Surgery in Treating Children With Neuroblastoma
- Conditions
- Neuroblastoma
- Interventions
- Procedure: conventional surgeryBiological: filgrastimRadiation: radiation therapyBiological: sargramostimDrug: carboplatinDrug: cyclophosphamideDrug: doxorubicin hydrochlorideDrug: etoposideProcedure: adjuvant therapy
- Registration Number
- NCT00003119
- Lead Sponsor
- Children's Oncology Group
- Brief Summary
RATIONALE: Surgery alone may be effective in treating children with neuroblastoma.
PURPOSE: Phase III trial to study the effectiveness of surgery alone in treating children who have neuroblastoma.
- Detailed Description
OBJECTIVES:
* To determine if asymptomatic patients with low-risk neuroblastoma treated with surgery alone will have a 3-year survival rate of 95%.
* Estimate the response and 3-year event-free survival rates of symptomatic patients treated with chemotherapy.
* Estimate the event-free survival and overall survival rates in patients who relapse or progress after initial treatment with surgery alone.
* Determine the acute and chronic toxic effects associated with treating low-risk neuroblastoma with surgery alone or surgery and chemotherapy.
OUTLINE: This is a multicenter study. Patients are stratified according to disease stage, MYCN status, age, and histology.
Patients undergo primary tumor resection and biopsy of regional nodes. Patients with at least 50% of the tumor resected are followed monthly for 3 months, every 3 months for 9 months, every 6 months for one year, and then annually thereafter.
Regimen I
* Patients with clinically symptomatic (e.g., respiratory distress, spinal cord compromise with or without neurologic deficit, inferior vena cava compression with renal or bowel ischemia, intractable vomiting due to gastrointestinal obstruction, genitourinary obstruction, or coagulopathy) low-risk neuroblastoma or who have less than 50% of the primary tumor resected receive 4 different courses of chemotherapy.
* Course 1: Patients receive carboplatin IV over 1 hour followed by etoposide IV over 2 hours on day 0 and etoposide only on days 1 and 2.
* Course 2: Patients receive carboplatin IV over 1 hour, cyclophosphamide IV over 1 hour, and doxorubicin IV over 15-60 minutes on day 1.
* Course 3: Patients receive cyclophosphamide IV over 1 hour followed by etoposide IV over 2 hours on day 0 and etoposide only on days 1 and 2.
* Course 4: Patients receive carboplatin IV over 1 hour and etoposide IV over 2 hours followed by doxorubicin IV over 15-60 minutes on day 0 and etoposide only on days 1 and 2.
Regimen II
* Patients who progress to or recur with unfavorable biology intermediate-risk disease receive an additional 4 courses of chemotherapy.
* Course 5: Patients receive treatment as in course 3 above.
* Course 6: Patients receive treatment as in course 2 above.
* Course 7: Patients receive treatment as in course 1 above.
* Course 8: Patients receive cyclophosphamide IV over 1 hour followed by doxorubicin IV over 15-60 minutes on day 1.
All infants under 60 days of age receive filgrastim (G-CSF) or sargramostim (GM-CSF) subcutaneously beginning 24 to 36 hours after chemotherapy and continuing until blood counts recover.
Courses in both regimens repeat every 3 weeks in the absence of unacceptable toxicity.
Patients at risk for symptomatic spinal cord compression may also receive chemotherapy. Patients experiencing progressive or recurrent disease after observation undergo repeat surgery and/or chemotherapy as above. Patients with clinically symptomatic disease may also undergo radiotherapy if response to chemotherapy is not rapid.
Patients are followed every 2 months for 1 year, every 3 months for 1 year, every 6 months for 1 year, and then annually thereafter.
