Regional Radiotherapy in Biomarker Low-Risk Node Positive and T3N0 Breast Cancer
- Conditions
- Breast Cancer
- Interventions
- Radiation: RadiationOther: No Radiation
- Registration Number
- NCT03488693
- Lead Sponsor
- Canadian Cancer Trials Group
- Brief Summary
The purpose of this study is to compare the effects on low risk breast cancer receiving usual care that includes regional radiation therapy, with receiving no regional radiation therapy. Researchers want to see if not giving this type of radiation treatment works as well at preventing breast cancer from coming back.
- Detailed Description
Women with node positive breast cancer normally will receive endocrine therapy and some may receive chemotherapy to help prevent the cancer from coming back. Many women will also receive radiotherapy to the whole breast/chest area and the surrounding lymph glands (called regional radiotherapy). No one really knows whether patients with low risk breast cancer need to receive regional radiotherapy. Some women may be getting regional radiotherapy who do not need it. These women may be exposed to the side effects of their treatment without benefit.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 2140
- Patients must be women with newly diagnosed histologically proven invasive carcinoma of the breast with no evidence of metastases, staged as per site standard of care.
- Patients must have been treated by BCS or mastectomy with clear margins of excision. Post-mastectomy positive margins for invasive disease and/or DCIS is not allowed. Multifocal disease (i.e. the presence of two or more foci or breast cancer within the same breast quadrant) and multicentric disease (i.e. the presence of two or more foci of breast cancer in different quadrants of the same breast) are allowed.
- Patients with T3N0 disease are eligible.
- Patients with disease limited to nodal micrometastases are eligible
- Patients with nodal macrometastases (>2mm) treated by axillary dissection must have 1-3 positive axillary nodes (macrometastases, > 2 mm).
- Patients treated by mastectomy and SLNB alone must have only 1-2 positive axillary nodes (macrometastases, > 2 mm).
- Patients must be ER ≥ 1% and HER2 negative on local testing
- Patients must have an Oncotype DX recurrence score ≤25 obtained from testing of breast tumour tissue from a core biopsy or from the surgical specimen.
- Patient must consent to provision of, and investigator(s) must agree to submit to the CCTG Central Tumour Bank, a representative formalin fixed paraffin block of tumour tissue in order that the specific correlative marker assays described in the protocol may be conducted
- Patient must consent to provision of samples of blood in order that the specific correlative marker assays described in the protocol may be conducted.
- Patients must have had endocrine therapy initiated or planned for ≥ 5 years. Premenopausal women will receive ovarian ablation plus aromatase inhibitor therapy or tamoxifen if adjuvant chemotherapy was not administered. For all patients, endocrine therapy can be given concurrently or following RT.
- Patients may or may not have had adjuvant chemotherapy.
- RT must commence within 16 weeks of definitive surgery if the patient is not treated with chemotherapy. If adjuvant chemotherapy is given, RT must begin within 12 weeks after the last dose. (Note: adjuvant chemotherapy may be ongoing at the time of randomization). Definitive surgery is defined as the last breast cancer-related surgery.
- Patient's ECOG performance status must be 0, 1 or 2.
- Patient's age must be ≥ 35 years.
- For the first 736 eligible English or French-speaking subjects who have agreed to optional questionnaire completion: Patient is able (i.e. sufficiently fluent) and willing to complete the quality of life, health utilities and lost productivity questionnaires in either English or French (note: enrollment completed 2022Aug02)
- Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements
- Patients must be accessible for treatment and follow-up. Investigators must assure themselves the patients randomized on this trial will be available for complete documentation of the treatment, adverse events, and follow-up.
- In accordance with CCTG policy, protocol treatment is to begin within 6 weeks of patient randomization.
- Women of childbearing potential must have agreed to use an effective contraceptive method. A woman is considered to be of "childbearing potential" if she has had menses at any time in the preceding 12 consecutive months.
- Patients with nodal disease limited to isolated tumour cells (pN0i+ < 0.2 mm).
- Patients with pT3N1 and pT4 disease (Note: patients with T3N0 are eligible).
- Any prior history, not including the index cancer, of ipsilateral invasive breast cancer or ipsilateral DCIS treated with radiation therapy. (Patients with synchronous or previous ipsilateral LCIS are eligible.)
- Synchronous or previous contralateral invasive breast cancer. (Patients with contralateral DCIS are eligible unless previously treated with radiation.)
