Cisplatin and Radiation Therapy With or Without Tirapazamine in Treating Patients With Cervical Cancer

Phase 3

Terminated

Conditions: Cervical Adenocarcinoma
Cervical Adenosquamous Cell Carcinoma
Cervical Squamous Cell Carcinoma
Stage IB Cervical Cancer
Stage IIA Cervical Cancer
Stage IIB Cervical Cancer
Stage III Cervical Cancer
Stage IVA Cervical Cancer

Interventions: Drug: cisplatin
Drug: tirapazamine

Registration Number: NCT00262821

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase III trial is studying cisplatin, radiation therapy, and tirapazamine to see how well they work compared to cisplatin and radiation therapy in treating patients with cervical cancer. Drugs used in chemotherapy, such as cisplatin and tirapazamine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 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. Cisplatin and tirapazamine may make tumor cells more sensitive to radiation therapy. It is not yet known whether giving cisplatin together with radiation therapy is more effective with or without tirapazamine in treating cervical cancer.

Detailed Description: PRIMARY OBJECTIVE:

I. Compare the progression-free survival of patients with stage IB, IIA, IIB, IIIB, or IVA carcinoma of the cervix treated with cisplatin and radiotherapy with vs without tirapazamine.

SECONDARY OBJECTIVES:

I. Compare overall survival of patients treated with these regimens. II. Compare the toxicity of these regimens in these patients.

TERTIARY OBJECTIVES:

I. Correlate study treatment with tumor expression of carbonic anhydrase IX (CA-IX) and recurrence-free survival, overall survival, or metastasis in patients treated with these regimens.

II. Correlate expression of CA-IX, hypoxia inducible factor-1α, CD-31, thrombospondin-1, CD-105, or vascular endothelial growth factor (VEGF) in primary tumor tissue with recurrence-free survival, overall survival, or metastasis in patients treated with these regimens.

III. Correlate pre-treatment and/or post-treatment serum concentrations of angiogenic markers including angiogenin or VEGF with recurrence-free survival, overall survival, or metastasis in patients treated with these regimens.

IV. Correlate various combinations of biological markers of hypoxia and angiogenesis with recurrence-free survival, overall survival, or metastasis in patients treated with these regimens.

V. Correlate levels of individual biological markers of hypoxia or angiogenesis with clinicopathological characteristics including tumor size, histologic subtype, FIGO stage, depth of invasion, pelvic node status, site of recurrence, and hemoglobin level as well as patient, age, race and performance status in patients treated with these regimens.

OUTLINE: This is a randomized, controlled, multicenter study. Patients are stratified according to FIGO stage of disease (IB2 vs IIA vs IIB vs IIIB vs IVA), brachytherapy method (low-dose rate vs high-dose rate), surgical staging of para-aortic nodes (yes vs no). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive cisplatin IV over 30-60 minutes once weekly on days 1, 8, 15, 22, 29, and 36 (weeks 1-6). Patients also undergo external beam radiotherapy to the pelvis once daily on days 1-5, 8-12, 15-19, 22-26, and 29-33 (weeks 1-5). Patients then receive either 1 or 2 applications of low-dose rate brachytherapy in weeks 6-8 OR 5 applications of high-dose rate (HDR)\* brachytherapy once weekly in weeks 4-8 and 3-5 days of parametrial boost radiotherapy\*\* beginning after the first brachytherapy implant. Treatment continues in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive tirapazamine IV over 2 hours on days 1, 8, 10, 12, 15, 22, 24, 26, and 29 and cisplatin IV over 1 hour on days 1, 15, and 29. Patients also undergo radiotherapy and brachytherapy as in arm I. Treatment continues in the absence of disease progression or unacceptable toxicity.

NOTE: \*No external beam radiotherapy is administered on the day of HDR brachytherapy. If the majority of external beam radiotherapy has been administered, HDR brachytherapy may be administered in 2 applications per week (separated by at least 72 hours) in order to complete all treatment within 8 weeks.

NOTE: \*\* Patients may receive a parametrial boost at the discretion of the treating radiation oncologist.

After completion of study treatment, patients are followed for at least 5 years.

