Cisplatin and Radiation Therapy With or Without Carboplatin and Paclitaxel in Patients With Locally Advanced Cervical Cancer
- Conditions
- Stage IB Cervical Cancer AJCC v6 and v7Cervical Adenosquamous CarcinomaStage IIIB Cervical Cancer AJCC v6 and v7Stage IIA Cervical Cancer AJCC v7Cervical Squamous Cell Carcinoma, Not Otherwise SpecifiedStage IVA Cervical Cancer AJCC v6 and v7Cervical AdenocarcinomaStage IIB Cervical Cancer AJCC v6 and v7
- Interventions
- Radiation: BrachytherapyDrug: CisplatinDrug: CarboplatinRadiation: External Beam Radiation TherapyDrug: PaclitaxelOther: Quality-of-Life Assessment
- Registration Number
- NCT01414608
- Lead Sponsor
- GOG Foundation
- Brief Summary
This randomized phase III trial studies how well giving cisplatin and radiation therapy together with or without carboplatin and paclitaxel works in treating patients with cervical cancer has spread from where it started to nearby tissue or lymph nodes. Drugs used in chemotherapy, such as cisplatin, carboplatin, and paclitaxel, work in different ways to stop the growth of \[cancer/tumor\] cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. External radiation therapy uses high-energy x rays to kill tumor cells. Internal radiation uses radioactive material placed directly into or near a tumor to kill tumor cells. It is not yet known whether giving cisplatin and external and internal radiation therapy together with carboplatin and paclitaxel kills more tumor cells.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine if the addition of adjuvant chemotherapy to standard cisplatin-based chemoradiation improves overall survival.
SECONDARY OBJECTIVES:
I. To determine the progression-free survival rates. II. To determine acute and long-term toxicities. III. To determine patterns of disease recurrence. IV. To determine the association between radiation protocol compliance and outcomes.
V. To determine patient quality of life, including psycho-sexual health.
TERTIARY OBJECTIVES:
I. To determine the association between the results of a follow-up positron emission tomography (PET) scan performed 4-6 months post completion of chemoradiation and outcomes for all patients in the trial.
II. To determine the biological predictors of patients' outcomes based on translational laboratory studies of blood and tissue specimens.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive cisplatin intravenously (IV) over 60-90 minutes on days 1, 8, 15, 22, and 29. Patients also undergo external-beam radiation therapy once daily, 5 days a week, for approximately 5 weeks. Patients then undergo high-dose rate, pulsed-dose rate, or low-dose rate intracavitary brachytherapy.
ARM II: Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Patients may undergo baseline tumor biopsy and blood collection for future correlative studies.
Patients complete the European Organization for Research and Treatment of Cancer (EORTC) Core questionnaire (QLQ-C30), the EORTC cervix cancer module (CX24), the ovarian cancer module (OV28), and the Sexual function-Vaginal Changes Questionnaire (SVQ) questionnaires at baseline, during, and after completion of study treatment.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 926
-
Eligible patients will have locally advanced cervical cancer suitable for primary treatment with chemoradiation with curative intent, in addition to:
- Federation of Gynecology and Obstetrics (FIGO) 2008 stage IB1 & node positive, IB2, IIA, IIB, IIIB, or IVA disease
-
Eastern Cooperative Oncology Group (ECOG) performance status 0-2
-
Histological diagnosis of squamous cell carcinoma, adenocarcinoma or adenosquamous cell carcinoma of the cervix
-
White blood cells (WBC) >= 3.0 x 10^9/L
-
Absolute neutrophil count (ANC) >= 1.5 x 10^9/L
-
Platelet count >= 100 x 10^9/L
-
Bilirubin =< 1.5 times upper limit of normal (ULN)
-
Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 x ULN (if both tests are done, both results need to be =< 2.5 x ULN)
-
Creatinine =< ULN (Common Toxicity Criteria [CTC] grade 0) OR calculated creatinine clearance (Cockcroft-Gault formula) >= 60 mL/min OR >= 50 mL/min by ethylenediaminetetraacetic acid (EDTA) creatinine clearance
-
Written informed consent
- Any previous pelvic radiotherapy
- Para-aortic nodal involvement above the level of the common iliac nodes or L3/L4 (if biopsy proven, PET positive, or >= 15 mm short-axis diameter on computed tomography [CT])
- FIGO 2008 stage IIIA disease
- Patients assessed at presentation as requiring interstitial brachytherapy treatment
- Patients with bilateral hydronephrosis unless at least one side has been stented and renal function fulfills the required inclusion criteria
- Previous chemotherapy for this tumor
- Evidence of distant metastases
- Prior diagnosis of Crohn's disease or ulcerative colitis
- Peripheral neuropathy >= grade 2 (per Common Terminology Criteria for Adverse Events [CTCAE] version [v]4)
- Patients who have undergone a previous hysterectomy or will have a hysterectomy as part of their initial cervical cancer therapy; this includes patients with a prior history of supracervical hysterectomy
- Patients with other invasive malignancies, with the exception of non-melanoma skin cancer and in situ melanoma, who had (or have) any evidence of the other cancer present within the last 5 years
- Patients who are pregnant or lactating