- History of non-breast malignancies except adequately treated non-melanoma skin cancers, in situ cancers treated by local excision or other cancers curatively treated with no evidence of disease for ≥ 5 years.
- Patients who are pregnant.
- Patients that have had prior ipsilateral chestwall/thoracic radiation.
- Patients treated with chemo or endocrine therapy administered in the neoadjuvant setting for breast cancer. Endocrine therapy exposure 12 weeks or less prior to surgery is permitted.
- Patients with serious non-malignant disease (e.g. cardiovascular, scleroderma etc.) which would preclude RT.
- Patients with any serious active or co-morbid medical conditions, laboratory abnormality, psychiatric illness, active or uncontrolled infections, or serious illnesses or medical conditions that would prevent the patient from participating or to be managed according to the protocol (according to investigator's decision).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Regional Radiotherapy Radiation A. WBI plus RT to the regional nodes (supraclavicular, non-dissected axillary, and internal mammary) following BCS or; B. RT to the chestwall and regional nodes (supraclavicular, non-dissected axillary, and internal mammary) following mastectomy No Regional Radiotherapy Radiation A. Whole Breast Irradiation (WBI) following BCS or; B. No Radiotherapy (RT) following mastectomy No Regional Radiotherapy No Radiation A. Whole Breast Irradiation (WBI) following BCS or; B. No Radiotherapy (RT) following mastectomy
- Primary Outcome Measures
Name Time Method compare the breast cancer recurrence-free interval (BCRFI) between patients that received regional RT or not 9.5 years Defined as time from randomization to time of invasive recurrent disease in the ipsilateral chestwall, breast, regional nodes, distant sites or death due to BC.
- Secondary Outcome Measures
Name Time Method Compare the invasive disease-free survival between patients that received regional RT or not. 9.5 years Defined as time from randomization to time of invasive recurrent disease in the ipsilateral chestwall, breast, regional nodes, distant sites or death due to BC
Compare arm volume and mobility measurements between patients that received regional RT or not 9.5 years A Fisher's Exact Test will be used to compare lymphedema and arm abduction deficit between two arms. Defined as a difference in arm abduction of 10% or greater in the comparison of the ipsilateral to the contralateral arm.
Compare the breast cancer mortality between patients that received regional RT or not. 9.5 years Defined as death due to BC
Number and severity of adverse events using the current CTCAE version 4 9.5 years Compare the cost-effectiveness between patients that received regional RT or not 9.5 years Costs will be expressed in $US and $CAN base currencies based on the final year of the study. An average cost per study subject by treatment arm for an overall mean cost per study arm will be generated
Compare the overall survival (OS) between patients that received regional RT or not 9.5 years Defined as the time from randomization to the time of death from any cause
Compare the locoregional recurrence-free interval (LRRFI) between patients that received regional RT or not. 9.5 years Defined as time from randomization to time of invasive recurrent disease in the ipsilateral chestwall, breast or regional nodes, or death to due to BC
Compare the distant recurrence-free interval (DRFI) between patients that received regional RT or not. 9.5 years Defined as time from randomization to time of invasive recurrent disease in distant sites or death due to BC
Compare patient-reported outcomes (PROs) and the quality of life (QOL) between patients that received regional RT or not 9.5 years using the NSABP Questionnaire for patients treated by BCS or mastectomy.
Compare the quality of life (QOL) between patients that received regional RT or not 9.5 years skin symptoms and fatigue (EORTC QLQ-BR23) will be compared between the two treatment groups using a similar approach.
