MedPath

Pilocarpine in Preventing Mucositis and Dry Mouth in Patients Receiving Radiation Therapy for Head and Neck Cancer

Phase 3
Completed
Conditions
Oral Complications
Head and Neck Cancer
Interventions
Registration Number
NCT00003139
Lead Sponsor
Radiation Therapy Oncology Group
Brief Summary

RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs such as pilocarpine may protect normal cells from the side effects of radiation therapy. It is not yet known if pilocarpine may be effective in preventing mucositis and dry mouth in patients receiving radiation therapy for head and neck cancer.

PURPOSE: Randomized, double-blinded, phase III trial to study the effectiveness of pilocarpine in preventing mucositis and dry mouth in patients receiving radiation therapy for head and neck cancer.

Detailed Description

OBJECTIVES: I. Determine whether prophylactic use of pilocarpine can shelter unstimulated and stimulated whole salivary flow in patients with head and neck cancer. II. Determine whether prophylactic use of pilocarpine can moderate xerostomia in these patients. III. Determine whether prophylactic use of pilocarpine can reduce the grade and duration of radiation induced mucositis in these patients. IV. Evaluate quality of life outcomes between patients receiving pilocarpine versus placebo. V. Evaluate the impact of xerostomia on patients receiving irradiation to the head and neck.

OUTLINE: This is a randomized, double blind study. Patients receive a central axis midplane dose of radiotherapy five days per week over 6 to 7 weeks. Oral pilocarpine or placebo is administered beginning 3 days prior to radiotherapy, one tablet four times per day for three months. A tablet will be taken 45-60 minutes before radiotherapy. After three months, and after a 3-4 day rest period, all patients receive non blinded pilocarpine for an additional three month period. Patients are followed at weeks 4, 13, and 26 after the start of radiotherapy.

PROJECTED ACCRUAL: A total of 244 patients will be accrued (122 per treatment arm).

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
249
Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type
INTERVENTIONAL
Study Design
CROSSOVER
Arm && Interventions
GroupInterventionDescription
PlaceboPlaceboPlacebo tablets commencing 3 days prior to irradiation
Pilocarpine hydrocloridepilocarpine hydrochloride5mg pilocarpine hydrochloride tablets commencing 3 days prior to irradiation
Primary Outcome Measures
NameTimeMethod
Acute salivary gland toxicityFrom the start of treatment to 13 weeks
Secondary Outcome Measures
NameTimeMethod
Acute mucositis in the pharynx, palate, tongue, or buccalFrom the start of treatment to 13 weeks
Quality of life as measured by the University of Washington Head and Neck Symptom questionnairePretreatment to 26 weeks from the start of treatment
Effects of continuing pilocarpine out to 6 months from the start of treatmentFrom the start of treatment to 26 weeks

Trial Locations

Locations (232)

Anne Arundel Oncology Center

πŸ‡ΊπŸ‡Έ

Annapolis, Maryland, United States

Marlene & Stewart Greenebaum Cancer Center, University of Maryland

πŸ‡ΊπŸ‡Έ

Baltimore, Maryland, United States

Greater Baltimore Medical Center and Cancer Center

πŸ‡ΊπŸ‡Έ

Baltimore, Maryland, United States

Johns Hopkins Oncology Center

πŸ‡ΊπŸ‡Έ

Baltimore, Maryland, United States

Kimmel Cancer Center of Thomas Jefferson University - Philadelphia

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Saint John Regional Hospital

πŸ‡¨πŸ‡¦

Saint John, New Brunswick, Canada

Northwestern Memorial Hospital

πŸ‡ΊπŸ‡Έ

Chicago, Illinois, United States

University of Pittsburgh Cancer Institute

πŸ‡ΊπŸ‡Έ

Pittsburgh, Pennsylvania, United States

Western Pennsylvania Hospital

πŸ‡ΊπŸ‡Έ

Pittsburgh, Pennsylvania, United States

MBCCOP - University of South Alabama

πŸ‡ΊπŸ‡Έ

Mobile, Alabama, United States

Veterans Affairs Medical Center - Long Beach

πŸ‡ΊπŸ‡Έ

Long Beach, California, United States

Sutter Health Western Division Cancer Research Group

πŸ‡ΊπŸ‡Έ

Greenbrae, California, United States

USC/Norris Comprehensive Cancer Center

πŸ‡ΊπŸ‡Έ

Los Angeles, California, United States

Santa Cruz Radiation Oncology Medical Group, Inc.