Recruitment & Eligibility

Status: TERMINATED

Sex: Female

Target Recruitment: 402

Inclusion Criteria

Histologically confirmed invasive squamous cell carcinoma, adenocarcinoma, or adenosquamous cell carcinoma of the uterine cervix
- Stage IB2, IIA, IIB, IIIB, or IVA disease
  - Stage IIA tumors must be > 4 cm
- Primary, untreated disease
Negative, non-suspicious para-aortic nodes by lymphangiogram, CT scan, MRI, or lymphadenectomy
Must have been adequately clinically staged
Suitable for treatment with radical intent using concurrent chemotherapy and pelvic radiotherapy
No disease involvement of the lower third of the vagina regardless of stage (all stage IIIA, IIIB and IVA with lower one-third involvement)
No carcinoma of the cervical stump
Performance status - GOG 0-3
Absolute neutrophil count ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3
Bilirubin ≤ 1.5 times upper limit of normal (ULN)
SGOT ≤ 3 times ULN
Alkaline phosphatase ≤ 3 times ULN
Creatinine ≤ ULN or calculated creatinine clearance ≥ 60mL/min
No New York Heart Association class III-IV heart failure
No history of myocardial infarction
No unstable angina
No uncontrolled hypertension
No pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No septicemia or severe infection
No other invasive malignancy within the past 5 years except nonmelanoma skin cancer
No prior hysterectomy or planned hysterectomy as part of initial cervix cancer therapy
No prior coronary artery bypass surgery
No prior cancer therapy that would preclude study treatment
No concurrent angina medication
No concurrent intensity-modulated radiotherapy

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm II (cisplatin, tirapazamine)	cisplatin	Patients receive tirapazamine IV over 2 hours on days 1, 8, 10, 12, 15, 22, 24, 26, and 29 and cisplatin IV over 1 hour on days 1, 15, and 29.
Arm I (cisplatin)	cisplatin	Patients receive cisplatin IV on days 1, 8, 15, 22, 29, and 36 (weeks 1-6).
Arm II (cisplatin, tirapazamine)	tirapazamine	Patients receive tirapazamine IV over 2 hours on days 1, 8, 10, 12, 15, 22, 24, 26, and 29 and cisplatin IV over 1 hour on days 1, 15, and 29.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival - Percentage of Patients Alive and Progression Free	From study entry until first disease progression, death or date of last contact, up to 6 years	Patients' progression status based on clinical, radiological or pathological (histological) evidence of disease after study therapy. Progression includes any death without evidence of disease progression. Progression-free Survival (PFS) is defined as time in month from study enrollment to disease progression, death or date of last contact.

Secondary Outcome Measures

Name	Time	Method
Adverse Events (Grade 3 or Higher) During Treatment Period	All Adverse Events (AEs) occuring during treatment and up to 30 days after stopping the study treatment are reported	Number of participants with a maximum grade of 3 or higher during treatment period. Adverse events are graded and categorized using CTCAE v3.0.
Overall Survival	From study entry to death or last contact, up to 6 years	The observed length of life from entry into the study to death or date of last contact.