Trial Locations
- Locations (459)
Health Sciences North
🇨🇦Sudbury, Ontario, Canada
Odette Cancer Centre- Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
University Health Network-Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
University of Arizona Cancer Center-Orange Grove Campus
🇺🇸Tucson, Arizona, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Kaiser Permanente-Anaheim
🇺🇸Anaheim, California, United States
Kaiser Permanente-Bellflower
🇺🇸Bellflower, California, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
City of Hope Corona
🇺🇸Corona, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Kaiser Permanente Dublin
🇺🇸Dublin, California, United States
UC San Diego Health System - Encinitas
🇺🇸Encinitas, California, United States
Fresno Cancer Center
🇺🇸Fresno, California, United States
City of Hope at Irvine Lennar
🇺🇸Irvine, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
City of Hope Antelope Valley
🇺🇸Lancaster, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Los Angeles General Medical Center
🇺🇸Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Providence Queen of The Valley
🇺🇸Napa, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸Oakland, California, United States
Kaiser Permanente-Ontario
🇺🇸Ontario, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Desert Regional Medical Center
🇺🇸Palm Springs, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸Rancho Cordova, California, United States
Rohnert Park Cancer Center
🇺🇸Rohnert Park, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸Roseville, California, United States
Mercy Cancer Center - Sacramento
🇺🇸Sacramento, California, United States
Saint Helena Hospital
🇺🇸Saint Helena, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Saint John's Cancer Institute
🇺🇸Santa Monica, California, United States
City of Hope South Pasadena
🇺🇸South Pasadena, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸South San Francisco, California, United States
City of Hope South Bay
🇺🇸Torrance, California, United States
City of Hope Upland
🇺🇸Upland, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸Vallejo, California, United States
BASS Medical Group - Lennon
🇺🇸Walnut Creek, California, United States
UCHealth University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
UCHealth Memorial Hospital Central
🇺🇸Colorado Springs, Colorado, United States
Memorial Hospital North
🇺🇸Colorado Springs, Colorado, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
UCHealth - Cherry Creek
🇺🇸Denver, Colorado, United States
AdventHealth Porter
🇺🇸Denver, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Lutheran Hospital - Cancer Centers of Colorado
🇺🇸Golden, Colorado, United States
Banner North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
UCHealth Greeley Hospital
🇺🇸Greeley, Colorado, United States
UCHealth Highlands Ranch Hospital
🇺🇸Highlands Ranch, Colorado, United States
AdventHealth Littleton
🇺🇸Littleton, Colorado, United States
Banner McKee Medical Center
🇺🇸Loveland, Colorado, United States
Intermountain Health Lutheran Hospital
🇺🇸Wheat Ridge, Colorado, United States
Smilow Cancer Hospital Care Center - Guilford
🇺🇸Guilford, Connecticut, United States
Smilow Cancer Hospital-Hamden Care Center
🇺🇸Hamden, Connecticut, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Norwalk Hospital
🇺🇸Norwalk, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull
🇺🇸Trumbull, Connecticut, United States
Smilow Cancer Hospital Care Center - Waterford
🇺🇸Waterford, Connecticut, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
Sibley Memorial Hospital
🇺🇸Washington, District of Columbia, United States
Boca Raton Regional Hospital
🇺🇸Boca Raton, Florida, United States
Morton Plant Hospital
🇺🇸Clearwater, Florida, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
🇺🇸Coral Gables, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
🇺🇸Deerfield Beach, Florida, United States
Broward Health Medical Center
🇺🇸Fort Lauderdale, Florida, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
🇺🇸Hollywood, Florida, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Miami Cancer Institute
🇺🇸Miami, Florida, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Memorial Hospital West
🇺🇸Pembroke Pines, Florida, United States
Miami Cancer Institute at Plantation
🇺🇸Plantation, Florida, United States
Saint Anthony's Hospital Cancer Care Center
🇺🇸Saint Petersburg, Florida, United States
Saint Joseph's Hospital/Children's Hospital-Tampa
🇺🇸Tampa, Florida, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Cleveland Clinic-Weston
🇺🇸Weston, Florida, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Swedish Covenant Hospital
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Advocate Illinois Masonic Medical Center