πŸ‡ΊπŸ‡Έ

Santa Cruz, California, United States

David Grant Medical Center

πŸ‡ΊπŸ‡Έ

Travis Air Force Base, California, United States

Radiation Oncology Center - Walnut Creek

πŸ‡ΊπŸ‡Έ

Walnut Creek, California, United States

Health First Holmes Regional Medical Center

πŸ‡ΊπŸ‡Έ

Melbourne, Florida, United States

Baptist Hospital of Miami

πŸ‡ΊπŸ‡Έ

Miami, Florida, United States

Florida Radiation Oncology Group

πŸ‡ΊπŸ‡Έ

Orange Park, Florida, United States

Bayfront Medical Center

πŸ‡ΊπŸ‡Έ

Saint Petersburg, Florida, United States

Gulf Coast Cancer Treatment Center

πŸ‡ΊπŸ‡Έ

Panama City, Florida, United States

Ingalls Memorial Hospital

πŸ‡ΊπŸ‡Έ

Harvey, Illinois, United States

University of Chicago Cancer Research Center

πŸ‡ΊπŸ‡Έ

Chicago, Illinois, United States

Methodist Medical Center of Illinois

πŸ‡ΊπŸ‡Έ

Peoria, Illinois, United States

CCOP - Carle Cancer Center

πŸ‡ΊπŸ‡Έ

Urbana, Illinois, United States

Joint Center for Radiation Therapy

πŸ‡ΊπŸ‡Έ

Boston, Massachusetts, United States

Radiation Oncology Affiliates of Maryland, P.A.

