Hormone Therapy and Radiation Therapy or Hormone Therapy and Radiation Therapy Followed by Docetaxel and Prednisone in Treating Patients With Localized Prostate Cancer
- Conditions
- Prostate Cancer
- Interventions
- Drug: Oral antiandrogenRadiation: Radiation therapyDrug: LHRH agonist
- Registration Number
- NCT00288080
- Lead Sponsor
- Radiation Therapy Oncology Group
- Brief Summary
RATIONALE: Androgens can cause the growth of prostate cancer cells. Hormone therapy using drugs, such as leuprolide, goserelin, flutamide, or bicalutamide, may fight prostate cancer by lowering the amount of androgens the body makes. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as docetaxel and prednisone, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether giving hormone therapy and radiation therapy together with chemotherapy is more effective than giving hormone therapy together with radiation therapy in treating prostate cancer.
PURPOSE: This randomized phase III trial is studying hormone therapy and radiation therapy followed by docetaxel and prednisone to see how well it works compared to hormone therapy and radiation therapy in treating patients with localized prostate cancer.
- Detailed Description
OBJECTIVES:
Primary
* Compare the relative efficacy, in terms of overall survival, of the combination of androgen suppression and radiotherapy versus androgen suppression and radiotherapy followed by docetaxel and prednisone in patients with localized, high-risk prostate cancer.
Secondary
* Compare the disease-free survival and incidence of adverse events in patients treated with these regimens.
* Compare the biochemical control, local control, and freedom from distant metastases in patients treated with these regimens.
* Determine the validity of prostate-specific antigen (PSA)-defined endpoints as a surrogate for overall survival of patients treated with these regimens.
* Compare the time interval between biochemical failure and distant metastases with respect to testosterone level in patients treated with these regimens.
OUTLINE: This is an open-label, randomized, multicenter study. Patients are stratified according to risk group.
* Arm I: Patients receive androgen suppression therapy comprising luteinizing hormone-releasing hormone (LHRH) agonist (e.g., leuprolide acetate, goserelin, buserelin, or triptorelin) and oral antiandrogen (i.e., oral flutamide 3 times daily for 2 months or oral bicalutamide once daily for 2 months). Beginning at week 8, patients undergo radiotherapy 5 days a week for approximately 8 weeks. Antiandrogen therapy is discontinued at completion of radiotherapy, but LHRH agonist therapy continues for 20 months.
* Arm II: Patients receive androgen suppression therapy and undergo radiotherapy as in arm I. Beginning 4 weeks after completion of radiotherapy, patients receive docetaxel IV over 1 hour on day 1 and oral prednisone daily on days 1-21. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients continue LHRH agonist therapy as in arm I.
After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 600 patients will be accrued for this study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 612
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Androgen suppression + Radiation Therapy LHRH agonist Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of radiation therapy (RT). Androgen suppression + Radiation Therapy + Chemotherapy LHRH agonist Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression. Androgen suppression + Radiation Therapy Oral antiandrogen Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of radiation therapy (RT). Androgen suppression + Radiation Therapy Radiation therapy Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of radiation therapy (RT). Androgen suppression + Radiation Therapy + Chemotherapy Oral antiandrogen Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression. Androgen suppression + Radiation Therapy + Chemotherapy Radiation therapy Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression. Androgen suppression + Radiation Therapy + Chemotherapy Dexamethasone Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression. Androgen suppression + Radiation Therapy + Chemotherapy Prednisone Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression. Androgen suppression + Radiation Therapy + Chemotherapy docetaxel Androgen suppression (AS; LHRH agonist and oral antiandrogen) for 8 weeks followed by radiation therapy and concurrent AS. LHRH continues for 24 months after initiation of any treatment, oral antiandrogen discontinues at the end of RT. Following completion of RT, 6 cycles of docetaxel (premedicated with dexamethasone) and prednisone are delivered concurrently with androgen suppression.
- Primary Outcome Measures
Name Time Method Overall Survival From randomization to date of death or last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. Four-year rates are shown. Survival time is defined as time from randomization to date of death from any cause and is estimated by the Kaplan-Meier method. Patients last known to be alive are censored at the date of last contact.