Trial Locations

Locations (281): Saint Joseph's Hospital of Atlanta
🇺🇸
Atlanta, Georgia, United States
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
🇺🇸
Columbus, Ohio, United States
Thomas Jefferson University Hospital
🇺🇸
Philadelphia, Pennsylvania, United States
Magee-Womens Hospital of UPMC
🇺🇸
Pittsburgh, Pennsylvania, United States
Montana Cancer Consortium CCOP
🇺🇸
Billings, Montana, United States
BCCA-Vancouver Cancer Centre
🇨🇦
Vancouver, British Columbia, Canada
University of Illinois
🇺🇸
Chicago, Illinois, United States
University of Chicago
🇺🇸
Chicago, Illinois, United States
MetroHealth Medical Center
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
University of Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸
Cincinnati, Ohio, United States
Saint Joseph Medical Center
🇺🇸
Tacoma, Washington, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
University of Hawaii
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Mobile Infirmary Medical Center
🇺🇸
Mobile, Alabama, United States
Saint Francis Hospital
🇺🇸
Evanston, Illinois, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Indiana University Medical Center
🇺🇸
Indianapolis, Indiana, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
Maui Memorial Medical Center
🇺🇸
Wailuku, Hawaii, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
University of Massachusetts Medical School
🇺🇸
Worcester, Massachusetts, United States
Grand Rapids Clinical Oncology Program
🇺🇸
Grand Rapids, Michigan, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Saint Elizabeth Medical Center South
🇺🇸
Edgewood, Kentucky, United States
Siouxland Hematology Oncology Associates
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Maine Medical Center-Bramhall Campus
🇺🇸
Portland, Maine, United States
Iowa Oncology Research Association CCOP
🇺🇸
Des Moines, Iowa, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
Green Bay Oncology - Escanaba
🇺🇸
Escanaba, Michigan, United States
Montefiore Medical Center-Weiler Division
🇺🇸
Bronx, New York, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸
Bethlehem, Pennsylvania, United States
Mercy Health Partners-Hackley Campus
🇺🇸
Muskegon, Michigan, United States
Orange Regional Medical Center
🇺🇸
Middletown, New York, United States
Providence Hospital
🇺🇸
Southfield, Michigan, United States
William Beaumont Hospital-Royal Oak
🇺🇸
Royal Oak, Michigan, United States
Virtua West Jersey Hospital Voorhees
🇺🇸
Voorhees, New Jersey, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Gynecologic Oncology of West Michigan PLLC
🇺🇸
Grand Rapids, Michigan, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Center for Cancer Care and Research
🇺🇸
Saint Louis, Missouri, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Tulsa Cancer Institute
🇺🇸
Tulsa, Oklahoma, United States
Lake University Ireland Cancer Center
🇺🇸
Mentor, Ohio, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Akron General Medical Center
🇺🇸
Akron, Ohio, United States
Hope Women's Cancer Centers-Asheville
🇺🇸
Asheville, North Carolina, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Memorial Sloan-Kettering Cancer Center
🇺🇸
New York, New York, United States
Queens Hospital Center
🇺🇸
Jamaica, New York, United States
North Shore-LIJ Health System/Center for Advanced Medicine
🇺🇸
New Hyde Park, New York, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Wilson Medical Center
🇺🇸
Wilson, North Carolina, United States
Women's Cancer Care Associates LLC
🇺🇸
Albany, New York, United States
Aultman Health Foundation
🇺🇸
Canton, Ohio, United States
Island Gynecologic Oncology
🇺🇸
Brightwaters, New York, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
North Shore-LIJ Health System CCOP
🇺🇸
Manhasset, New York, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Lancaster General Hospital
🇺🇸
Lancaster, Pennsylvania, United States
Wright-Patterson Medical Center
🇺🇸
Wright-Patterson Air Force Base, Ohio, United States
Northwest CCOP
🇺🇸
Tacoma, Washington, United States
Odette Cancer Centre- Sunnybrook Health Sciences Centre
🇨🇦
Toronto, Ontario, Canada
Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
CHUM - Hopital Notre-Dame
🇨🇦
Montreal, Quebec, Canada
Green Bay Oncology - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
Wheeling Hospital
🇺🇸
Wheeling, West Virginia, United States
BCCA-Fraser Valley Cancer Centre
🇨🇦
Surrey, British Columbia, Canada
Thunder Bay Regional Health Science Centre
🇨🇦
Thunder Bay, Ontario, Canada
Green Bay Oncology at Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Health Sciences North
🇨🇦
Sudbury, Ontario, Canada
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Good Samaritan Community Hospital
🇺🇸
Puyallup, Washington, United States
CHUQ - Pavilion Hotel-Dieu de Quebec