πŸ‡ΊπŸ‡Έ

Baltimore, Maryland, United States

MBCCOP - LSU Medical Center

πŸ‡ΊπŸ‡Έ

New Orleans, Louisiana, United States

CCOP - Kansas City

πŸ‡ΊπŸ‡Έ

Kansas City, Missouri, United States

CCOP - Metro-Minnesota

πŸ‡ΊπŸ‡Έ

Saint Louis Park, Minnesota, United States

Marquette General Hospital

πŸ‡ΊπŸ‡Έ

Marquette, Michigan, United States

CCOP - Kalamazoo

πŸ‡ΊπŸ‡Έ

Kalamazoo, Michigan, United States

State University of New York Health Science Center at Brooklyn

πŸ‡ΊπŸ‡Έ

Brooklyn, New York, United States

Community Medical Center

πŸ‡ΊπŸ‡Έ

Toms River, New Jersey, United States

Kaplan Cancer Center

πŸ‡ΊπŸ‡Έ

New York, New York, United States

Vassar Brothers Hospital

πŸ‡ΊπŸ‡Έ

Poughkeepsie, New York, United States

Lineberger Comprehensive Cancer Center, UNC

πŸ‡ΊπŸ‡Έ

Chapel Hill, North Carolina, United States

Akron General Medical Center

πŸ‡ΊπŸ‡Έ

Akron, Ohio, United States

CCOP - Dayton

πŸ‡ΊπŸ‡Έ

Kettering, Ohio, United States

St. John Medical Center

πŸ‡ΊπŸ‡Έ

Tulsa, Oklahoma, United States

Mercy Catholic Medical Center, Mercy Fitzgerald Divison

πŸ‡ΊπŸ‡Έ

Darby, Pennsylvania, United States

CCOP - MainLine Health

πŸ‡ΊπŸ‡Έ

Wynnewood, Pennsylvania, United States

Grand View Hospital

πŸ‡ΊπŸ‡Έ

Sellersville, Pennsylvania, United States

Wilkes Barre General Hospital

πŸ‡ΊπŸ‡Έ

Wilkes-Barre, Pennsylvania, United States

Julie and Ben Rogers Cancer Institute

πŸ‡ΊπŸ‡Έ

Beaumont, Texas, United States

University of Texas Medical Branch

πŸ‡ΊπŸ‡Έ

Galveston, Texas, United States

University of Texas - MD Anderson Cancer Center

πŸ‡ΊπŸ‡Έ

Houston, Texas, United States

Bayshore Medical Center

πŸ‡ΊπŸ‡Έ

Pasadena, Texas, United States

Cancer Center, University of Virginia HSC

πŸ‡ΊπŸ‡Έ

Charlottesville, Virginia, United States

Southern Wisconsin Radiotherapy Center

πŸ‡ΊπŸ‡Έ

Madison, Wisconsin, United States

University of Wisconsin Comprehensive Cancer Center

πŸ‡ΊπŸ‡Έ

Madison, Wisconsin, United States

Ottawa Regional Cancer Centre - Civic Campus

πŸ‡¨πŸ‡¦

Ottawa, Ontario, Canada

Tom Baker Cancer Center - Calgary

πŸ‡¨πŸ‡¦

Calgary, Alberta, Canada

Northwestern Ontario Regional Cancer Centre, Thunder Bay

πŸ‡¨πŸ‡¦

Thunder Bay, Ontario, Canada

Kingston Regional Cancer Centre

πŸ‡¨πŸ‡¦

Kingston, Ontario, Canada

UNI-MED Medical Center

πŸ‡ΊπŸ‡Έ

Minot, North Dakota, United States

UCSF Cancer Center and Cancer Research Institute

πŸ‡ΊπŸ‡Έ

San Francisco, California, United States

LDS Hospital

πŸ‡ΊπŸ‡Έ

Salt Lake City, Utah, United States

Mary Bird Perkins Cancer Center

πŸ‡ΊπŸ‡Έ

Baton Rouge, Louisiana, United States

Centre Hospitalier de l'Universite de Montreal

πŸ‡¨πŸ‡¦

Montreal, Quebec, Canada

CCOP - Ochsner

πŸ‡ΊπŸ‡Έ

New Orleans, Louisiana, United States

University of Tennessee, Memphis Cancer Center

πŸ‡ΊπŸ‡Έ

Memphis, Tennessee, United States

Romagosa Radiation Oncology Center

πŸ‡ΊπŸ‡Έ

Lafayette, Louisiana, United States

Maine Medical Center

πŸ‡ΊπŸ‡Έ

Portland, Maine, United States

CCOP - Baptist Cancer Institute

πŸ‡ΊπŸ‡Έ

Memphis, Tennessee, United States

St. Francis Medical Center

πŸ‡ΊπŸ‡Έ

Trenton, New Jersey, United States

Baptist Regional Cancer Center - Knoxville

πŸ‡ΊπŸ‡Έ

Knoxville, Tennessee, United States

CCOP - Upstate Carolina

πŸ‡ΊπŸ‡Έ

Spartanburg, South Carolina, United States

Elliot Regional Cancer Center

πŸ‡ΊπŸ‡Έ

Manchester, New Hampshire, United States

Veterans Affairs Medical Center - White River Junction

πŸ‡ΊπŸ‡Έ

White River Junction, Vermont, United States