- Secondary Outcome Measures
Name Time Method Validity of PSA Endpoint as a Surrogate for Overall Survival From randomization to last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. Prentice's operational criteria for determining whether determining whether biochemical failure (surrogate endpoint) is a suitable endpoint for overall survival (true endpoint):
1. Treatment is prognostic for true endpoint
2. Treatment is prognostic for surrogate endpoint
3. Surrogate is prognostic for true endpoint
4. The full effect of the treatment on the true endpoint is explained by the surrogate.
If any of the criteria are not met, it is concluded that biochemical failure is not a suitable surrogate for overall survival. Therefore, if any of the criteria are met, the other criteria do not do not need to be evaluated.Incidence of Adverse Events From start of treatment until the end of follow-up Adverse events are graded using CTCAE v3.0. The worst grade of all adverse events for each patient is counted.
Disease-free Survival From randomization to date of progression, death, or last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. A failure for disease-free survival is the first of the following: biochemical failure, local failure, distant metastases, or death due to any cause. The corresponding outcome time was measured from the date of randomization. Disease-free survival rates at 4 years were calculated using the Kaplan-Meier method.
The Time Interval Between Biochemical Failure and Distant Failure Respect to Testosterone Level From date of biochemical failure to development of distant metastasis. Maximum follow-up was 12.9 years. Biochemical failure is defined as the first of either prostate-specific antigen (PSA) failure or the initiation of salvage hormone therapy. PSA failure is defined as a rise in PSA of 2 ng/ml over the nadir PSA. Distant failure is defined as the first occurrence of distant metastasis.
Distant Metastasis From randomization to date of distant metastasis, death, or last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. Distant failure was considered when there was evidence of metastatic disease. Patients who experienced death without distant failure, local failure prior to distant failure, and biochemical failure prior to distant failure were censored on the date of the competing event. The corresponding outcome time was measured from the date of randomization. Distant failure rates at 4 year were calculated using the Kaplan-Meier method.
Biochemical Control From randomization to date of biochemical failure, death, or last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. Four-year rates are shown (Kaplan-Meier estimates). Biochemical control is defined as freedom from biochemical failure. Biochemical failure was considered as the first of either prostate-specific antigen (PSA) failure or initiation of salvage hormone therapy. PSA failure was defined as a rise of 2 ng/ml over the nadir PSA. Patients who experienced death without biochemical failure, local failure prior to biochemical failure, or development of distant metastases prior to biochemical failure were censored on the date of the competing event. The corresponding outcome time was measured from the date of randomization.
Local Control From randomization to date of local failure, death, or last follow-up. Analysis occurs after all patients have been potentially followed for 4 years. Local control is defined as the absence of local failure which is the first of either progression or recurrence within the prostate. Progression of the tumor was considered to have occurred when there was a 25% or greater increase in the product of the two largest perpendicular diameters of the prostate. Recurrence was defined as the reappearance of disease after a complete response. Patients who experienced death without local failure, biochemical failure prior to local failure, and development of distant metastases prior to local failure were censored on the date of the competing event. The corresponding outcome time was measured from the date of randomization. Due to an insufficient number of events (2 in each arm), this endpoint was not statistically compared. Local control rates at 4 years were calculated using the Kaplan-Meier method.
