Paclitaxel and Radiation Therapy With or Without Trastuzumab in Treating Patients Who Have Undergone Surgery for Bladder Cancer
- Conditions
- Bladder Urothelial CarcinomaStage III Bladder Cancer AJCC v6 and v7Stage I Bladder Cancer AJCC v6 and v7Stage II Bladder Cancer AJCC v6 and v7
- Interventions
- Registration Number
- NCT00238420
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This phase I/II trial is studying the side effects of giving paclitaxel together with radiation therapy with or without trastuzumab and to see how well it works to kill any remaining tumor cells in patients who have undergone surgery for bladder cancer. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Paclitaxel may also make tumor cells more sensitive to radiation therapy. Monoclonal antibodies, such as trastuzumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving paclitaxel together with radiation therapy and trastuzumab may kill more tumor cells. Giving these treatments after surgery may kill any remaining tumor cells.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine the acute toxicity (=\< 90 days from protocol treatment start) from chemoradiotherapy including paclitaxel +/- trastuzumab and irradiation in non-cystectomy patients with or without her2/neu overexpression.
SECONDARY OBJECTIVES:
I. To determine the ability of patients with bladder cancer who are non-cystectomy candidates to complete this treatment program.
II. To evaluate the efficacy of this treatment program in achieving a complete response of the primary tumor.
III. To measure the 5-year disease-free and overall survival of patients with bladder cancer treated with transurethral resection of the bladder followed by chemoradiotherapy.
IV. To estimate the value of tumor and/or serum biomarkers as predictors of initial tumor response and recurrence-free survival.
OUTLINE: This is a non-randomized, multicenter study. Patients are assigned to 1 of 2 treatment groups according to HER2/neu status (HER2/neu 2+ or 3+ staining \[group 1\] vs HER2/neu 0 or 1+ staining \[group 2\]).
GROUP I: Patients receive paclitaxel intravenously (IV) over 1 hour on days 1, 8, 15, 22, 29, 36, and 43 and trastuzumab (Herceptin®) IV over 90 minutes on day 1 and then over 30 minutes on days 8, 15, 22, 29, 36, and 43. Patients also undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50. Treatment continues in the absence of disease progression or unacceptable toxicity.
GROUP II: Patients receive paclitaxel and undergo radiotherapy as in group 1.
After completion of study treatment, patients are followed at 4-5 weeks, every 3 months for 1 year, every 4 months for 1 year, every 6 months for 3 years, and then annually thereafter.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 70
-
Histologically or cytologically confirmed primary transitional cell carcinoma (TCC) of the bladder
- Histologic evidence of muscularis propria invasion
-
Meets 1 of the following stage criteria:
- Stage T2-4a; NX, N0, or N1; and M0 disease
- Clinical stage T1, grade 3/3 disease AND requires definitive local therapy
-
Tumor involvement of the prostatic urethra allowed provided the following criteria are met:
- Tumor was visibly completely resected
- No evidence of stromal invasion of the prostate
- No evidence of distant metastases by chest x-ray (or chest CT scan) within 8 weeks prior to registration
- No evidence of distant metastases by abdominal/pelvic CT scan (or MRI scan) within 8 weeks prior to registration
-
Has undergone transurethral bladder resection (as thorough as is judged safely possible) within the past 3-8 weeks, including bimanual examination with tumor mapping
-
Sufficient tumor tissue available for HER2/neu analysis
-
Not a candidate for radical cystectomy
-
Performance status - Zubrod 0-2
-
Absolute neutrophil count >= 1,800/mm^3
-
Platelet count >= 100,000/mm^3
-
Hemoglobin >= 8.0 g/dL (transfusion or other intervention allowed)
-
Bilirubin < 2.0 mg/dL
-
Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) < 2.5 times upper limit of normal
-
No hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
-
Creatinine =< 3.0 mg/dL
-
Left ventricular ejection fraction (LVEF) >= 40% by multigated acquisition scan (MUGA) scan or echocardiogram
-
No unstable angina and/or congestive heart failure requiring hospitalization within the past 6 months
-
No transmural myocardial infarction within the past 6 months
-
Not pregnant or nursing
-
No nursing for 6 months after completion of study treatment (for patients receiving trastuzumab [Herceptin®])