- Any contraindication to the use of cisplatin, carboplatin, or paclitaxel chemotherapy
- Serious illness or medical condition that precludes the safe administration of the trial treatment including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Patients who are known to be human immunodeficiency virus (HIV) positive
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm II (cisplatin, radiation therapy, brachytherapy, chemo) Quality-of-Life Assessment Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Arm I (cisplatin, radiation therapy, brachytherapy) Quality-of-Life Assessment Patients receive cisplatin IV over 60-90 minutes on days 1, 8, 15, 22, and 29. Patients also undergo external-beam radiation therapy once daily, 5 days a week, for approximately 5 weeks. Patients then undergo high-dose rate, pulsed-dose rate, or low-dose rate intracavitary brachytherapy. Arm I (cisplatin, radiation therapy, brachytherapy) Brachytherapy Patients receive cisplatin IV over 60-90 minutes on days 1, 8, 15, 22, and 29. Patients also undergo external-beam radiation therapy once daily, 5 days a week, for approximately 5 weeks. Patients then undergo high-dose rate, pulsed-dose rate, or low-dose rate intracavitary brachytherapy. Arm II (cisplatin, radiation therapy, brachytherapy, chemo) External Beam Radiation Therapy Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Arm I (cisplatin, radiation therapy, brachytherapy) External Beam Radiation Therapy Patients receive cisplatin IV over 60-90 minutes on days 1, 8, 15, 22, and 29. Patients also undergo external-beam radiation therapy once daily, 5 days a week, for approximately 5 weeks. Patients then undergo high-dose rate, pulsed-dose rate, or low-dose rate intracavitary brachytherapy. Arm II (cisplatin, radiation therapy, brachytherapy, chemo) Brachytherapy Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Arm I (cisplatin, radiation therapy, brachytherapy) Cisplatin Patients receive cisplatin IV over 60-90 minutes on days 1, 8, 15, 22, and 29. Patients also undergo external-beam radiation therapy once daily, 5 days a week, for approximately 5 weeks. Patients then undergo high-dose rate, pulsed-dose rate, or low-dose rate intracavitary brachytherapy. Arm II (cisplatin, radiation therapy, brachytherapy, chemo) Cisplatin Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Arm II (cisplatin, radiation therapy, brachytherapy, chemo) Paclitaxel Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Arm II (cisplatin, radiation therapy, brachytherapy, chemo) Carboplatin Patients receive cisplatin and undergo external-beam radiation and brachytherapy as in arm I. Beginning 4 weeks later, patients also receive adjuvant chemotherapy comprising paclitaxel IV over 3 hours and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Overall Survival Rate at 5 Years 5 years from study randomization Estimate for probability of overall survival at 5 years by Kaplan-Meier method, where overall survival is defined as the time from randomization to time of death due to any cause or the date of last contact, whichever occurs first.
- Secondary Outcome Measures
Name Time Method Number of Participants With Adverse Events (Grade 3 or Higher) in First Year 1 year after randomization Number of participants with a maximum grade of 3 or higher for pre-specified adverse events that occurred during the first year after randomization. Adverse events are graded and categorized using CTCAE v4.0.
Progression-free Survival Rate at 5 Years 5 years from study randomization Estimate for probability of progression free at 5 years by Kaplan-Meier method, where progression-free survival is defined as the time from randomization to the time of disease progression, death from any cause or date of last contact, whichever occurs first. Disease progression is defined by increasing clinical, radiological or pathological evidence of disease from participant entry to when investigator deems a progression. RECIST V1.0 was not used to determine response on this study.
Radiation Protocol Compliance Average duration of 7 weeks Radiation protocol compliance measured by external beam dose delivered
Quality of Life for Global Health Status Baseline and 12 months Quality of Life measured by change of global health status score from baseline to 12 months follow-up. A cancer-specific questionnaire with 30 items which summarize as five functioning scales, a global health status/quality of life scale, three symptom scales and six single items assessing additional symptoms and perceived financial impact. The minimum global health status score was 0 and the maximum global health status score was 100. A higher global health status score means better outcome.
Patterns of Disease Recurrence through study completion an average of 60 months Number of patients for the site of disease recurrence. Disease was considered as persistent if participant had evidence of disease at study entry and disease did not progress during study. Disease status was considered locoregional alone if a participant had disease progression in the pelvis region including vagina after study entry. Disease status was considered distant if a participant had disease progression outside the pelvis (for example the abdomen and lung) after study entry. Criteria used to determine the no progression group includes participants that expired without documentation of progression.
