - Duluth Clinic Cancer Center
🇺🇸Duluth, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
Midlands Cancer Center at Midlands Community Hospital
🇺🇸Papillion, Nebraska, United States
Veterans Affairs Medical Center - East Orange
🇺🇸East Orange, New Jersey, United States
Miller-Dwan Medical Center
🇺🇸Duluth, Minnesota, United States
Hunterdon Regional Cancer Center at Hunterdon Medical Center
🇺🇸Flemington, New Jersey, United States
CentraCare Clinic - River Campus
🇺🇸Saint Cloud, Minnesota, United States
St. John's Regional Health Center
🇺🇸Springfield, Missouri, United States
Joe Arrington Cancer Research and Treatment Center
🇺🇸Lubbock, Texas, United States
St. Rita's Medical Center
🇺🇸Lima, Ohio, United States
CCOP - MainLine Health
🇺🇸Wynnewood, Pennsylvania, United States
Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Wayne Memorial Hospital, Incorporated
🇺🇸Goldsboro, North Carolina, United States
Bismarck Cancer Center
🇺🇸Bismarck, North Dakota, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
Good Samaritan Health Systems
🇺🇸Kearney, Nebraska, United States
Shore Memorial Hospital - Somers Point
🇺🇸Somers Point, New Jersey, United States
Community Regional Cancer Center at Community Medical Center
🇺🇸Toms River, New Jersey, United States
Leo W. Jenkins Cancer Center at Pitt County Memorial Hospital
🇺🇸Greenville, North Carolina, United States
Trinity Cancer Care Center
🇺🇸Minot, North Dakota, United States
Cancer Care Center at Medcenter One Hospital
🇺🇸Bismarck, North Dakota, United States
St. Charles Mercy Hospital
🇺🇸Oregon, Ohio, United States
Mid Dakota Clinic, P.C.
🇺🇸Bismarck, North Dakota, United States
Aultman Hospital Cancer Center at Aultman Health Foundation
🇺🇸Canton, Ohio, United States
St. Elizabeth Boardman Cancer Center
🇺🇸Boardman, Ohio, United States
Blanchard Valley Medical Associates
🇺🇸Findlay, Ohio, United States
St. Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Avera McKennan Hospital and University Health Center
🇺🇸Sioux Falls, South Dakota, United States
Veterans Affairs Medical Center - Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Medical X-Ray Center, P. C.
🇺🇸Sioux Falls, South Dakota, United States
Sioux Valley Hospital and University of South Dakota Medical Center
🇺🇸Sioux Falls, South Dakota, United States
Lankenau Cancer Center at Lankenau Hospital
🇺🇸Wynnewood, Pennsylvania, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Green Bay Oncology, Limited at St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Central Wisconsin Cancer Program at Agnesian HealthCare
🇺🇸Fond Du Lac, Wisconsin, United States
Pretoria Academic Hospital
🇿🇦Pretoria, 0001, South Africa
Martha Jefferson Hospital Cancer Care Center
🇺🇸Charlottesville, Virginia, United States
Utah Cancer Specialists at UCS Cancer Center
🇺🇸Salt Lake City, Utah, United States
University of Wisconsin Cancer Center at Aspirus Wausau Hospital
🇺🇸Wausau, Wisconsin, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸Omaha, Nebraska, United States
Methodist Cancer Center at Methodist Hospital - Omaha
🇺🇸Omaha, Nebraska, United States
Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Ellis Fischel Cancer Center at University of Missouri - Columbia
🇺🇸Columbia, Missouri, United States
St. Mary's Hospital Medical Center
🇺🇸Green Bay, Wisconsin, United States
St. Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Fort Wayne Medical Oncology and Hematology
🇺🇸Fort Wayne, Indiana, United States
Midwest Cancer Research Group, Incorporated
🇺🇸Skokie, Illinois, United States
Saint Anthony Memorial Health Centers
🇺🇸Michigan City, Indiana, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸La Porte, Indiana, United States
CCOP - Northern Indiana CR Consortium
🇺🇸South Bend, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Mercy Capitol Hospital
🇺🇸Des Moines, Iowa, United States
CCOP - Iowa Oncology Research Association
🇺🇸Des Moines, Iowa, United States
McFarland Clinic, P.C.