🇺🇸Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Northwestern Medicine Cancer Center Kishwaukee
🇺🇸DeKalb, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸Evanston, Illinois, United States
Northwestern Medicine Cancer Center Delnor
🇺🇸Geneva, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸Glenview, Illinois, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
NorthShore University HealthSystem-Highland Park Hospital
🇺🇸Highland Park, Illinois, United States
Northwestern Medicine Lake Forest Hospital
🇺🇸Lake Forest, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸New Lenox, Illinois, United States
University of Chicago Medicine-Orland Park
🇺🇸Orland Park, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸Park Ridge, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
UW Health Carbone Cancer Center Rockford
🇺🇸Rockford, Illinois, United States
Springfield Memorial Hospital
🇺🇸Springfield, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸Warrenville, Illinois, United States
IU Health West Hospital
🇺🇸Avon, Indiana, United States
IU Health North Hospital
🇺🇸Carmel, Indiana, United States
UChicago Medicine Northwest Indiana
🇺🇸Crown Point, Indiana, United States
IU Health Central Indiana Cancer Centers-Fishers
🇺🇸Fishers, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
IU Health Methodist Hospital
🇺🇸Indianapolis, Indiana, United States
Community Cancer Center East
🇺🇸Indianapolis, Indiana, United States
Community Cancer Center South
🇺🇸Indianapolis, Indiana, United States
Community Cancer Center North
🇺🇸Indianapolis, Indiana, United States
IU Health Ball Memorial Hospital
🇺🇸Muncie, Indiana, United States
Saint Luke's Hospital
🇺🇸Cedar Rapids, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Greater Regional Medical Center
🇺🇸Creston, Iowa, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
The University of Kansas Cancer Center - Olathe
🇺🇸Olathe, Kansas, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
University of Kansas Health System Saint Francis Campus
🇺🇸Topeka, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Saint Elizabeth Healthcare Edgewood
🇺🇸Edgewood, Kentucky, United States
Saint Elizabeth Healthcare Fort Thomas
🇺🇸Fort Thomas, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸Lexington, Kentucky, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸Louisville, Kentucky, United States
Owensboro Health Mitchell Memorial Cancer Center
🇺🇸Owensboro, Kentucky, United States
LSU Health Sciences Center at Shreveport
🇺🇸Shreveport, Louisiana, United States
MaineHealth Coastal Cancer Treatment Center
🇺🇸Bath, Maine, United States
Lafayette Family Cancer Center-EMMC
🇺🇸Brewer, Maine, United States
MaineHealth Maine Medical Center - Portland
🇺🇸Portland, Maine, United States
MaineHealth Cancer Care Center of York County
🇺🇸Sanford, Maine, United States
MaineHealth Maine Medical Center- Scarborough
🇺🇸Scarborough, Maine, United States
Luminis Health Anne Arundel Medical Center
🇺🇸Annapolis, Maryland, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Saint Agnes Hospital
🇺🇸Baltimore, Maryland, United States
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
🇺🇸Baltimore, Maryland, United States
MedStar Good Samaritan Hospital
🇺🇸Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸Baltimore, Maryland, United States
Suburban Hospital
🇺🇸Bethesda, Maryland, United States
University of Maryland Shore Medical Center at Easton
🇺🇸Easton, Maryland, United States
UM Baltimore Washington Medical Center/Tate Cancer Center
🇺🇸Glen Burnie, Maryland, United States
UM Saint Joseph Medical Center
🇺🇸Towson, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸Boston, Massachusetts, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Lowell General Hospital
🇺🇸Lowell, Massachusetts, United States
Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
McLaren Cancer Institute-Bay City
🇺🇸Bay City, Michigan, United States
McLaren Cancer Institute-Clarkston
🇺🇸Clarkston, Michigan, United States
Corewell Health Dearborn Hospital
🇺🇸Dearborn, Michigan, United States
Corewell Health Farmington Hills Hospital
🇺🇸Farmington Hills, Michigan, United States
McLaren Cancer Institute-Flint
🇺🇸Flint, Michigan, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
🇺🇸Grand Rapids, Michigan, United States
Trinity Health Grand Rapids Hospital
🇺🇸Grand Rapids, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Karmanos Cancer Institute at McLaren Greater Lansing
🇺🇸Lansing, Michigan, United States
McLaren Cancer Institute-Macomb
🇺🇸Mount Clemens, Michigan, United States
McLaren Cancer Institute-Central Michigan
🇺🇸Mount Pleasant, Michigan, United States
Trinity Health Muskegon Hospital
🇺🇸Muskegon, Michigan, United States
Henry Ford Health Providence Novi Hospital
🇺🇸Novi, Michigan, United States
McLaren Cancer Institute-Northern Michigan
🇺🇸Petoskey, Michigan, United States