PROJECTED ACCRUAL: A total of 820 patients will be accrued for this study within 4 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 968
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment 1 - Asymptomatic - no immediate chemotherapy conventional surgery - Treatment 1 - Asymptomatic - no immediate chemotherapy radiation therapy - Symptomatic - immediate chemotherapy filgrastim - Symptomatic - immediate chemotherapy sargramostim - Symptomatic - immediate chemotherapy carboplatin - Symptomatic - immediate chemotherapy cyclophosphamide - Symptomatic - immediate chemotherapy doxorubicin hydrochloride - Symptomatic - immediate chemotherapy adjuvant therapy - Symptomatic - immediate chemotherapy conventional surgery - Symptomatic - immediate chemotherapy radiation therapy - Symptomatic - immediate chemotherapy etoposide -
- Primary Outcome Measures
Name Time Method Estimate the 3 year survival rate for low risk asymptomatic stage 2A/2B patients who are treated with surgery alone The primary objective is to estimate the 3 year survival rate for low risk asymptomatic stage 2A/2B patients who are treated with surgery alone. Under the assumption that about 90% of the low risk 2A/2B patients will be asymptomatic, and 10% of these will be lost to follow up, the projected sample size will enable estimation of the survival rate with a standard error less than .03. This sample size will also provide sufficient power for the sequential monitoring plan (see below) for this subgroup of patients.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (234)
University of Chicago Cancer Research Center
🇺🇸Chicago, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Illinois Medical Center
🇺🇸Chicago, Illinois, United States
Children's Memorial Hospital - Chicago
🇺🇸Chicago, Illinois, United States
Floating Hospital for Children
🇺🇸Boston, Massachusetts, United States
Group Health Central Hospital
🇺🇸Seattle, Washington, United States
Jackson Memorial Hospital
🇺🇸Miami, Florida, United States
Baptist-South Miami Regional Cancer Program
🇺🇸Miami, Florida, United States
St. Vincent Hospitals and Health Care Centers
🇺🇸Indianapolis, Indiana, United States
Sunrise Hospital and Medical Center
🇺🇸Las Vegas, Nevada, United States
Kaiser Permanente Medical Center/Kaiser Foundation Hospital - San Diego
🇺🇸San Diego, California, United States
Children's Hospital and Health Center, San Diego
🇺🇸San Diego, California, United States
Cincinnati Children's Hospital Medical Center
🇺🇸Cincinnati, Ohio, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Methodist Cancer Center at Methodist Specialty and Transplant Hospital
🇺🇸San Antonio, Texas, United States
Children's Hospitals and Clinics - Minneapolis
🇺🇸Minneapolis, Minnesota, United States
New York Medical College
🇺🇸Valhalla, New York, United States
Children's Hospital of Orange County
🇺🇸Orange, California, United States
UCSF Comprehensive Cancer Center
🇺🇸San Francisco, California, United States
Huntsman Cancer Institute
🇺🇸Salt Lake City, Utah, United States
Swiss Pediatric Oncology Group Bern
🇨🇭Bern, Switzerland
Swiss Pediatric Oncology Group Lausanne
🇨🇭Lausanne, Switzerland
British Columbia Children's Hospital
🇨🇦Vancouver, British Columbia, Canada
St. Mary's Hospital
🇺🇸West Palm Beach, Florida, United States
Allan Blair Cancer Centre at Pasqua Hospital
🇨🇦Regina, Saskatchewan, Canada
Memorial Sloan-Kettering Cancer Center
🇺🇸New York, New York, United States
Phoenix Children's Hospital
🇺🇸Phoenix, Arizona, United States
Children's Hospital of Michigan
🇺🇸Detroit, Michigan, United States
Josephine Ford Cancer Center at Henry Ford Health System
🇺🇸Detroit, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Presbyterian - St. Luke's Medical Center
🇺🇸Denver, Colorado, United States
CCOP - Columbia River Oncology Program
🇺🇸Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center & Children's Hospital
🇺🇸Portland, Oregon, United States
Nemours Children's Clinic
🇺🇸Jacksonville, Florida, United States
Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
🇺🇸Long Beach, California, United States
University of South Alabama Cancer Research Institute
🇺🇸Mobile, Alabama, United States
Broward General Medical Center
🇺🇸Fort Lauderdale, Florida, United States
University of Alabama at Birmingham Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
Loma Linda University Cancer Institute at Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Arizona Cancer Center at University of Arizona Health Sciences Center
🇺🇸Tucson, Arizona, United States
Southern California Permanente Medical Group