-
Negative pregnancy test
-
Fertile patients must use effective contraception during and for 6 months after completion of study treatment
-
Able to tolerate systemic chemotherapy and pelvic radiotherapy
-
No other invasive malignancy within the past 3 years except nonmelanoma skin cancer
-
No history of allergic reaction to study drugs
-
No history of inflammatory bowel disease
-
No acute bacterial or fungal infection requiring IV antibiotics
-
No AIDS
-
No other severe active comorbidity
-
No prior systemic chemotherapy with anthracyclines or taxanes
-
No prior systemic chemotherapy for TCC
-
No prior pelvic radiotherapy
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group I (paclitaxel, trastuzumab, radiation therapy) Radiation Therapy Patients receive paclitaxel IV over 1 hour on days 1, 8, 15, 22, 29, 36, and 43 and trastuzumab IV over 90 minutes on day 1 and then over 30 minutes on days 8, 15, 22, 29, 36, and 43. Patients also undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50. Treatment continues in the absence of disease progression or unacceptable toxicity. Group I (paclitaxel, trastuzumab, radiation therapy) Trastuzumab Patients receive paclitaxel IV over 1 hour on days 1, 8, 15, 22, 29, 36, and 43 and trastuzumab IV over 90 minutes on day 1 and then over 30 minutes on days 8, 15, 22, 29, 36, and 43. Patients also undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50. Treatment continues in the absence of disease progression or unacceptable toxicity. Group II (paclitaxel, radiation therapy) Radiation Therapy Patients receive paclitaxel and undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50. Group I (paclitaxel, trastuzumab, radiation therapy) Paclitaxel Patients receive paclitaxel IV over 1 hour on days 1, 8, 15, 22, 29, 36, and 43 and trastuzumab IV over 90 minutes on day 1 and then over 30 minutes on days 8, 15, 22, 29, 36, and 43. Patients also undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50. Treatment continues in the absence of disease progression or unacceptable toxicity. Group II (paclitaxel, radiation therapy) Paclitaxel Patients receive paclitaxel and undergo radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, 36-40, 43-47, and 50.
- Primary Outcome Measures
Name Time Method Acute Treatment-related Toxicity From start of protocol treatment to 90 days In each group, the number of patients was tabulated by type and grade (gr) of treatment-related toxicity (CTCAE v3.0). Only the following types of toxicity within 90 days of treatment start were considered: ≥ gr4 neutropenia, ≥ gr4 febrile neutropenia, ≥ gr3 diarrhea, ≥ gr3 nausea/vomiting, ≥ gr3 thrombocytopenia, ≥ gr3 renal, pulmonary, hepatic, or neurologic toxicity, ≥ gr3 rectal or genitourinary bleeding, ≥ gr3 left ventricular failure, or ≥ gr2 other cardiac toxicity. The study was designed to estimate the rate of acute treatment-related toxicity separately in each group of patients. Using the Fleming's one-sample multiple test procedure with Type I and II errors each set at 10%, 40 cases/group were required to reject the null hypothesis that the true toxicity rate is greater than 25% in favor of the alternative hypothesis that the true rate is no more than 10%. Six or more patients with the designated toxicities out of 40 would result in rejecting the null hypothesis.
- Secondary Outcome Measures
Name Time Method Treatment Completion From registration to end of treatment; up to 64 days." The number of patients within each group who completed all elements of protocol treatment are reported.
Complete Response to Treatment At 12 weeks from treatment start The number of patients within each group who achieved a complete response to protocol treatment by 12 weeks are reported. Complete response is defined as no gross tumor at cystoscopy or negative biopsies or both by week 12 after completion of protocol treatment.
Progression-free Survival From start of treatment to last follow-up. Maximum follow-up at time of analysis was 9.9 years. Disease (failure) is defined as any bladder cancer progression determined by all measures of disease including physical exam, imaging, and biopsies. Disease-free survival time is defined as time from treatment start to the date of first progression, death, or last known follow-up (censored). Disease-free survival rates are estimated using the Kaplan-Meier method. Analysis occurred after all patients had been on study for at least 5 years. This is a non-randomized phase I/II trial in which the two patient groups are not compared.