Trial Locations
- Locations (254)
DeCesaris Cancer Institute at Anne Arundel Medical Center
🇺🇸Annapolis, Maryland, United States
St. Agnes Hospital Cancer Center
🇺🇸Baltimore, Maryland, United States
Cleveland Clinic Cancer Center at Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Torrance Memorial Medical Center
🇺🇸Torrance, California, United States
John Muir/Mt. Diablo Comprehensive Cancer Center
🇺🇸Walnut Creek, California, United States
Memorial Medical Center
🇺🇸Modesto, California, United States
Auburn Radiation Oncology
🇺🇸Auburn, California, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Sierra Nevada Cancer Center at Sierra Nevada Memorial Hospital
🇺🇸Grass Valley, California, United States
Providence Saint Joseph Medical Center - Burbank
🇺🇸Burbank, California, United States
Northwest Community Hospital
🇺🇸Arlington Heights, Illinois, United States
Mercy Cancer Center at Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
Radiation Oncology Center - Roseville
🇺🇸Roseville, California, United States
William W. Backus Hospital
🇺🇸Norwich, Connecticut, United States
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center
🇺🇸Boise, Idaho, United States
Regional Cancer Center at Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Washington Township Hospital
🇺🇸Fremont, California, United States
Decatur Memorial Hospital Cancer Care Institute
🇺🇸Decatur, Illinois, United States
Winship Cancer Institute of Emory University
🇺🇸Atlanta, Georgia, United States
CCOP - Christiana Care Health Services
🇺🇸Newark, Delaware, United States
Poudre Valley Radiation Oncology
🇺🇸Fort Collins, Colorado, United States
Lucy Curci Cancer Center at Eisenhower Memorial Hospital and Medical Center
🇺🇸Rancho Mirage, California, United States
Eastern Connecticut Hematology and Oncology Associates
🇺🇸Norwich, Connecticut, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
McFarland Clinic, PC
🇺🇸Ames, Iowa, United States
David C. Pratt Cancer Center at St. John's Mercy
🇺🇸Saint Louis, Missouri, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Radiation Oncology Associates Southwest
🇺🇸Fort Wayne, Indiana, United States
John B. Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Parkview Regional Cancer Center at Parkview Health
🇺🇸Fort Wayne, Indiana, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸Fridley, Minnesota, United States
Maine Center for Cancer Medicine and Blood Disorders - Scarborough
🇺🇸Scarborough, Maine, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Breslin Cancer Center at Ingham Regional Medical Center
🇺🇸Lansing, Michigan, United States
Hudner Oncology Center at Saint Anne's Hospital - Fall River
🇺🇸Fall River, Massachusetts, United States
William Beaumont Hospital - Royal Oak Campus
🇺🇸Royal Oak, Michigan, United States
Holden Comprehensive Cancer Center at University of Iowa
🇺🇸Iowa City, Iowa, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
South Suburban Oncology Center
🇺🇸Quincy, Massachusetts, United States
Great Falls Clinic - Main Facility
🇺🇸Great Falls, Montana, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
James P. Wilmot Cancer Center at University of Rochester Medical Center
🇺🇸Rochester, New York, United States
Charles F. Kettering Memorial Hospital
🇺🇸Kettering, Ohio, United States
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
🇺🇸Saint Louis, Missouri, United States
Cancer Treatment Center
🇺🇸Wooster, Ohio, United States
Cancer Institute of New Jersey at Cooper - Voorhees
🇺🇸Voorhees, New Jersey, United States
UPMC Cancer Center - Natrona Heights
🇺🇸Natrona Heights, Pennsylvania, United States
CCOP - Main Line Health
🇺🇸Wynnewood, Pennsylvania, United States
Presbyterian Cancer Center at Presbyterian Hospital
🇺🇸Charlotte, North Carolina, United States
Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
New York Oncology Hematology, PC at Albany Regional Cancer Care
🇺🇸Albany, New York, United States
SUNY Upstate Medical University Hospital
🇺🇸Syracuse, New York, United States
Elliot Regional Cancer Center at Elliot Hospital
🇺🇸Manchester, New Hampshire, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
Kingsbury Center for Cancer Care at Cheshire Medical Center
🇺🇸Keene, New Hampshire, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
Leo W. Jenkins Cancer Center at ECU Medical School
🇺🇸Greenville, North Carolina, United States
Dartmouth - Hitchcock Concord
🇺🇸Concord, New Hampshire, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸Tulsa, Oklahoma, United States