🇺🇸Downey, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Chao Family Comprehensive Cancer Center at University of California Irvine Cancer Center
🇺🇸Orange, California, United States
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Children's Hospital Los Angeles
🇺🇸Los Angeles, California, United States
Cedars-Sinai Comprehensive Cancer Center at Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States
Lucile Packard Children's Hospital at Stanford University Medical Center
🇺🇸Palo Alto, California, United States
Jonsson Comprehensive Cancer Center, UCLA
🇺🇸Los Angeles, California, United States
Joe DiMaggio Children's Hospital at Memorial
🇺🇸Hollywood, Florida, United States
David Grant Medical Center
🇺🇸Travis Air Force Base, California, United States
Santa Barbara Cottage Hospital
🇺🇸Santa Barbara, California, United States
Alfred I. duPont Hospital for Children
🇺🇸Wilmington, Delaware, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Children's Hospital of Denver
🇺🇸Denver, Colorado, United States
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Miami Children's Hospital
🇺🇸Miami, Florida, United States
MBCCOP-Medical College of Georgia Cancer Center
🇺🇸Augusta, Georgia, United States
AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Scottish Rite Campus
🇺🇸Atlanta, Georgia, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Riley Children Cancer Center at Riley Hospital for Children
🇺🇸Indianapolis, Indiana, United States
Walter Reed Army Medical Center
🇺🇸Silver Spring, Maryland, United States
Greenebaum Cancer Center at University of Maryland Medical Center
🇺🇸Baltimore, Maryland, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
🇺🇸Baltimore, Maryland, United States
Baystate Regional Cancer Program at Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
CCOP - Beaumont
🇺🇸Royal Oak, Michigan, United States
Children's Hospitals and Clinics - Minnesota
🇺🇸Saint Paul, Minnesota, United States
St. Mary's - Duluth Clinic Cancer Center
🇺🇸Duluth, Minnesota, United States
Schneider Children's Hospital
🇺🇸New Hyde Park, New York, United States
St. Louis Children's Hospital
🇺🇸Saint Louis, Missouri, United States
Brooklyn Hospital Center
🇺🇸Brooklyn, New York, United States
Duke Comprehensive Cancer Center
🇺🇸Durham, North Carolina, United States
Children's Medical Center - Dayton
🇺🇸Dayton, Ohio, United States
Columbus Children's Hospital
🇺🇸Columbus, Ohio, United States
CCOP - Oklahoma
🇺🇸Tulsa, Oklahoma, United States
St. Christopher's Hospital for Children
🇺🇸Philadelphia, Pennsylvania, United States
East Tennessee Children's Hospital
🇺🇸Knoxville, Tennessee, United States
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
Texas Tech University Health Sciences Center School of Medicine
🇺🇸Amarillo, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
CCOP - Scott and White Hospital
🇺🇸Temple, Texas, United States
Deaconess Medical Center
🇺🇸Spokane, Washington, United States
Cabell Huntington Hospital
🇺🇸Huntington, West Virginia, United States
Children's Hospital of Eastern Ontario
🇨🇦Ottawa, Ontario, Canada
Alberta Children's Hospital
🇨🇦Calgary, Alberta, Canada
Princess Margaret Hospital for Children
🇦🇺Perth, Western Australia, Australia
Hospital for Sick Children
🇨🇦Toronto, Ontario, Canada
Children's Hospital of Omaha
🇺🇸Omaha, Nebraska, United States
St. Joseph's Children's Hospital
🇺🇸Tampa, Florida, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
UNMC Eppley Cancer Center at the University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Midwest Children's Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Advocate Hope Children's Hospital
🇺🇸Oak Lawn, Illinois, United States
Rebecca and John Moores UCSD Cancer Center
🇺🇸La Jolla, California, United States
University of Connecticut Comprehensive Cancer Center at University of Connecticut Health Center
🇺🇸Farmington, Connecticut, United States
Lombardi Cancer Center at Georgetown University Medical Center
🇺🇸Washington, District of Columbia, United States
All Children's Hospital
🇺🇸St. Petersburg, Florida, United States
Medical Center of Central Georgia
🇺🇸Macon, Georgia, United States
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Mountain States Tumor Institute - Boise
🇺🇸Boise, Idaho, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital
🇺🇸Baltimore, Maryland, United States
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Breslin Cancer Center at Ingham Regional Medical Center
🇺🇸Lansing, Michigan, United States
Cardinal Glennon Children's Hospital
🇺🇸Saint Louis, Missouri, United States