British Columbia Cancer Agency - Vancouver Island Cancer Centre

πŸ‡¨πŸ‡¦

Victoria, British Columbia, Canada

Fox Chase Cancer Center at Virtua-Memorial Hospital Burlington County

πŸ‡ΊπŸ‡Έ

Mount Holly, New Jersey, United States

Schiffler Oncology Center

πŸ‡ΊπŸ‡Έ

Wheeling, West Virginia, United States

Veterans Affairs Medical Center - Birmingham

πŸ‡ΊπŸ‡Έ

Birmingham, Alabama, United States

University of Alabama Comprehensive Cancer Center

πŸ‡ΊπŸ‡Έ

Birmingham, Alabama, United States

Barbara Ann Karmanos Cancer Institute

πŸ‡ΊπŸ‡Έ

Detroit, Michigan, United States

CCOP - Columbia River Program

πŸ‡ΊπŸ‡Έ

Portland, Oregon, United States

Green Mountain Oncology Group

πŸ‡ΊπŸ‡Έ

Rutland, Vermont, United States

Bridgeport Hospital

πŸ‡ΊπŸ‡Έ

Bridgeport, Connecticut, United States

University of Florida Health Science Center

πŸ‡ΊπŸ‡Έ

Gainesville, Florida, United States

Kaiser Permanente Medical Center - Los Angeles

πŸ‡ΊπŸ‡Έ

Los Angeles, California, United States

Veterans Affairs Outpatient Clinic - Martinez

πŸ‡ΊπŸ‡Έ

Martinez, California, United States

CCOP - Mount Sinai Medical Center

πŸ‡ΊπŸ‡Έ

Miami Beach, Florida, United States

Mercy Medical Center - Redding

πŸ‡ΊπŸ‡Έ

Redding, California, United States

Arizona Cancer Center

πŸ‡ΊπŸ‡Έ

Tucson, Arizona, United States

Huntsville Hospital System

πŸ‡ΊπŸ‡Έ

Huntsville, Alabama, United States

California Cancer Center

πŸ‡ΊπŸ‡Έ

Fresno, California, United States

Urology Associates - Mobile AL

πŸ‡ΊπŸ‡Έ

Mobile, Alabama, United States

Providence Cancer Therapy Center

πŸ‡ΊπŸ‡Έ

Anchorage, Alaska, United States

Jonsson Comprehensive Cancer Center, UCLA

πŸ‡ΊπŸ‡Έ

Los Angeles, California, United States

Mount Diablo Medical Center

πŸ‡ΊπŸ‡Έ

Concord, California, United States

Providence Saint Joseph Medical Center - Burbank

πŸ‡ΊπŸ‡Έ

Burbank, California, United States

Glendale Memorial Hospital and Health Center

πŸ‡ΊπŸ‡Έ

Glendale, California, United States

Alabama Oncology, LLC

πŸ‡ΊπŸ‡Έ

Montgomery, Alabama, United States

Radiation Oncology Associates of West Alabama

πŸ‡ΊπŸ‡Έ

Tuscallosa, Alabama, United States

Beckman Research Institute, City of Hope

πŸ‡ΊπŸ‡Έ

Duarte, California, United States

CCOP - Bay Area Tumor Institute

πŸ‡ΊπŸ‡Έ

Oakland, California, United States

Loma Linda University Medical Center

πŸ‡ΊπŸ‡Έ

Loma Linda, California, United States

University of Colorado Cancer Center

πŸ‡ΊπŸ‡Έ

Denver, Colorado, United States

Walter Reed Army Medical Center

πŸ‡ΊπŸ‡Έ

Washington, District of Columbia, United States

Memorial Hospital Cancer Center

πŸ‡ΊπŸ‡Έ

Colorado Springs, Colorado, United States

Whittingham Cancer Center

πŸ‡ΊπŸ‡Έ

Norwalk, Connecticut, United States

CCOP - Atlanta Regional

πŸ‡ΊπŸ‡Έ

Atlanta, Georgia, United States

Sylvester Cancer Center, University of Miami

πŸ‡ΊπŸ‡Έ

Miami, Florida, United States

CCOP - Christiana Care Health Services

πŸ‡ΊπŸ‡Έ

Wilmington, Delaware, United States

St. John's Medical Center

πŸ‡ΊπŸ‡Έ

Anderson, Indiana, United States

Lykes Center for Radiation Therapy

πŸ‡ΊπŸ‡Έ

Clearwater, Florida, United States

Emory University Hospital - Atlanta

πŸ‡ΊπŸ‡Έ

Atlanta, Georgia, United States

MD Anderson Cancer Center Orlando

πŸ‡ΊπŸ‡Έ

Orlando, Florida, United States

CCOP - Central Illinois

πŸ‡ΊπŸ‡Έ

Springfield, Illinois, United States

West Florida Cancer Institute - Pensacola

πŸ‡ΊπŸ‡Έ

Pensacola, Florida, United States

South Georgia Medical Center

πŸ‡ΊπŸ‡Έ

Valdosta, Georgia, United States

Clarion Health Partners Inc.