🇨🇦
Quebec City, Quebec, Canada
Southwest VA Regional Cancer Center
🇺🇸
Norton, Virginia, United States
Tom Baker Cancer Centre
🇨🇦
Calgary, Alberta, Canada
Bon Secours Mary Immaculate Hospital
🇺🇸
Newport News, Virginia, United States
Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
Multicare Health System
🇺🇸
Tacoma, Washington, United States
Carilion Clinic Gynecological Oncology
🇺🇸
Roanoke, Virginia, United States
Aurora West Allis Medical Center
🇺🇸
West Allis, Wisconsin, United States
Meharry Medical College
🇺🇸
Nashville, Tennessee, United States
Vanderbilt-Ingram Cancer Center
🇺🇸
Nashville, Tennessee, United States
Intermountain Health Care
🇺🇸
Salt Lake City, Utah, United States
Radiation Oncology Practice Corporation Southwest
🇺🇸
Overland Park, Kansas, United States
Wesley Medical Center
🇺🇸
Wichita, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸
Wichita, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Providence Medical Center
🇺🇸
Kansas City, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Wichita CCOP
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Abington Memorial Hospital
🇺🇸
Abington, Pennsylvania, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Froedtert and the Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
Long Island Jewish Medical Center
🇺🇸
New Hyde Park, New York, United States
New York University Langone Medical Center
🇺🇸
New York, New York, United States
Good Samaritan Hospital Medical Center
🇺🇸
West Islip, New York, United States
Stony Brook University Medical Center
🇺🇸
Stony Brook, New York, United States
State University of New York Upstate Medical University
🇺🇸
Syracuse, New York, United States
Metro Health Hospital
🇺🇸
Wyoming, Michigan, United States
Carle Clinic-Urbana Main
🇺🇸
Urbana, Illinois, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Providence Alaska Medical Center
🇺🇸
Anchorage, Alaska, United States
University of Alabama at Birmingham
🇺🇸
Birmingham, Alabama, United States
Washington Regional Medical Center - Fayetteville
🇺🇸
Fayetteville, Arkansas, United States
Western Regional CCOP
🇺🇸
Phoenix, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸
Little Rock, Arkansas, United States
East Bay Radiation Oncology Center
🇺🇸
Castro Valley, California, United States
Banner Good Samaritan Medical Center
🇺🇸
Phoenix, Arizona, United States
City of Hope Medical Center
🇺🇸
Duarte, California, United States
Jonsson Comprehensive Cancer Center
🇺🇸
Los Angeles, California, United States
Bay Area Tumor Institute CCOP
🇺🇸
Oakland, California, United States
Stanford University Hospitals and Clinics
🇺🇸
Stanford, California, United States
Olive View-University of California Los Angeles Medical Center
🇺🇸
Sylmar, California, United States
Memorial Hospital Colorado Springs
🇺🇸
Colorado Springs, Colorado, United States
Colorado Gynecologic Oncology Group
🇺🇸
Aurora, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Hartford Hospital
🇺🇸
Hartford, Connecticut, United States
The Hospital of Central Connecticut
🇺🇸
New Britain, Connecticut, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Florida Gynecologic Oncology
🇺🇸
Fort Myers, Florida, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Piedmont Hospital
🇺🇸
Atlanta, Georgia, United States
Northside Hospital
🇺🇸
Atlanta, Georgia, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Georgia Regents University
🇺🇸
Augusta, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Wellstar Kennestone Hospital
🇺🇸
Marietta, Georgia, United States
Hawaii Minority Based CCOP
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Advocate Lutheran General Hospital.
🇺🇸
Park Ridge, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Gynecologic Oncology of Indiana
🇺🇸
Indianapolis, Indiana, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
IU Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸
Ames, Iowa, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
University of Iowa Hospitals and Clinics
🇺🇸
Iowa City, Iowa, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Louisiana State University Health Sciences Center Shreveport
🇺🇸
Shreveport, Louisiana, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Spectrum Health Big Rapids Hospital
🇺🇸
Big Rapids, Michigan, United States
Spectrum Health-Blodgett Campus
🇺🇸
Grand Rapids, Michigan, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸
Iron Mountain, Michigan, United States
Lakeland Hospital
🇺🇸
Saint Joseph, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Saint Louis University Hospital
🇺🇸
Saint Louis, Missouri, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Centerpoint Medical Center LLC
🇺🇸
Independence, Missouri, United States
University of Missouri - Ellis Fischel
🇺🇸