Trial Locations
- Locations (325)
Grady Health System
🇺🇸Atlanta, Georgia, United States
John H Stroger Jr Hospital of Cook County
🇺🇸Chicago, Illinois, United States
UPMC-Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
John Muir Medical Center-Concord Campus
🇺🇸Concord, California, United States
Sutter Davis Hospital
🇺🇸Davis, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸Roseville, California, United States
Kaiser Permanente-Fremont
🇺🇸Fremont, California, United States
Palo Alto Medical Foundation-Camino Division
🇺🇸Mountain View, California, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸Cameron Park, California, United States
Mills-Peninsula Medical Center
🇺🇸Burlingame, California, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸Glenview, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸Evanston, Illinois, United States
Memorial Sloan Kettering Sleepy Hollow
🇺🇸Sleepy Hollow, New York, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
Woman's Hospital
🇺🇸Baton Rouge, Louisiana, United States
Maine Medical Center-Bramhall Campus
🇺🇸Portland, Maine, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Northwell Health/Center for Advanced Medicine
🇺🇸Lake Success, New York, United States
Atrium Health Cabarrus/LCI-Concord
🇺🇸Concord, North Carolina, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸Burlington, North Carolina, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Juravinski Cancer Centre at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Zhongshan Hospital Fudan University
🇨🇳Guangdong Province, Shanghai, China
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
California Pacific Medical Center-Pacific Campus
🇺🇸San Francisco, California, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
University of South Alabama Mitchell Cancer Institute
🇺🇸Mobile, Alabama, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Arizona Oncology Associates-West Orange Grove
🇺🇸Tucson, Arizona, United States
Arizona Oncology Associates-Wilmot
🇺🇸Tucson, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Sutter Auburn Faith Hospital
🇺🇸Auburn, California, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸Auburn, California, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸Mountain View, California, United States
Kaiser Permanente-Oakland
🇺🇸Oakland, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
Palo Alto Medical Foundation Health Care
🇺🇸Palo Alto, California, United States
Kaiser Permanente-Roseville
🇺🇸Roseville, California, United States
Sutter Roseville Medical Center
🇺🇸Roseville, California, United States
Kaiser Permanente-San Francisco
🇺🇸San Francisco, California, United States
Kaiser Permanente-San Rafael
🇺🇸San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Palo Alto Medical Foundation-Santa Cruz
🇺🇸Santa Cruz, California, United States
Sutter Pacific Medical Foundation
🇺🇸Santa Rosa, California, United States
Kaiser Permanente-South San Francisco
🇺🇸South San Francisco, California, United States
Olive View-University of California Los Angeles Medical Center
🇺🇸Sylmar, California, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville
🇺🇸Vacaville, California, United States
Kaiser Permanente-Vallejo
🇺🇸Vallejo, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸Vallejo, California, United States
John Muir Medical Center-Walnut Creek
🇺🇸Walnut Creek, California, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
🇺🇸Deerfield Beach, Florida, United States
Jackson Memorial Hospital-Holtz Children's Hospital
🇺🇸Miami, Florida, United States
Sarasota Memorial Hospital
🇺🇸Sarasota, Florida, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Emory University Hospital Midtown
🇺🇸Atlanta, Georgia, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸Gainesville, Georgia, United States
Central Georgia Gynecologic Oncology
🇺🇸Macon, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Saint Luke's Cancer Institute - Boise
🇺🇸Boise, Idaho, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
West Penn Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Memorial Hermann Texas Medical Center
🇺🇸Houston, Texas, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
West Texas Cancer Center
🇺🇸Odessa, Texas, United States
Houston Methodist Sugar Land Hospital
🇺🇸Sugar Land, Texas, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Rocky Mountain Cancer Centers-Greenwood Village
🇺🇸Greenwood Village, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸Englewood, Colorado, United States
Southwest Oncology PC
🇺🇸Durango, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸Colorado Springs, Colorado, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸Lakewood, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Rocky Mountain Cancer Centers - Pueblo
🇺🇸Pueblo, Colorado, United States
University of Minnesota/Masonic Cancer Center
🇺🇸Minneapolis, Minnesota, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Rocky Mountain Cancer Centers-Parker
🇺🇸Parker, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸Thornton, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸Longmont, Colorado, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
Gynecologic Oncology Group of Arizona
🇺🇸Phoenix, Arizona, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Arizona Oncology Associates-Biltmore Cancer Center
🇺🇸Phoenix, Arizona, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Western States Cancer Research NCORP
🇺🇸Denver, Colorado, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
University of Connecticut