🇺🇸Ames, Iowa, United States
Genesis Regional Cancer Center at Genesis Medical Center
🇺🇸Davenport, Iowa, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
🇺🇸Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Burgess Health Center
🇺🇸Onawa, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - North Iowa
🇺🇸Mason City, Iowa, United States
Siouxland Hematology-Oncology Associates at June E. Nylen Cancer Center
🇺🇸Sioux City, Iowa, United States
Central Baptist Hospital
🇺🇸Lexington, Kentucky, United States
St. Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Medical Oncology and Hematology Associates - West Des Moines
🇺🇸West Des Moines, Iowa, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸Adrian, Michigan, United States
University Hospitals Ireland Cancer Center at Mercy Medical Center
🇺🇸Canton, Ohio, United States
Fremont Memorial Hospital
🇺🇸Fremont, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
St. Luke's Hospital
🇺🇸Maumee, Ohio, United States
Firelands Regional Medical Center
🇺🇸Sandusky, Ohio, United States
MetroHealth's Cancer Care Center at MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
Toledo Hospital
🇺🇸Toledo, Ohio, United States
Promedica Cancer Center at Flower Hospital
🇺🇸Sylvania, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
CCOP - Toledo Community Hospital
🇺🇸Toledo, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸Toledo, Ohio, United States
St. Elizabeth Cancer Center at St. Elizabeth Health Center - Youngstown
🇺🇸Youngstown, Ohio, United States
St. Joseph Health Care Center
🇺🇸Warren, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Delaware County Regional Cancer Center at Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Lewistown Hospital
🇺🇸Lewistown, Pennsylvania, United States
Penn State Cancer Institute at Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Albert Einstein Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Phoenixville Hospital
🇺🇸Phoenixville, Pennsylvania, United States
Hillman Cancer Center at University of Pittsburgh Cancer Institute
🇺🇸Pittsburgh, Pennsylvania, United States
Marshfield Clinic - Marshfield Center
🇺🇸Marshfield, Wisconsin, United States
Guthrie Medical Center - Sayre
🇺🇸Sayre, Pennsylvania, United States
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus
🇺🇸Seattle, Washington, United States
Chester County Hospital
🇺🇸West Chester, Pennsylvania, United States
Reading Hospital and Medical Center
🇺🇸West Reading, Pennsylvania, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸Tulsa, Oklahoma, United States
Hubert H. Humphrey Cancer Center at North Memorial Medical Center
🇺🇸Robbinsdale, Minnesota, United States
Virginia Piper Cancer Institute at Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Park Nicollet Health Services
🇺🇸Saint Louis Park, Minnesota, United States
OSF St. Francis Medical Center
🇺🇸Peoria, Illinois, United States
Illinois Valley Community Hospital
🇺🇸Peru, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
Hematology Oncology Associates - Skokie
🇺🇸Skokie, Illinois, United States
Forsyth Regional Cancer Center at Forsyth Medical Center
🇺🇸Winston-Salem, North Carolina, United States
CCOP - Illinois Oncology Research Association
🇺🇸Peoria, Illinois, United States
Carle Cancer Center at Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
CCOP - Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Saint Joseph Regional Medical Center
🇺🇸South Bend, Indiana, United States
Mercy Medical Center - Sioux City
🇺🇸Sioux City, Iowa, United States
Medical College of Ohio Cancer Institute
🇺🇸Toledo, Ohio, United States
Valley Cancer Center
🇺🇸Spring Valley, Illinois, United States
Haematology-Oncology Associates of Ohio and Michigan, P.C.