Columbia, Missouri, United States
Saint John's Mercy Medical Center
🇺🇸
Saint Louis, Missouri, United States
Ozark Health Ventures LLC-Cancer Research for The Ozarks Springfield
🇺🇸
Springfield, Missouri, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸
Billings, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Good Samaritan Hospital
🇺🇸
Kearney, Nebraska, United States
Center of Hope at Renown Medical Center
🇺🇸
Reno, Nevada, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Jersey Shore Medical Center
🇺🇸
Neptune, New Jersey, United States
UMDNJ - New Jersey Medical School
🇺🇸
Newark, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Community Medical Center
🇺🇸
Toms River, New Jersey, United States
State University of New York Downstate Medical Center
🇺🇸
Brooklyn, New York, United States
North Shore University Hospital
🇺🇸
Manhasset, New York, United States
New Hanover Regional Medical Center
🇺🇸
Wilmington, North Carolina, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
Salem Hospital
🇺🇸
Salem, Oregon, United States
Cancer Care Associates-Midtown
🇺🇸
Tulsa, Oklahoma, United States
Scranton Hematology Oncology
🇺🇸
Scranton, Pennsylvania, United States
Western Pennsylvania Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Mercy Hospital
🇺🇸
Scranton, Pennsylvania, United States
Hematology and Oncology Associates of North East Pennsylvania
🇺🇸
Scranton, Pennsylvania, United States
Chattanooga Gynecological Oncology
🇺🇸
Chattanooga, Tennessee, United States
Women and Infants Hospital
🇺🇸
Providence, Rhode Island, United States
Black Hills Obstetrics and Gynecology
🇺🇸
Rapid City, South Dakota, United States
Chattanooga's Program in Women's Oncology
🇺🇸
Chattanooga, Tennessee, United States
The Don and Sybil Harrington Cancer Center
🇺🇸
Amarillo, Texas, United States
University of Texas Southwestern Medical Center
🇺🇸
Dallas, Texas, United States
University of Texas Medical Branch at Galveston
🇺🇸
Galveston, Texas, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Brooke Army Medical Center
🇺🇸
Fort Sam Houston, Texas, United States
Texas Tech University Health Sciences Center
🇺🇸
Lubbock, Texas, United States
Doctor's Hospital of Laredo
🇺🇸
Laredo, Texas, United States
American Fork Hospital
🇺🇸
American Fork, Utah, United States
Cottonwood Hospital Medical Center
🇺🇸
Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸
Ogden, Utah, United States
Utah Valley Regional Medical Center
🇺🇸
Provo, Utah, United States
Dixie Medical Center Regional Cancer Center
🇺🇸
Saint George, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸
Salt Lake City, Utah, United States
Fletcher Allen Health Care-Medical Center
🇺🇸
Burlington, Vermont, United States
LDS Hospital
🇺🇸
Salt Lake City, Utah, United States
University of Virginia
🇺🇸
Charlottesville, Virginia, United States
Northern Virginia Pelvic Surgery Associates
🇺🇸
Annandale, Virginia, United States
Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Allan Blair Cancer Centre
🇨🇦
Regina, Saskatchewan, Canada
Highlands Oncology Group PA - Fayetteville
🇺🇸
Fayetteville, Arkansas, United States
University of California Medical Center At Irvine-Orange Campus
🇺🇸
Orange, California, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Pomona Valley Hospital Medical Center
🇺🇸
Pomona, California, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Dekalb Medical Center
🇺🇸
Decatur, Georgia, United States
Tripler Army Medical Center
🇺🇸
Honolulu, Hawaii, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
East Tennessee State University
🇺🇸
Johnson City, Tennessee, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Mountainside Hospital
🇺🇸
Montclair, New Jersey, United States
Lehigh Valley Hospital
🇺🇸
Allentown, Pennsylvania, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸
Mount Holly, New Jersey, United States
Logan Regional Hospital
🇺🇸
Logan, Utah, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
Renown Regional Medical Center
🇺🇸
Reno, Nevada, United States
UF Cancer Center at Orlando Health
🇺🇸
Orlando, Florida, United States
Yale University
🇺🇸
New Haven, Connecticut, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸
Louisville, Kentucky, United States
Radiation Oncology Practice Corporation South
🇺🇸
Kansas City, Missouri, United States
Radiation Oncology Practice Corporation - North
🇺🇸
Kansas City, Missouri, United States
University of North Carolina
🇺🇸
Chapel Hill, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Tulane University Health Sciences Center
🇺🇸
New Orleans, Louisiana, United States
Virginia Commonwealth University
🇺🇸
Richmond, Virginia, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Billings Clinic
🇺🇸
Billings, Montana, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States