🇺🇸Farmington, Connecticut, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
UMass Memorial Medical Center - Memorial Division
🇺🇸Worcester, Massachusetts, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
CHUM - Centre Hospitalier de l'Universite de Montreal
🇨🇦Montreal, Quebec, Canada
The Research Institute of the McGill University Health Centre (MUHC)
🇨🇦Montreal, Quebec, Canada
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
MGC Hematology Oncology-Union
🇺🇸Union, South Carolina, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸Basking Ridge, New Jersey, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
MD Anderson Cancer Center at Cooper-Voorhees
🇺🇸Voorhees, New Jersey, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
London Regional Cancer Program
🇨🇦London, Ontario, Canada
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Dixie Medical Center Regional Cancer Center
🇺🇸Saint George, Utah, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Jersey Shore Medical Center
🇺🇸Neptune, New Jersey, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
National University Hospital Singapore
🇸🇬Singapore, Singapore
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Black Hills Obstetrics and Gynecology
🇺🇸Rapid City, South Dakota, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Wentworth-Douglass Hospital
🇺🇸Dover, New Hampshire, United States
Gibbs Cancer Center-Gaffney
🇺🇸Gaffney, South Carolina, United States
CHUM - Hopital Notre-Dame
🇨🇦Montreal, Quebec, Canada
McGill University Department of Oncology
🇨🇦Montreal, Quebec, Canada
University Health Network-Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
NYU Winthrop Hospital
🇺🇸Mineola, New York, United States
King Faisal Specialist Hospital and Research Centre
🇸🇦Riyadh, Saudi Arabia
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
Northwestern Medicine Cancer Center Delnor
🇺🇸Geneva, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
NorthShore University HealthSystem-Highland Park Hospital
🇺🇸Highland Park, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸Warrenville, Illinois, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
The Community Hospital
🇺🇸Munster, Indiana, United States
Memorial Medical Center - Las Cruces
🇺🇸Las Cruces, New Mexico, United States
Women's Cancer Care Associates LLC
🇺🇸Albany, New York, United States
New York Hospital Medical Center of Queens
🇺🇸Fresh Meadows, New York, United States
Memorial Sloan Kettering Commack
🇺🇸Commack, New York, United States
Memorial Sloan Kettering Westchester
🇺🇸Harrison, New York, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
New York-Presbyterian/Brooklyn Methodist Hospital
🇺🇸Brooklyn, New York, United States
Queens Hospital Center
🇺🇸Jamaica, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
Lenox Hill Hospital
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
North Shore University Hospital
🇺🇸Manhasset, New York, United States
Memorial Sloan Kettering Nassau
🇺🇸Uniondale, New York, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
New Hanover Regional Medical Center/Zimmer Cancer Center
🇺🇸Wilmington, North Carolina, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
University of Cincinnati/Barrett Cancer Center
🇺🇸Cincinnati, Ohio, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Wright-Patterson Medical Center
🇺🇸Wright-Patterson Air Force Base, Ohio, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Drexel University School of Medicine
🇺🇸Philadelphia, Pennsylvania, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Texas Oncology at Baylor Charles A Sammons Cancer Center
🇺🇸Dallas, Texas, United States
Lyndon Baines Johnson General Hospital
🇺🇸Houston, Texas, United States
Texas Oncology Bedford
🇺🇸Bedford, Texas, United States
Texas Oncology - Fort Worth Cancer Center
🇺🇸Fort Worth, Texas, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
Carilion Clinic Gynecological Oncology
🇺🇸Roanoke, Virginia, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
MultiCare Auburn Medical Center
🇺🇸Auburn, Washington, United States
MultiCare Gig Harbor Medical Park
🇺🇸Gig Harbor, Washington, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Houston Methodist Hospital
🇺🇸Houston, Texas, United States
Mercy Cancer Center - Sacramento
🇺🇸Sacramento, California, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Southeast Clinical Oncology Research Consortium NCORP
🇺🇸Winston-Salem, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Long Island Jewish Medical Center
🇺🇸New Hyde Park, New York, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Norton Hospital Pavilion and Medical Campus
🇺🇸Louisville, Kentucky, United States
Norton Brownsboro Hospital and Medical Campus
🇺🇸Louisville, Kentucky, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Louisiana State University Health Science Center
🇺🇸New Orleans, Louisiana, United States
Tulane University Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸New Orleans, Louisiana, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Texas Oncology-Austin Midtown
🇺🇸Austin, Texas, United States
Texas Oncology - Central Austin Cancer Center
🇺🇸Austin, Texas, United States
Texas Oncology - South Austin Cancer Center
🇺🇸Austin, Texas, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Lovelace Radiation Oncology
🇺🇸Albuquerque, New Mexico, United States
Highland Hospital
🇺🇸Rochester, New York, United States
University of Rochester
🇺🇸Rochester, New York, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Palo Alto Medical Foundation-Sunnyvale
🇺🇸Sunnyvale, California, United States