McLaren-Port Huron
🇺🇸Port Huron, Michigan, United States
Corewell Health William Beaumont University Hospital
🇺🇸Royal Oak, Michigan, United States
Henry Ford Health Providence Southfield Hospital
🇺🇸Southfield, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Corewell Health Beaumont Troy Hospital
🇺🇸Troy, Michigan, United States
University of Michigan Health - West
🇺🇸Wyoming, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Baptist Memorial Hospital and Cancer Center-Desoto
🇺🇸Southhaven, Mississippi, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
MU Health - University Hospital/Ellis Fischel Cancer Center
🇺🇸Columbia, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸Jefferson City, Missouri, United States
University of Kansas Cancer Center - North
🇺🇸Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Community Medical Center
🇺🇸Toms River, New Jersey, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Radiation Oncology Centers of Nevada Central
🇺🇸Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Southeast
🇺🇸Las Vegas, Nevada, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸Concord, New Hampshire, United States
Wentworth-Douglass Hospital
🇺🇸Dover, New Hampshire, United States
Exeter Hospital
🇺🇸Exeter, New Hampshire, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
🇺🇸Lebanon, New Hampshire, United States
Solinsky Center for Cancer Care
🇺🇸Manchester, New Hampshire, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸Basking Ridge, New Jersey, United States
Englewood Hospital and Medical Center
🇺🇸Englewood, New Jersey, United States
CentraState Medical Center
🇺🇸Freehold, New Jersey, United States
The Cancer Institute of New Jersey Hamilton
🇺🇸Hamilton, New Jersey, United States
Memorial Sloan Kettering Monmouth
🇺🇸Middletown, New Jersey, United States
Memorial Sloan Kettering Bergen
🇺🇸Montvale, New Jersey, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Sidney Kimmel Cancer Center Washington Township
🇺🇸Sewell, New Jersey, United States
Robert Wood Johnson University Hospital Somerset
🇺🇸Somerville, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Lovelace Radiation Oncology
🇺🇸Albuquerque, New Mexico, United States
New Mexico Oncology Hematology Consultants
🇺🇸Albuquerque, New Mexico, United States
Memorial Medical Center-Las Cruces
🇺🇸Las Cruces, New Mexico, United States
Mount Sinai Queens
🇺🇸Astoria, New York, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
New York-Presbyterian/Brooklyn Methodist Hospital
🇺🇸Brooklyn, New York, United States
Maimonides Medical Center
🇺🇸Brooklyn, New York, United States
Sands Cancer Center
🇺🇸Canandaigua, New York, United States
Memorial Sloan Kettering Commack
🇺🇸Commack, New York, United States
Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
Noyes Memorial Hospital/Myers Cancer Center
🇺🇸Dansville, New York, United States
Memorial Sloan Kettering Westchester
🇺🇸Harrison, New York, United States
NYU Langone Hospital - Long Island
🇺🇸Mineola, New York, United States
Mount Sinai Union Square
🇺🇸New York, New York, United States
Mount Sinai Chelsea
🇺🇸New York, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
Mount Sinai West
🇺🇸New York, New York, United States
Mount Sinai Hospital
🇺🇸New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Nyack Hospital
🇺🇸Nyack, New York, United States
Wilmot Cancer Institute Radiation Oncology at Greece
🇺🇸Rochester, New York, United States
Highland Hospital
🇺🇸Rochester, New York, United States
Rochester General Hospital
🇺🇸Rochester, New York, United States
Pluta Cancer Center
🇺🇸Rochester, New York, United States
University of Rochester
🇺🇸Rochester, New York, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Memorial Sloan Kettering Nassau
🇺🇸Uniondale, New York, United States
Wilmot Cancer Institute at Webster
🇺🇸Webster, New York, United States
Mission Hospital
🇺🇸Asheville, North Carolina, United States
Hope Women's Cancer Centers-Asheville
🇺🇸Asheville, North Carolina, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
CaroMont Regional Medical Center
🇺🇸Gastonia, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
UH Seidman Cancer Center at UH Avon Health Center
🇺🇸Avon, Ohio, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
Cleveland Clinic Mercy Hospital
🇺🇸Canton, Ohio, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Geauga Hospital
🇺🇸Chardon, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Dublin Methodist Hospital
🇺🇸Dublin, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸Elyria, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸Grove City, Ohio, United States
OhioHealth Mansfield Hospital
🇺🇸Mansfield, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital
🇺🇸Middleburg Heights, Ohio, United States
University Hospitals Parma Medical Center
🇺🇸Parma, Ohio, United States