Blumenthal Cancer Center at Carolinas Medical Center
🇺🇸Charlotte, North Carolina, United States
CentraState Medical Center
🇺🇸Freehold, New Jersey, United States
Samaritan North Cancer Care Center
🇺🇸Dayton, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Barberton Citizens Hospital
🇺🇸Barberton, Ohio, United States
Rosenfeld Cancer Center at Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
UPMC - Shadyside
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center at UPMC St. Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center at UPMC Passavant
🇺🇸Pittsburgh, Pennsylvania, United States
Cancer Institute of New Mexico
🇺🇸Santa Fe, New Mexico, United States
Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Guthrie Cancer Center at Guthrie Clinic Sayre
🇺🇸Sayre, Pennsylvania, United States
West Virginia University Health Sciences Center - Charleston
🇺🇸Charleston, West Virginia, United States
Cancer Center at Clarion Hospital
🇺🇸Clarion, Pennsylvania, United States
Hillcrest Cancer Center at Hillcrest Hospital
🇺🇸Mayfield Heights, Ohio, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
UPMC Cancer Center at Beaver Medical Center
🇺🇸Beaver, Pennsylvania, United States
Delaware County Regional Cancer Center at Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
Cancer Care Center, Incorporated
🇺🇸Salem, Ohio, United States
Mercy Fitzgerald Hospital
🇺🇸Darby, Pennsylvania, United States
Cleveland Clinic Cancer Center
🇺🇸Independence, Ohio, United States
CCOP - Greenville
🇺🇸Greenville, South Carolina, United States
Willamette Valley Cancer Center - Eugene
🇺🇸Eugene, Oregon, United States
Celilo Cancer Center at Mid-Columbia Medical Center
🇺🇸The Dalles, Oregon, United States
Texas Oncology, PA at Harris Center HEB
🇺🇸Bedford, Texas, United States
Jameson Memorial Hospital - North Campus
🇺🇸New Castle, Pennsylvania, United States
Klabzuba Cancer Center at Harris Methodist Fort Worth Hospital
🇺🇸Fort Worth, Texas, United States
Fox Chase Cancer Center - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
UPMC Cancer Center at Jefferson Regional Medical Center
🇺🇸Clairton, Pennsylvania, United States
CCOP - Upstate Carolina
🇺🇸Spartanburg, South Carolina, United States
Medical University of Ohio Cancer Center
🇺🇸Toledo, Ohio, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Salem Hospital Regional Cancer Care Services
🇺🇸Salem, Oregon, United States
Flower Hospital Cancer Center
🇺🇸Sylvania, Ohio, United States
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
UPMC Cancer Center - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
Cancer Center of Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸Seneca, Pennsylvania, United States
Texas Oncology, PA at Texas Oncology Cancer Center Sugar Land
🇺🇸Sugar Land, Texas, United States
Northwest Ohio Oncology Center
🇺🇸Maumee, Ohio, United States
Texas Oncology, PA at Texas Cancer Center Dallas Southwest
🇺🇸Dallas, Texas, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸Green Bay, Wisconsin, United States
UPMC Cancer Center - Uniontown
🇺🇸Uniontown, Pennsylvania, United States
Community Memorial Hospital Cancer Care Center
🇺🇸Menomonee Falls, Wisconsin, United States
York Cancer Center at Apple Hill Medical Center
🇺🇸York, Pennsylvania, United States
Naval Medical Center - Portsmouth
🇺🇸Portsmouth, Virginia, United States
CCOP - Northwest
🇺🇸Tacoma, Washington, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
St. Joseph Regional Cancer Center
🇺🇸Bryan, Texas, United States
Texas Oncology, PA at Texas Cancer Center - Sherman
🇺🇸Sherman, Texas, United States
Madigan Army Medical Center - Tacoma
🇺🇸Tacoma, Washington, United States
Gundersen Lutheran Center for Cancer and Blood
🇺🇸La Crosse, Wisconsin, United States
Columbia Saint Mary's Hospital - Ozaukee
🇺🇸Mequon, Wisconsin, United States
Allan Blair Cancer Centre at Pasqua Hospital
🇨🇦Regina, Saskatchewan, Canada
Cross Cancer Institute at University of Alberta
🇨🇦Edmonton, Alberta, Canada
Ottawa Hospital Regional Cancer Centre - General Campus
🇨🇦Ottawa, Ontario, Canada
Margaret and Charles Juravinski Cancer Centre
🇨🇦Hamilton, Ontario, Canada
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
University of Wisconcin Cancer Center at Aspirus Wausau Hospital
🇺🇸Wausau, Wisconsin, United States
McGill Cancer Centre at McGill University
🇨🇦Montreal, Quebec, Canada
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
Veterans Affairs Medical Center - Indianapolis
🇺🇸Indianapolis, Indiana, United States