πŸ‡ΊπŸ‡Έ

Indianapolis, Indiana, United States

Lutheran General Cancer Care Center

πŸ‡ΊπŸ‡Έ

Park Ridge, Illinois, United States

Ball Memorial Hospital

πŸ‡ΊπŸ‡Έ

Muncie, Indiana, United States

Wendt Regional Cancer Center of Finley Hospital

πŸ‡ΊπŸ‡Έ

Dubuque, Iowa, United States

Merle M. Mahr Cancer Center

πŸ‡ΊπŸ‡Έ

Madisonville, Kentucky, United States

University of Iowa Hospitals and Clinics

πŸ‡ΊπŸ‡Έ

Iowa City, Iowa, United States

East Jefferson General Hospital

πŸ‡ΊπŸ‡Έ

Metairie, Louisiana, United States

Veterans Affairs Medical Center - Lexington

πŸ‡ΊπŸ‡Έ

Lexington, Kentucky, United States

Harbor Hospital Center

πŸ‡ΊπŸ‡Έ

Baltimore, Maryland, United States

Western Baptist Hospital

πŸ‡ΊπŸ‡Έ

Paducah, Kentucky, United States

Henry Ford Hospital

πŸ‡ΊπŸ‡Έ

Detroit, Michigan, United States

Cape Cod Hospital

πŸ‡ΊπŸ‡Έ

Hyannis, Massachusetts, United States

CCOP - Montana Cancer Consortium

πŸ‡ΊπŸ‡Έ

Billings, Montana, United States

CCOP - North Shore University Hospital

πŸ‡ΊπŸ‡Έ

Manhasset, New York, United States

Elizabeth General Medical Center - West

πŸ‡ΊπŸ‡Έ

Elizabeth, New Jersey, United States

Norris Cotton Cancer Center

πŸ‡ΊπŸ‡Έ

Lebanon, New Hampshire, United States

CCOP - Southern Nevada Cancer Research Foundation

πŸ‡ΊπŸ‡Έ

Las Vegas, Nevada, United States

Ellis Fischel Cancer Center - Columbia

πŸ‡ΊπŸ‡Έ

Columbia, Missouri, United States

Ireland Cancer Center

πŸ‡ΊπŸ‡Έ

Cleveland, Ohio, United States

Albert Einstein Comprehensive Cancer Center

πŸ‡ΊπŸ‡Έ

Bronx, New York, United States

South Jersey Hospital - Millville

πŸ‡ΊπŸ‡Έ

Millville, New Jersey, United States

New York Medical College

πŸ‡ΊπŸ‡Έ

Valhalla, New York, United States

East Carolina University School of Medicine

πŸ‡ΊπŸ‡Έ

Greenville, North Carolina, United States

Allegheny University Hospitals- Hahnemann

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Saint Joseph Medical Center

πŸ‡ΊπŸ‡Έ

Albuquerque, New Mexico, United States

Christ Hospital

πŸ‡ΊπŸ‡Έ

Cincinnati, Ohio, United States

Memorial Sloan-Kettering Cancer Center

πŸ‡ΊπŸ‡Έ

New York, New York, United States

Veterans Affairs Medical Center - Albany

πŸ‡ΊπŸ‡Έ

Albany, New York, United States

Meritcare Roger Maris Cancer Center

πŸ‡ΊπŸ‡Έ

Fargo, North Dakota, United States

Cancer Center of Albany Medical Center

πŸ‡ΊπŸ‡Έ

Albany, New York, United States

CCOP - Columbus

πŸ‡ΊπŸ‡Έ

Columbus, Ohio, United States

Veterans Affairs Medical Center - Dayton

πŸ‡ΊπŸ‡Έ

Dayton, Ohio, United States

Champlain Valley Physicians Hospital Medical Center

πŸ‡ΊπŸ‡Έ