Overall Survival From the date of treatment started to death, assessed up to at least 5 years Overall survival time is defined as time from treatment start to the date of death from any cause or last known follow-up (censored). Overall survival rates are estimated using the Kaplan-Meier method. Analysis occurred after all patients had been on study for at least 5 years. This is a non-randomized phase I/II trial in which the two patient groups are not compared.
Trial Locations
- Locations (183)
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Mobile Infirmary Medical Center
🇺🇸Mobile, Alabama, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Saint Anne's Hospital
🇺🇸Fall River, Massachusetts, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Institute-Summerlin Campus
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Research Foundation NCORP
🇺🇸Las Vegas, Nevada, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸Great Falls, Montana, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸Cameron Park, California, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Saint Joseph Medical Center
🇺🇸Tacoma, Washington, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Carle Cancer Institute Normal
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Galesburg Cottage Hospital
🇺🇸Galesburg, Illinois, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Kewanee Hospital
🇺🇸Kewanee, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸Monmouth, Illinois, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Illinois CancerCare-Spring Valley
🇺🇸Spring Valley, Illinois, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Mercy Capitol
🇺🇸Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Christiana Care - Union Hospital
🇺🇸Elkton, Maryland, United States
Southwest Medical Center
🇺🇸Liberal, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Cleveland Clinic Mercy Hospital
🇺🇸Canton, Ohio, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Inspira Medical Center Vineland
🇺🇸Vineland, New Jersey, United States
Vidant Oncology-Kinston
🇺🇸Kinston, North Carolina, United States
Providence Milwaukie Hospital
🇺🇸Milwaukie, Oregon, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Fox Chase Cancer Center Buckingham
🇺🇸Furlong, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Riddle Memorial Hospital
🇺🇸Media, Pennsylvania, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Cottonwood Hospital Medical Center
🇺🇸Murray, Utah, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Main Line Health NCORP
🇺🇸Wynnewood, Pennsylvania, United States
Danville Regional Medical Center
🇺🇸Danville, Virginia, United States
EvergreenHealth Medical Center
🇺🇸Kirkland, Washington, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
McGill University Department of Oncology
🇨🇦Montreal, Quebec, Canada
Valley Medical Center
🇺🇸Renton, Washington, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
London Regional Cancer Program
🇨🇦London, Ontario, Canada
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Atlantic Health Sciences Corporation-Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Saint George Regional Medical Center
🇺🇸Saint George, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville
🇺🇸Vacaville, California, United States
Heartland Cancer Research NCORP
🇺🇸Decatur, Illinois, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Northeast Radiation Oncology Center
🇺🇸Dunmore, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸Peoria, Illinois, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸Auburn, California, United States
University of Florida Health Science Center - Jacksonville
🇺🇸Jacksonville, Florida, United States
Mercy General Hospital Radiation Oncology Center
🇺🇸Sacramento, California, United States
Saint Francis Hospital - Wilmington
🇺🇸Wilmington, Delaware, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
Jupiter Medical Center
🇺🇸Jupiter, Florida, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Holy Family Medical Center
🇺🇸Monmouth, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Radiation Oncology Associates PC
🇺🇸Fort Wayne, Indiana, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸Des Moines, Iowa, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸Boston, Massachusetts, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Cheshire Medical Center-Dartmouth-Hitchcock Keene
🇺🇸Keene, New Hampshire, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Hudson Valley Oncology Associates
🇺🇸Poughkeepsie, New York, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Saint Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Mid Dakota Clinic
🇺🇸Bismarck, North Dakota, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Summa Health System - Barberton Campus
🇺🇸Barberton, Ohio, United States
UH Seidman Cancer Center at Salem Regional Medical Center
🇺🇸Salem, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Cancer Treatment Center
🇺🇸Wooster, Ohio, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Sandra L Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
Norris Cotton Cancer Center-North
🇺🇸Saint Johnsbury, Vermont, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
Compass Oncology Vancouver
🇺🇸Vancouver, Washington, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Northwest NCI Community Oncology Research Program
🇺🇸Tacoma, Washington, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸Roseville, California, United States
The Reverend Roger Patrick Dorcy Cancer Center at Saint Mary-Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Illinois CancerCare-Havana
🇺🇸Havana, Illinois, United States
Duly Health and Care Joliet
🇺🇸Joliet, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸Hopedale, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States