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Cancer Center at Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
St. Joseph's Hospital and Medical Center
🇺🇸Paterson, New Jersey, United States
Valerie Fund Children's Center at Atlantic Health
🇺🇸Summit, New Jersey, United States
Herbert Irving Comprehensive Cancer Center at Columbia University
🇺🇸New York, New York, United States
James P. Wilmot Cancer Center at University of Rochester Medical Center
🇺🇸Rochester, New York, United States
New York Weill Cornell Cancer Center at Cornell University
🇺🇸New York, New York, United States
Mission Hospitals
🇺🇸Asheville, North Carolina, United States
Presbyterian Healthcare
🇺🇸Charlotte, North Carolina, United States
Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Forum Health-Tod Childrens Hospital
🇺🇸Youngstown, Ohio, United States
Children's Hospital at Oklahoma University Medical Center
🇺🇸Oklahoma City, Oklahoma, United States
Doernbecher Children's Hospital at Oregon Health & Science University
🇺🇸Portland, Oregon, United States
San Antonio Military Pediatric Cancer and Blood Disorders Center
🇺🇸Lackland Air Force Base, Texas, United States
Naval Medical Center, Portsmouth
🇺🇸Portsmouth, Virginia, United States
West Virginia University Hospitals
🇺🇸Morgantown, West Virginia, United States
Montreal Children's Hospital at McGill University Health Center
🇨🇦Montreal, Quebec, Canada
Hopital Sainte Justine
🇨🇦Montreal, Quebec, Canada
Centre de Recherche du Centre Hospitalier de l'Universite Laval
🇨🇦Sainte Foy, Quebec, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Academisch Ziekenhuis Groningen
🇳🇱Groningen, Netherlands
Starship Children's Health
🇳🇿Auckland, New Zealand
Puerto Rico Cancer Center at University of Puerto Rico - Medical Sciences Campus
🇵🇷San Juan, Puerto Rico
Swiss Pediatric Oncology Group Geneva
🇨🇭Geneva, Switzerland
Children's Hospital of Southwest Florida
🇺🇸Fort Myers, Florida, United States
Children's Hospital Central California
🇺🇸Madera, California, United States
Children's National Medical Center
🇺🇸Washington, District of Columbia, United States
Sacred Heart Children's Hospital
🇺🇸Pensacola, Florida, United States
Holden Comprehensive Cancer Center at University of Iowa
🇺🇸Iowa City, Iowa, United States
Cancer Center of Albany Medical Center
🇺🇸Albany, New York, United States
Saint Jude Midwest Affiliate
🇺🇸Peoria, Illinois, United States
Lutheran General Cancer Care Center
🇺🇸Park Ridge, Illinois, United States
Maine Children's Cancer Program
🇺🇸Scarborough, Maine, United States
UMASS Memorial Cancer Center - University Campus
🇺🇸Worcester, Massachusetts, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
William Beaumont Hospital - Royal Oak
🇺🇸Royal Oak, Michigan, United States
Spectrum Health and DeVos Children's Hospital
🇺🇸Grand Rapids, Michigan, United States
SUNY Upstate Medical University Hospital
🇺🇸Syracuse, New York, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Cancer Institute of New Jersey at Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Brookdale University Hospital and Medical Center
🇺🇸Brooklyn, New York, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Comprehensive Cancer Center at Maimonides Medical Center
🇺🇸Brooklyn, New York, United States
Long Island Cancer Center at Stony Brook University Hospital
🇺🇸Stony Brook, New York, United States
Blumenthal Cancer Center at Carolinas Medical Center
🇺🇸Charlotte, North Carolina, United States
Dakota Cancer Institute at Innovis Health - Dakota Clinic
🇺🇸Fargo, North Dakota, United States
Leo W. Jenkins Cancer Center of University Health Systems of Eastern Carolina
🇺🇸Greenville, North Carolina, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸Cleveland, Ohio, United States
Cook Children's Medical Center - Fort Worth
🇺🇸Fort Worth, Texas, United States
Children's Hospital Medical Center of Akron
🇺🇸Akron, Ohio, United States
Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Natalie Warren Bryant Cancer Center
🇺🇸Tulsa, Oklahoma, United States
Children's Hospital of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Palmetto Health South Carolina Cancer Center
🇺🇸Columbia, South Carolina, United States
Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Penn State Cancer Institute at Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Children's Hospital of Greenville Hospital System
🇺🇸Greenville, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Simmons Cancer Center at University of Texas Southwestern Medical Center - Dallas
🇺🇸Dallas, Texas, United States
Vanderbilt Children's Hospital
🇺🇸Nashville, Tennessee, United States