Plattsburgh, New York, United States

Arthur G. James Cancer Hospital - Ohio State University

πŸ‡ΊπŸ‡Έ

Columbus, Ohio, United States

Samaritan Regional Cancer Center

πŸ‡ΊπŸ‡Έ

Corvallis, Oregon, United States

Akron City Hospital

πŸ‡ΊπŸ‡Έ

Akron, Ohio, United States

CCOP - Toledo Community Hospital Oncology Program

πŸ‡ΊπŸ‡Έ

Toledo, Ohio, United States

Albert Einstein Cancer Center

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Cross Cancer Institute

πŸ‡¨πŸ‡¦

Edmonton, Alberta, Canada

Deaconess Medical Center

πŸ‡ΊπŸ‡Έ

Spokane, Washington, United States

Northeastern Ontario Regional Cancer Centre, Sudbury

πŸ‡¨πŸ‡¦

Sudbury, Ontario, Canada

Medical University of South Carolina

πŸ‡ΊπŸ‡Έ

Charleston, South Carolina, United States

Naval Medical Center, Portsmouth

πŸ‡ΊπŸ‡Έ

Portsmouth, Virginia, United States

Virginia Mason Medical Center

πŸ‡ΊπŸ‡Έ

Seattle, Washington, United States

Vanderbilt Cancer Center

πŸ‡ΊπŸ‡Έ

Nashville, Tennessee, United States

Mercy Hospital Cancer Center - Scranton

πŸ‡ΊπŸ‡Έ

Scranton, Pennsylvania, United States

CCOP - Southwestern Vermont Regional Cancer Center

πŸ‡ΊπŸ‡Έ

Bennington, Vermont, United States

Jackson-Madison County General Hospital

πŸ‡ΊπŸ‡Έ

Jackson, Tennessee, United States

York Hospital

πŸ‡ΊπŸ‡Έ

York, Pennsylvania, United States

Massey Cancer Center

πŸ‡ΊπŸ‡Έ

Richmond, Virginia, United States

CCOP - Greenville

πŸ‡ΊπŸ‡Έ

Greenville, South Carolina, United States

Martha Jefferson Hospital

πŸ‡ΊπŸ‡Έ

Charlottesville, Virginia, United States

Cancer Care Ontario-London Regional Cancer Centre

πŸ‡¨πŸ‡¦

London, Ontario, Canada

Cancer Care Ontario-Hamilton Regional Cancer Centre

πŸ‡¨πŸ‡¦

Hamilton, Ontario, Canada

St. Vincent Hospital

πŸ‡ΊπŸ‡Έ

Green Bay, Wisconsin, United States

Princess Margaret Hospital

πŸ‡¨πŸ‡¦

Toronto, Ontario, Canada

Community Memorial Hospital

πŸ‡ΊπŸ‡Έ

Menomonee Falls, Wisconsin, United States

Nova Scotia Cancer Centre

πŸ‡¨πŸ‡¦

Halifax, Nova Scotia, Canada

Doctor Leon Richard Oncology Centre

πŸ‡¨πŸ‡¦

Moncton, New Brunswick, Canada

McGill University Department of Oncology

πŸ‡¨πŸ‡¦

Montreal, Quebec, Canada

Saskatoon Cancer Centre

πŸ‡¨πŸ‡¦

Saskatoon, Saskatchewan, Canada

Mayo Clinic Cancer Center

πŸ‡ΊπŸ‡Έ

Rochester, Minnesota, United States

Methodist Cancer Center - Omaha

πŸ‡ΊπŸ‡Έ

Omaha, Nebraska, United States

CCOP - Missouri Valley Cancer Consortium

πŸ‡ΊπŸ‡Έ

Omaha, Nebraska, United States

St. Joseph's Hospital

πŸ‡ΊπŸ‡Έ

Milwaukee, Wisconsin, United States

Veterans Affairs Medical Center - Milwaukee (Zablocki)