Central Indiana Cancer Centers - East
🇺🇸Indianapolis, Indiana, United States
CCOP - Nevada Cancer Research Foundation
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Institute
🇺🇸Las Vegas, Nevada, United States
Charles M. Barrett Cancer Center at University Hospital
🇺🇸Cincinnati, Ohio, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Duke Comprehensive Cancer Center
🇺🇸Durham, North Carolina, United States
Providence Cancer Center
🇺🇸Anchorage, Alaska, United States
Arizona Oncology - Tucson
🇺🇸Tucson, Arizona, United States
Radiation Oncology Centers - Cameron Park
🇺🇸Cameron Park, California, United States
Enloe Cancer Center at Enloe Medical Center
🇺🇸Chico, California, United States
Cancer Care Center at John Muir Health - Concord Campus
🇺🇸Concord, California, United States
Rebecca and John Moores UCSD Cancer Center
🇺🇸La Jolla, California, United States
CCOP - Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Solano Radiation Oncology Center
🇺🇸Vacaville, California, United States
Bay Medical
🇺🇸Panama City, Florida, United States
Georgia Cancer Center for Excellence at Grady Memorial Hospital
🇺🇸Atlanta, Georgia, United States
Northeast Georgia Medical Center
🇺🇸Gainesville, Georgia, United States
Elmhurst Memorial Hospital
🇺🇸Elmhurst, Illinois, United States
Advocate Lutheran General Cancer Care Center
🇺🇸Park Ridge, Illinois, United States
Cancer Institute at St. John's Hospital
🇺🇸Springfield, Illinois, United States
Center for Cancer Care at OSF Saint Anthony Medical Center
🇺🇸Rockford, Illinois, United States
Saint John's Cancer Center at Saint John's Medical Center
🇺🇸Anderson, Indiana, United States
Tulane Cancer Center Office of Clinical Research
🇺🇸Alexandria, Louisiana, United States
Shields Radiation Oncology Center - Mansfield
🇺🇸Mansfield, Massachusetts, United States
NSMC Cancer Center - Peabody
🇺🇸Peabody, Massachusetts, United States
St. Luke's Hospital Cancer Care Center
🇺🇸Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, 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 - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
Cancer Institute of Cape Girardeau, LLC
🇺🇸Cape Girardeau, Missouri, United States
Regional Cancer Center at Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
St. John's Regional Medical Center
🇺🇸Joplin, Missouri, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸Springfield, Missouri, United States
Seacoast Cancer Center at Wentworth - Douglass Hospital
🇺🇸Dover, New Hampshire, United States
Center for Cancer Care at Exeter Hospital
🇺🇸Exeter, New Hampshire, United States
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Lovelace Medical Center - Downtown
🇺🇸Albuquerque, New Mexico, United States
Cancer Institute of New Jersey at Cooper University Hospital - Camden
🇺🇸Camden, New Jersey, United States
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
🇺🇸New Brunswick, New Jersey, United States
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton
🇺🇸Marlton, New Jersey, United States
Radiation Oncology Associates, PA
🇺🇸Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Veterans Affairs Medical Center - Syracuse
🇺🇸Syracuse, New York, United States
CaroMont Cancer Center at Gaston Memorial Hospital
🇺🇸Gastonia, North Carolina, United States
High Point Regional Hospital
🇺🇸High Point, North Carolina, United States
New Hanover Radiation Oncology, PA
🇺🇸Wilmington, North Carolina, United States
Summa Center for Cancer Care at Akron City Hospital
🇺🇸Akron, Ohio, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸Cleveland, Ohio, United States
Good Samaritan Hospital
🇺🇸Dayton, Ohio, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
David L. Rike Cancer Center at Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Veterans Affairs Medical Center - Dayton
🇺🇸Dayton, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
St. Charles Mercy Hospital
🇺🇸Oregon, Ohio, United States
Cleveland Clinic - Wooster
🇺🇸Wooster, Ohio, United States
Penn State Cancer Institute at Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸McKeesport, Pennsylvania, United States
UPMC Cancer Center at the John P. Murtha Pavilion
🇺🇸Johnstown, Pennsylvania, United States
UPMC - Moon
🇺🇸Moon, Pennsylvania, United States
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
UPMC Cancer Center at Magee-Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center - Upper St. Clair
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Cancer Center at UPMC Presbyterian