Sioux Valley Hospital at University of South Dakota Medical Center
🇺🇸Sioux Falls, South Dakota, United States
East Tennessee State University Cancer Center at Johnson City Medical Center
🇺🇸Johnson City, Tennessee, United States
St. Jude Children's Research Hospital
🇺🇸Memphis, Tennessee, United States
Covenant Children's Hospital
🇺🇸Lubbock, Texas, United States
University of Texas - MD Anderson Cancer Center
🇺🇸Houston, Texas, United States
Center for Cancer Prevention and Care at Scott and White Clinic
🇺🇸Temple, Texas, United States
West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division
🇺🇸Charleston, West Virginia, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
Cancer Center at the University of Virginia
🇺🇸Charlottesville, Virginia, United States
MBCCOP - South Texas Pediatrics
🇺🇸San Antonio, Texas, United States
Carilion Medical Center for Children
🇺🇸Roanoke, Virginia, United States
Vermont Cancer Center at University of Vermont
🇺🇸Burlington, Vermont, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Bellin Memorial Hospital
🇺🇸Green Bay, Wisconsin, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
Children's Hospital and Regional Medical Center - Seattle
🇺🇸Seattle, Washington, United States
Children's Hospital of the King's Daughters
🇺🇸Norfolk, Virginia, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Mary Bridge Children's Hospital and Health Center
🇺🇸Tacoma, Washington, United States
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Madigan Army Medical Center
🇺🇸Tacoma, Washington, United States
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
CCOP - St. Vincent Hospital Cancer Center, Green Bay
🇺🇸Green Bay, Wisconsin, United States
CCOP - Marshfield Clinic Research Foundation
🇺🇸Marshfield, Wisconsin, United States
Sydney Children's Hospital
🇦🇺Randwick, New South Wales, Australia
Children's Hospital at Westmead
🇦🇺Westmead, New South Wales, Australia
IWK Health Centre
🇨🇦Halifax, Nova Scotia, Canada
Royal Children's Hospital
🇦🇺Parkville, Victoria, Australia
McMaster Children's Hospital at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Children's Hospital of Western Ontario
🇨🇦London, Ontario, Canada
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
San Jorge Childrens Hospital
🇵🇷Santurce, Puerto Rico
Albert Einstein Clinical Cancer Center
🇺🇸Bronx, New York, United States
Sutter Cancer Center
🇺🇸Sacramento, California, United States
University of California Davis Cancer Center
🇺🇸Sacramento, California, United States
Kaiser Permanente Medical Center - Sacramento
🇺🇸Sacramento, California, United States
Yale Comprehensive Cancer Center
🇺🇸New Haven, Connecticut, United States
Florida Hospital Cancer Institute
🇺🇸Orlando, Florida, United States
Nemours Children's Clinic-Orlando
🇺🇸Orlando, Florida, United States
Kosair Children's Hospital
🇺🇸Louisville, Kentucky, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Children's Mercy Hospital
🇺🇸Kansas City, Missouri, United States
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Comprehensive Cancer Center at Wake Forest University
🇺🇸Winston-Salem, North Carolina, United States
Hollings Cancer Center at Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Children's Hospital of Austin
🇺🇸Austin, Texas, United States
Shands Cancer Center at the University of Florida Health Science Center
🇺🇸Gainesville, Florida, United States
MBCCOP - Hawaii
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
Children's Hospital of New Orleans
🇺🇸New Orleans, Louisiana, United States
Massey Cancer Center at Virginia Commonwealth University
🇺🇸Richmond, Virginia, United States
MBCCOP - LSU Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Tulane Cancer Center at Tulane University Hospital and Clinic
🇺🇸New Orleans, Louisiana, United States
Ochsner Clinic Foundation
🇺🇸New Orleans, Louisiana, United States
Blank Children's Hospital
🇺🇸Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Markey Cancer Center at University of Kentucky Chandler Medical Center
🇺🇸Lexington, Kentucky, United States
University of New Mexico Cancer Research and Treatment Center
🇺🇸Albuquerque, New Mexico, United States
University of Wisconsin Comprehensive Cancer Center
🇺🇸Madison, Wisconsin, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Children's Hospital and Research Center at Oakland
🇺🇸Oakland, California, United States
Janeway Children's Health and Rehabilitation Centre
🇨🇦St. John's, Newfoundland and Labrador, Canada
Women's and Children's Hospital
🇦🇺North Adelaide, South Australia, Australia
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States