Mercy Health - Perrysburg Hospital
🇺🇸Perrysburg, Ohio, United States
University Hospitals Portage Medical Center
🇺🇸Ravenna, Ohio, United States
UH Seidman Cancer Center at Firelands Regional Medical Center
🇺🇸Sandusky, Ohio, United States
ProMedica Flower Hospital
🇺🇸Sylvania, Ohio, United States
University Hospitals Sharon Health Center
🇺🇸Wadsworth, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
UH Seidman Cancer Center at Saint John Medical Center
🇺🇸Westlake, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
Good Samaritan Hospital
🇺🇸Corvallis, Oregon, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Carlisle Regional Cancer Center
🇺🇸Carlisle, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸Chadds Ford, Pennsylvania, United States
Chambersburg Hospital
🇺🇸Chambersburg, Pennsylvania, United States
Ephrata Cancer Center
🇺🇸Ephrata, Pennsylvania, United States
UPMC Hillman Cancer Center Erie
🇺🇸Erie, Pennsylvania, United States
Saint Vincent Hospital
🇺🇸Erie, Pennsylvania, United States
UPMC Cancer Center at UPMC Horizon
🇺🇸Farrell, Pennsylvania, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸Harrisburg, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
IRMC Cancer Center
🇺🇸Indiana, Pennsylvania, United States
Jefferson Hospital
🇺🇸Jefferson Hills, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸Johnstown, Pennsylvania, United States
Lancaster General Ann B Barshinger Cancer Institute
🇺🇸Lancaster, Pennsylvania, United States
Lancaster General Hospital
🇺🇸Lancaster, Pennsylvania, United States
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
🇺🇸Mechanicsburg, Pennsylvania, United States
Riddle Memorial Hospital
🇺🇸Media, Pennsylvania, United States
Forbes Hospital
🇺🇸Monroeville, Pennsylvania, United States
UPMC Cancer Center - Monroeville
🇺🇸Monroeville, Pennsylvania, United States
Bryn Mawr Health Center
🇺🇸Newtown Square, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Jefferson Torresdale Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Allegheny General Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Saint Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
West Penn Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
Penn State Health Saint Joseph Medical Center
🇺🇸Reading, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸Washington, Pennsylvania, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Wexford Health and Wellness Pavilion
🇺🇸Wexford, Pennsylvania, United States
Asplundh Cancer Pavilion
🇺🇸Willow Grove, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
WellSpan Health-York Cancer Center
🇺🇸York, Pennsylvania, United States
UPMC Memorial
🇺🇸York, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Kent Hospital
🇺🇸Warwick, Rhode Island, United States
Saint Joseph's/Candler - Bluffton Campus
🇺🇸Bluffton, South Carolina, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Boiling Springs, South Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
Self Regional Healthcare
🇺🇸Greenwood, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
The Radiation Oncology Center-Hilton Head/Bluffton
🇺🇸Hilton Head Island, South Carolina, United States
Beaufort Memorial/New River Cancer Center
🇺🇸Okatie, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Lexington Medical Center
🇺🇸West Columbia, South Carolina, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸Memphis, Tennessee, United States
Houston Methodist San Jacinto Hospital
🇺🇸Baytown, Texas, United States
MD Anderson in The Woodlands
🇺🇸Conroe, Texas, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
🇺🇸Houston, Texas, United States
Ben Taub General Hospital
🇺🇸Houston, Texas, United States
Houston Methodist Hospital
🇺🇸Houston, Texas, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Methodist Willowbrook Hospital
🇺🇸Houston, Texas, United States
MD Anderson West Houston
🇺🇸Houston, Texas, United States
Houston Methodist West Hospital
🇺🇸Houston, Texas, United States
Doctor's Hospital of Laredo
🇺🇸Laredo, Texas, United States
MD Anderson League City
🇺🇸League City, Texas, United States
Houston Methodist Saint John Hospital
🇺🇸Nassau Bay, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
MD Anderson in Sugar Land
🇺🇸Sugar Land, Texas, United States
Houston Methodist Sugar Land Hospital
🇺🇸Sugar Land, Texas, United States
Houston Methodist The Woodlands Hospital
🇺🇸The Woodlands, Texas, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸American Fork, Utah, United States
Sandra L Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Farmington Health Center
🇺🇸Farmington, Utah, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Riverton Hospital
🇺🇸Riverton, Utah, United States
Saint George Regional Medical Center
🇺🇸Saint George, Utah, United States
University of Utah Sugarhouse Health Center