🇺🇸Pittsburgh, Pennsylvania, United States
Washington Hospital Cancer Center
🇺🇸Washington, Pennsylvania, United States
Lankenau Cancer Center at Lankenau Hospital
🇺🇸Wynnewood, Pennsylvania, United States
M. D. Anderson Cancer Center at University of Texas
🇺🇸Houston, Texas, United States
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center
🇺🇸Murray, Utah, United States
Fletcher Allen Health Care - University Health Center Campus
🇺🇸Burlington, Vermont, United States
Providence Cancer Center at Sacred Heart Medical Center
🇺🇸Spokane, Washington, United States
Theda Care Cancer Institute
🇺🇸Appleton, Wisconsin, United States
Tom Baker Cancer Centre - Calgary
🇨🇦Calgary, Alberta, Canada
Centre Hospitalier Universitaire de Quebec
🇨🇦Quebec City, Quebec, Canada
Hopital Notre-Dame du CHUM
🇨🇦Montreal, Quebec, Canada
California Pacific Medical Center - California Campus
🇺🇸San Francisco, California, United States
Huntsman Cancer Institute at University of Utah
🇺🇸Salt Lake City, Utah, United States
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center
🇺🇸Kansas City, Kansas, United States
Kansas City Cancer Centers - Southwest
🇺🇸Overland Park, Kansas, United States
Bridgeport Hospital
🇺🇸Bridgeport, Connecticut, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
St. Vincent's Medical Center
🇺🇸Bridgeport, Connecticut, United States
Sletten Cancer Institute at Benefis Healthcare
🇺🇸Great Falls, Montana, United States
UAB Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
Arizona Oncology Services Foundation
🇺🇸Phoenix, Arizona, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Josephine Ford Cancer Center at Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Oklahoma University Cancer Institute
🇺🇸Oklahoma City, Oklahoma, United States
Knight Cancer Institute at Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Community Cancer Center at Rutland Regional Medical Center
🇺🇸Rutland, Vermont, United States
St. John's Regional Health Center
🇺🇸Springfield, Missouri, United States
Rocky Mountain Cancer Centers - Aurora
🇺🇸Aurora, Colorado, United States
University of Colorado Cancer Center at UC Health Sciences Center
🇺🇸Aurora, Colorado, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸Omaha, Nebraska, United States
Suburban Hospital
🇺🇸Bethesda, Maryland, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Methodist Estabrook Cancer Center
🇺🇸Omaha, Nebraska, United States
Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Alegant Health Cancer Center at Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center
🇺🇸Grand Junction, Colorado, United States
Columbia-Saint Mary's Cancer Care Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
Veterans Affairs Medical Center - Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
CCOP - Ochsner
🇺🇸New Orleans, Louisiana, United States
Wake Forest University Comprehensive Cancer Center
🇺🇸Winston-Salem, North Carolina, United States
Radiological Associates of Sacramento Medical Group, Incorporated
🇺🇸Sacramento, California, United States
University of California Davis Cancer Center
🇺🇸Sacramento, California, United States
Mercy General Hospital
🇺🇸Sacramento, California, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Forsyth Regional Cancer Center at Forsyth Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Yale Cancer Center
🇺🇸New Haven, Connecticut, United States
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
Hospital of Saint Raphael
🇺🇸New Haven, Connecticut, United States
University of Florida Shands Cancer Center
🇺🇸Gainesville, Florida, United States
Norton Suburban Hospital
🇺🇸Louisville, Kentucky, United States
Kansas City Cancer Centers - South
🇺🇸Kansas City, Missouri, 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
Veterans Affairs Medical Center - Richmond
🇺🇸Richmond, Virginia, United States
Virginia Commonwealth University Massey Cancer Center
🇺🇸Richmond, Virginia, United States
London Regional Cancer Program at London Health Sciences Centre
🇨🇦London, Ontario, Canada
CCOP - Toledo Community Hospital
🇺🇸Toledo, Ohio, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Vince Lombardi Cancer Clinic - Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center
🇺🇸Reading, Pennsylvania, United States
Dixie Regional Medical Center - East Campus
🇺🇸Saint George, Utah, United States
Northeast Radiation Oncology Center
🇺🇸Dunmore, Pennsylvania, United States
Grand View Hospital
🇺🇸Sellersville, Pennsylvania, United States