🇺🇸Lambertville, Michigan, United States
Hematology/Oncology of the North Shore at Gross Point Medical Center
🇺🇸Skokie, Illinois, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Indiana University Cancer Center
🇺🇸Indianapolis, Indiana, United States
Ottumwa Regional Health Center Cancer Center
🇺🇸Ottumwa, Iowa, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Baptist Cancer Institute - Jacksonville
🇺🇸Jacksonville, Florida, United States
Doctors Medical Center
🇺🇸Modesto, California, United States
Memorial Medical Center Cancer Services
🇺🇸Modesto, California, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Halifax Medical Center
🇺🇸Daytona Beach, Florida, United States
William W. Backus Hospital
🇺🇸Norwich, Connecticut, United States
Mayo Clinic - Jacksonville
🇺🇸Jacksonville, Florida, United States
Northeast Georgia Medical Center
🇺🇸Gainesville, Georgia, United States
Pearlman Comprehensive Cancer Center at South Georgia Medical Center
🇺🇸Valdosta, Georgia, United States
Rush-Copley Cancer Care Center
🇺🇸Aurora, Illinois, United States
Cancer Care and Research Pavilion at St. Joseph's/Candler
🇺🇸Savannah, Georgia, United States
St. Joseph Medical Center
🇺🇸Reading, Pennsylvania, United States
Graham Hospital
🇺🇸Canton, Illinois, United States
Hematology and Oncology Associates
🇺🇸Scranton, Pennsylvania, United States
St. Anthony's Memorial Hospital
🇺🇸Effingham, Illinois, United States
Eureka Community Hospital
🇺🇸Eureka, Illinois, United States
Galesburg Clinic
🇺🇸Galesburg, Illinois, United States
Evanston Northwestern Health Care - Evanston Hospital
🇺🇸Evanston, Illinois, United States
Galesburg Cottage Hospital
🇺🇸Galesburg, Illinois, United States
InterCommunity Cancer Center of Western Illinois
🇺🇸Galesburg, Illinois, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Hopedale Medical Complex
🇺🇸Hopedale, Illinois, United States
Midwest Center for Hematology/Oncology
🇺🇸Joliet, Illinois, United States
Joliet Oncology Hematology Associates, Limited - West
🇺🇸Joliet, Illinois, United States
Provena St. Mary's Wasser Regional Cancer Center - Kankakee
🇺🇸Kankakee, Illinois, United States
Kewanee Hospital
🇺🇸Kewanee, Illinois, United States
La Grange Memorial Hospital
🇺🇸La Grange, Illinois, United States
Deerpath Medical Associates
🇺🇸Lake Forest, Illinois, United States
North Shore Oncology and Hematology Associates, Limited - Libertyville
🇺🇸Libertyville, Illinois, United States
McDonough District Hospital
🇺🇸Macomb, Illinois, United States
Northwest Medical Specialist, PC
🇺🇸Niles, Illinois, United States
BroMenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸Fridley, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Mount Nittany Medical Center
🇺🇸State College, Pennsylvania, United States
Jennersville Regional Hospital
🇺🇸West Grove, Pennsylvania, United States
Doctor's Hospital of Laredo
🇺🇸Laredo, Texas, United States
Baptist Regional Cancer Center at Baptist Hospital of East Tennessee
🇺🇸Knoxville, Tennessee, United States
East Texas Medical Center Cancer Institute
🇺🇸Tyler, Texas, United States
Cottonwood Hospital Medical Center
🇺🇸Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Dixie Regional Medical Center
🇺🇸Saint George, Utah, United States
Utah Valley Regional Medical Center - Provo
🇺🇸Provo, Utah, United States
Marshall University Medical Center
🇺🇸Huntington, West Virginia, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Cancer Care Center at Holy Family Memorial Medical Center
🇺🇸Manitowoc, Wisconsin, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Veterans Affairs Medical Center - Atlanta (Decatur)
🇺🇸Decatur, Georgia, United States
California Cancer Center - Woodward Park Office
🇺🇸Fresno, California, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division
🇺🇸Charleston, West Virginia, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Bon Secours Cancer Care at St. Mary's Hospital
🇺🇸Richmond, Virginia, United States
Yale Comprehensive Cancer Center at Yale University School of Medicine
🇺🇸New Haven, Connecticut, United States
MBCCOP - LSU Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Medical Center of Louisiana - New Orleans
🇺🇸New Orleans, Louisiana, United States
University of Florida Shands Cancer Center
🇺🇸Gainesville, Florida, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
🇺🇸Baltimore, Maryland, United States
Community Hospital of Ottawa
🇺🇸Ottawa, Illinois, United States
Cancer Treatment Center at Pekin Hospital
🇺🇸Pekin, Illinois, United States
Zimmer Cancer Center at New Hanover Regional Medical Center
🇺🇸Wilmington, North Carolina, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Lancaster General Hospital
🇺🇸Lancaster, Pennsylvania, United States
Swedish American Hospital
🇺🇸Rockford, Illinois, United States
Louis Busch Hager Cancer Center at Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
Wilson Medical Center
🇺🇸Wilson, North Carolina, United States