πŸ‡ΊπŸ‡Έ

Milwaukee, Wisconsin, United States

Mallinckrodt Institute of Radiology

πŸ‡ΊπŸ‡Έ

Saint Louis, Missouri, United States

Cancer Research for the Ozarks

πŸ‡ΊπŸ‡Έ

Springfield, Missouri, United States

CCOP - Ozarks Regional

πŸ‡ΊπŸ‡Έ

Springfield, Missouri, United States

Dixie Regional Medical Center

πŸ‡ΊπŸ‡Έ

Saint George, Utah, United States

New York Methodist Hospital

πŸ‡ΊπŸ‡Έ

Brooklyn, New York, United States

Genesee Hospital - Rochester

πŸ‡ΊπŸ‡Έ

Rochester, New York, United States

St. Mary's Medical Center

πŸ‡ΊπŸ‡Έ

Saginaw, Michigan, United States

Hurley Medical Center

πŸ‡ΊπŸ‡Έ

Flint, Michigan, United States

CCOP - Southeast Cancer Control Consortium

πŸ‡ΊπŸ‡Έ

Winston-Salem, North Carolina, United States

Comprehensive Cancer Center of Wake Forest University Baptist Medical Center

πŸ‡ΊπŸ‡Έ

Winston-Salem, North Carolina, United States

H. Lee Moffitt Cancer Center and Research Institute

πŸ‡ΊπŸ‡Έ

Tampa, Florida, United States

Radiation Oncology Center - Sacramento

πŸ‡ΊπŸ‡Έ

Sacramento, California, United States

Radiation Therapy Associates - Fort Myers

πŸ‡ΊπŸ‡Έ

Fort Myers, Florida, United States

Veterans Affairs Medical Center - Ann Arbor

πŸ‡ΊπŸ‡Έ

Ann Arbor, Michigan, United States

CCOP - Ann Arbor Regional

πŸ‡ΊπŸ‡Έ

Ann Arbor, Michigan, United States

University of Michigan Comprehensive Cancer Center

πŸ‡ΊπŸ‡Έ

Ann Arbor, Michigan, United States

Saint Agnes Cancer Center

πŸ‡ΊπŸ‡Έ

Fresno, California, United States

Stanford University

πŸ‡ΊπŸ‡Έ

Stanford, California, United States

Cancer Care Center

πŸ‡ΊπŸ‡Έ

Pomona, California, United States

InterCommunity Cancer Center at Rome

πŸ‡ΊπŸ‡Έ

Rome, Georgia, United States

St. Joseph's Radiation Oncology Center

πŸ‡ΊπŸ‡Έ

South Bend, Indiana, United States

Community Hospitals of Indianapolis - Regional Cancer Center

πŸ‡ΊπŸ‡Έ

Indianapolis, Indiana, United States

Memorial Hospital of South Bend

πŸ‡ΊπŸ‡Έ

South Bend, Indiana, United States

Albert B. Chandler Medical Center, University of Kentucky

πŸ‡ΊπŸ‡Έ

Lexington, Kentucky, United States

James Graham Brown Cancer Center

πŸ‡ΊπŸ‡Έ

Louisville, Kentucky, United States

Medical Center at Bowling Green

πŸ‡ΊπŸ‡Έ

Bowling Green, Kentucky, United States

Massachusetts General Hospital Cancer Center

πŸ‡ΊπŸ‡Έ

Boston, Massachusetts, United States

Penn State Geisinger Medical Center

πŸ‡ΊπŸ‡Έ

Danville, Pennsylvania, United States

University of Pennsylvania Cancer Center

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Fox Chase Cancer Center

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Penn State Geisinger Cancer Center

πŸ‡ΊπŸ‡Έ

Hershey, Pennsylvania, United States

Reading Hospital and Medical Center

πŸ‡ΊπŸ‡Έ

Reading, Pennsylvania, United States

Wilford Hall - 59th Medical Wing

πŸ‡ΊπŸ‡Έ

Lackland Air Force Base, Texas, United States

Virginia Baptist Hospital

πŸ‡ΊπŸ‡Έ

Lynchburg, Virginia, United States

Veterans Affairs Medical Center - Madison

πŸ‡ΊπŸ‡Έ

Madison, Wisconsin, United States

Marshfield Clinic

πŸ‡ΊπŸ‡Έ

Marshfield, Wisconsin, United States

Swedish Hospital Tumor Institute

πŸ‡ΊπŸ‡Έ

Seattle, Washington, United States

Yakima Valley Memorial Hospital

πŸ‡ΊπŸ‡Έ

Yakima, Washington, United States

Columbia Hospital

πŸ‡ΊπŸ‡Έ

Milwaukee, Wisconsin, United States

St. Luke's Medical Center

πŸ‡ΊπŸ‡Έ

Milwaukee, Wisconsin, United States

Medical College of Wisconsin

πŸ‡ΊπŸ‡Έ

Milwaukee, Wisconsin, United States

Southeastern Wisconsin Regional Cancer Center

πŸ‡ΊπŸ‡Έ

Racine, Wisconsin, United States

CCOP - Santa Rosa Memorial Hospital

πŸ‡ΊπŸ‡Έ

Santa Rosa, California, United States

Veterans Affairs Medical Center - Saint Louis

πŸ‡ΊπŸ‡Έ

Saint Louis, Missouri, United States

Louisville Radiation Oncology

πŸ‡ΊπŸ‡Έ

Louisville, Kentucky, United States

Loyola University Medical Center

πŸ‡ΊπŸ‡Έ

Maywood, Illinois, United States

Delaware County Memorial Hospital

πŸ‡ΊπŸ‡Έ

Drexel Hill, Pennsylvania, United States

St. Louis University Health Sciences Center

πŸ‡ΊπŸ‡Έ

Saint Louis, Missouri, United States

Veterans Affairs Medical Center - Philadelphia

πŸ‡ΊπŸ‡Έ

Philadelphia, Pennsylvania, United States

Gundersen Lutheran Medical Foundation

πŸ‡ΊπŸ‡Έ

La Crosse, Wisconsin, United States

University of Rochester Cancer Center

πŸ‡ΊπŸ‡Έ

Rochester, New York, United States

Halifax Medical Center

πŸ‡ΊπŸ‡Έ

Daytona Beach, Florida, United States

Veterans Affairs Medical Center - East Orange

πŸ‡ΊπŸ‡Έ

East Orange, New Jersey, United States

John F. Kennedy Medical Center

πŸ‡ΊπŸ‡Έ

Edison, New Jersey, United States

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