🇺🇸Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
South Jordan Health Center
🇺🇸South Jordan, Utah, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸Berlin, Vermont, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Dartmouth Cancer Center - North
🇺🇸Saint Johnsbury, Vermont, United States
Augusta Health Center for Cancer and Blood Disorders
🇺🇸Fishersville, Virginia, United States
Naval Medical Center - Portsmouth
🇺🇸Portsmouth, Virginia, United States
CJW Medical Center - Johnston-Willis Campus
🇺🇸Richmond, Virginia, United States
MultiCare Auburn Medical Center
🇺🇸Auburn, Washington, United States
MultiCare Gig Harbor Medical Park
🇺🇸Gig Harbor, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
West Virginia University Healthcare
🇺🇸Morgantown, West Virginia, United States
Langlade Hospital and Cancer Center
🇺🇸Antigo, Wisconsin, United States
ThedaCare Regional Cancer Center
🇺🇸Appleton, Wisconsin, United States
HSHS Sacred Heart Hospital
🇺🇸Eau Claire, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸Eau Claire, Wisconsin, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Bellin Memorial Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - Johnson Creek
🇺🇸Johnson Creek, Wisconsin, United States
Aurora Cancer Care-Kenosha South
🇺🇸Kenosha, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
🇺🇸Madison, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University Hospital
🇺🇸Madison, Wisconsin, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸Marshfield, Wisconsin, United States
Froedtert Menomonee Falls Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Marshfield Medical Center - Minocqua
🇺🇸Minocqua, Wisconsin, United States
ProHealth D N Greenwald Center
🇺🇸Mukwonago, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Drexel Town Square Health Center
🇺🇸Oak Creek, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸Oconomowoc, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Aspirus Cancer Care - James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸Rice Lake, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸Sheboygan, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
Aspirus Cancer Care - Stevens Point
🇺🇸Stevens Point, Wisconsin, United States
Marshfield Medical Center-River Region at Stevens Point
🇺🇸Stevens Point, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Froedtert West Bend Hospital/Kraemer Cancer Center
🇺🇸West Bend, Wisconsin, United States
Diagnostic and Treatment Center
🇺🇸Weston, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸Weston, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸Wisconsin Rapids, Wisconsin, United States
Arthur J E Child Comprehensive Cancer Centre
🇨🇦Calgary, Alberta, Canada
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
BCCA-Abbotsford Cancer Centre
🇨🇦Abbotsford, British Columbia, Canada
BCCA-Cancer Centre for the Southern Interior
🇨🇦Kelowna, British Columbia, Canada
BCCA-Cancer Centre for the North
🇨🇦Prince George, British Columbia, Canada
BCCA-Fraser Valley Cancer Centre
🇨🇦Surrey, British Columbia, Canada
BCCA-Vancouver Cancer Centre
🇨🇦Vancouver, British Columbia, Canada
BCCA-Vancouver Island Cancer Centre
🇨🇦Victoria, British Columbia, Canada
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Atlantic Health Sciences Corporation-Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
Doctor H. Bliss Murphy Cancer Centre
🇨🇦St. John's, Newfoundland and Labrador, Canada
QEII Health Sciences Centre/Nova Scotia Health Authority
🇨🇦Halifax, Nova Scotia, Canada
Royal Victoria Regional Health Centre
🇨🇦Barrie, Ontario, Canada
Juravinski Cancer Centre at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Kingston Health Sciences Centre
🇨🇦Kingston, Ontario, Canada
Grand River Regional Cancer Centre at Grand River Hospital
🇨🇦Kitchener, Ontario, Canada
London Regional Cancer Program
🇨🇦London, Ontario, Canada
Trillium Health Partners - Credit Valley Hospital
🇨🇦Mississauga, Ontario, Canada
Ottawa Hospital and Cancer Center-General Campus
🇨🇦Ottawa, Ontario, Canada
Niagara Health System-Saint Catharines General
🇨🇦Saint Catharines, Ontario, Canada
Algoma District Cancer Program Sault Area Hospital
🇨🇦Sault Ste Marie, Ontario, Canada
CSSS Champlain-Charles Le Moyne
🇨🇦Greenfield Park, Quebec, Canada
Hopital de la Cite-de-la-Sante
🇨🇦Laval, Quebec, Canada
CIUSSSEMTL-Hopital Maisonneuve-Rosemont
🇨🇦Montreal, Quebec, Canada
CHUM - Centre Hospitalier de l'Universite de Montreal
🇨🇦Montreal, Quebec, Canada
The Research Institute of the McGill University Health Centre (MUHC)
🇨🇦Montreal, Quebec, Canada
Jewish General Hospital
🇨🇦Montreal, Quebec, Canada
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
🇨🇦Quebec City, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
🇨🇦Sherbrooke, Quebec, Canada
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada