Reduced-Dose Intensity-Modulated Radiation Therapy With or Without Cisplatin in Treating Patients With Advanced Oropharyngeal Cancer

Phase 2

Active, not recruiting

Conditions: Stage IVC Oropharyngeal Squamous Cell Carcinoma
Stage III Oropharyngeal Squamous Cell Carcinoma
Stage IVA Oropharyngeal Squamous Cell Carcinoma
Stage IVB Oropharyngeal Squamous Cell Carcinoma
Tongue Carcinoma

Interventions: Radiation: IMRT 5 weeks
Drug: Cisplatin
Radiation: IMRT 6 weeks

Registration Number: NCT02254278

Lead Sponsor: NRG Oncology

Brief Summary: This randomized phase II trial studies the side effects and how well modestly reduced-dose intensity-modulated radiation therapy (IMRT) with or without cisplatin works in treating patients with oropharyngeal cancer that has spread to other places in the body (advanced). Radiation therapy uses high energy x rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether IMRT is more effective with or without cisplatin in treating patients with oropharyngeal cancer.

Detailed Description: PRIMARY OBJECTIVES:

-To select the arm(s) achieving a 2-year progression-free survival rate of \>= 85% without unacceptable swallowing toxicity at 1 year.

SECONDARY OBJECTIVES:

* To determine patterns of failure (locoregional relapse versus distant) and survival -(overall and progression-free) at 6 months and 2 years.

* To determine acute toxicity profiles at the end of radiation therapy and at 1 and 6 months.

* To determine late toxicity profiles at 1 and 2 years.

* To determine patient-reported swallowing outcomes at 6 months and 1 and 2 years.

* To determine the predictive value of 12-14 week, post-treatment fludeoxyglucose F 18 (FDG)-positron emission tomography (PET)/computed tomography (CT) for locoregional control and progression free survival (PFS) at 2 years.

* To determine the predictive value of blood and tissue biomarkers for disease outcomes at 2 years.

* To determine swallowing recovery per videofluoroscopy imaging at 2 years.

After completion of study treatment, patients are followed at 1 and 3 months then every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 316

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
IMRT 6 weeks + cisplatin	IMRT 6 weeks	IMRT 6 weeks with concurrent cisplatin
IMRT 5 weeks	IMRT 5 weeks	IMRT 5 weeks
IMRT 6 weeks + cisplatin	Cisplatin	IMRT 6 weeks with concurrent cisplatin

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Alive Without Progression at Two Years (Progression-free Survival)	From randomization to 2 years	Progression is defined as local, regional, or distant disease progression or death due to any cause. Percentage is estimated using the binomial distribution.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With Local-regional Failure	From randomization to 2 years	Local-regional failure is defined as local or regional progression, salvage surgery of the primary tumor with tumor present/unknown, salvage neck dissection with tumor present/unknown \> 20 weeks after the end of radiation therapy, death due to study cancer without documented progression, or death due to unknown causes without documented progression. Distant metastasis and death due to other causes are considered competing risks. Local-regional failure time is defined as time from randomization to the date of first progression/death or last known follow-up (censored). Rates are estimated by the cumulative incidence method.
Percentage of Participants With Distant Metastasis	From randomization to 2 years	Distant metastasis is defined as distant progression. Local-regional failure and death due to any cause are considered competing risks. Distant metastasis time is defined as time from randomization to the date of progression/death or last known follow-up (censored). Rates are estimated by the cumulative incidence method.
Percentage of Participants Alive	from randomization to 2 years	Overall survival time is defined as time from randomization to the date of death or last known follow-up (censored). Overall survival rates are estimated by the Kaplan-Meier method.
Percentage of Participants With Grade 3+ Adverse Events	End of radiation therapy (RT) (approximately 6 weeks for Arm 1 and 5 weeks for Arm 2), then 1 month, 6 months, 1 year, and two years after end of RT	Adverse events were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Grade refers to the severity of the AE. The CTCAE v4.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild, Grade 2 Moderate, Grade 3 Severe, Grade 4 Life-threatening or disabling, Grade 5 Death related to AE.
Mean One-year Total MD Anderson Dysphagia Inventory (MDADI) Score (Patient-reported Swallowing Outcome)	One year post-RT. Radiation therapy (RT) ends at approximately 6 weeks for Arm 1 and 5 weeks for Arm 2	The MDADI is a 20-item tool with each item scored as Strongly agree; Agree; No opinion; Disagree; or Strongly disagree. There is 1 global item (G1), 6 emotional subscale items (E2-E7), 5 functional subscale items (F1-F5), and 8 physical subscale items (P1-P8). For all items except E7 and F2, Strongly agree corresponds to a score of 1, Agree 2, No opinion 3, Disagree 4, and Strongly disagree 5. For E7 and F2, the scores are reversed; these 2 items are rescored to match the others before calculating summary scores. The composite (total) score is the mean of the 19 items (other than G1) X 20. Composite scores range from 20 to 100 with higher scores indicating less dysphagia.
Negative Predictive Value (NPV) of Post-treatment FDG-PET/CT Scan [Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT)] for Progression-free Survival and Local-regional Control at Two Years	3 months (scan) and two years after the end of RT (approximately 6 weeks for Arm 1 and 5 weeks for Arm 2)	NPV is the percentage of participants alive and failure-free at 2 years among those with a negative post-treatment scan, as evaluated by central review. Negative scan determined as follows: primary site, right neck, left neck evaluated using a 5-point ordinal scale: 1-Definite complete metabolic response (CMR), 2-Likely CMR, 3-Likely inflammatory, 4-Likely residual metabolic disease (RMD), and 5-Definite RMD. 'Negative'= 1 or 2, 'Indeterminate'=3, 'Positive' = 4 or 5. 'Negative' for all three evaluation sites = overall score of 'Negative.' Progression (failure) is defined as local, regional, or distant disease progression (PR) or any death. Local-regional progression (failure) is defined as local or regional PR, salvage surgery of the primary tumor with tumor present/unknown, salvage neck dissection with tumor present/unknown \> 20 weeks post RT, death due to study cancer or unknown causes without documented PR. The protocol specified that both arms would be combined for analysis.
Percentage of Participants Positive for Human Papillomavirus (HPV) Deoxyribonucleic Acid (DNA) After Treatment (Detection Rate)	Between 2 weeks to 1 month after treatment completion (approximately 6 weeks).	Positive HPV DNA status is defined as 5 or more HPV DNA fragments per mL of blood plasma, assessed by tumor-tissue modified viral (TTMV) testing.
Change in Number of HPV DNA Fragments/mL (Copy Number) From Baseline to During Treatment (HPV DNA Rate Decline)	Baseline and during treatment (obtained after 20 Gy of radiotherapy and before 28 Gy, approximately between day 10 and 14)	Calculated as treatment value - baseline value. HPV DNA was assessed by tumor-tissue modified viral (TTMV) testing.
Correlation of Baseline Log HPV DNA Copy Number and Gross Tumor Volume (GTV)	Baseline	HPV DNA copy number is the number of HPV DNA fragments per mL of blood plasma, assessed by tumor-tissue modified viral (TTMV) testing. The natural logarithm of HPV DNA copy is used to determine correlation. GTV is the volume of the tumor determined by imaging used for treatment planning. The summary data of these two measures are reported separately in corresponding outcome measures. Correlation is measured by the Pearson correlation coefficient and ranges from -1 to +1, where ±1 indicates the strongest possible (negative or positive) correlation and 0 indicates no correlation. The study protocol indicates that participants are analyzed as a single group, treatment arms combined.
Natural Logarithm (ln) of Baseline HPV DNA Copy Number [for Purpose of Correlation]	Baseline	HPV DNA copy number is the number of HPV DNA fragments per mL of blood plasma, assessed by tumor-tissue modified viral (TTMV) testing. The natural logarithm of HPV DNA copy is used to determine correlation with gross tumor volume. Note that a natural log, by definition, has no units. The study protocol indicates that participants are analyzed as a single group, treatment arms combined. Correlation of Baseline Log HPV DNA Copy Number and Gross Tumor Volume (GTV) are reported in another outcome measure.
Gross Tumor Volume (GTV) [for Purpose of Correlation]	Baseline	GTV is the volume of the tumor determined by imaging used for radiation treatment planning. The study protocol indicates that participants are analyzed as a single group, treatment arms combined. Correlation of Baseline Log HPV DNA Copy Number and Gross Tumor Volume (GTV) are reported in another outcome measure.
HPV DNA Status by 2-year Local-regional Failure Status	From end of treatment (approximate 6 weeks) to 2 years	Local-regional failure is defined as local or regional progression, salvage surgery of the primary tumor with tumor present/unknown, salvage neck dissection with tumor present/unknown \> 20 weeks after the end of radiation therapy, death due to study cancer without documented progression, or death due to unknown causes without documented progression. Positive HPV DNA status is defined as 5 or more HPV DNA fragments per mL of blood plasma, assessed by tumor-tissue modified viral (TTMV) testing.
HPV DNA Status by 2-year Progression-free Survival Status	From end of treatment (approximate 6 weeks) to 2 years	Progression-free survival (PFS) failure is defined as local, regional, or distant disease progression or death due to any cause. Positive HPV DNA status is defined as 5 or more HPV DNA fragments per mL of blood plasma, assessed by tumor-tissue modified viral (TTMV) testing.

Trial Locations

Locations (222): Trinity Health Saint Joseph Mercy Hospital Ann Arbor
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Ann Arbor, Michigan, United States
Trinity Health Grand Rapids Hospital
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Grand Rapids, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Trinity Health Muskegon Hospital
🇺🇸
Muskegon, Michigan, United States
UCHealth University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
🇺🇸
Saint Joseph, Michigan, United States
Banner North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Olathe Health Cancer Center
🇺🇸
Olathe, Kansas, United States
University of Kansas Cancer Center - North
🇺🇸
Kansas City, Missouri, United States
UofL Health Medical Center Northeast
🇺🇸
Louisville, Kentucky, United States
University of Kansas Cancer Center - Lee's Summit
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Lee's Summit, Missouri, United States
Benefis Sletten Cancer Institute
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Great Falls, Montana, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸
Grand Island, Nebraska, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
🇺🇸
Lebanon, New Hampshire, United States
Mission Hospital
🇺🇸
Asheville, North Carolina, United States
ECU Health Oncology Kinston
🇺🇸
Kinston, North Carolina, United States
Novant Cancer Institute Radiation Oncology - Supply
🇺🇸
Supply, North Carolina, United States
Novant Health Cancer Institute Radiation Oncology - Wilmington
🇺🇸
Wilmington, North Carolina, United States
University of Cincinnati Cancer Center-UC Medical Center
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Cincinnati, Ohio, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸
West Chester, Ohio, United States
Jefferson Abington Hospital
🇺🇸
Abington, Pennsylvania, United States
UPMC Hillman Cancer Center in Coraopolis
🇺🇸
Moon, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
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Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
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Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
MD Anderson West Houston
🇺🇸
Houston, Texas, United States
Dartmouth Cancer Center - North
🇺🇸
Saint Johnsbury, Vermont, United States
University of Wisconsin Carbone Cancer Center - Johnson Creek
🇺🇸
Johnson Creek, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University Hospital
🇺🇸
Madison, Wisconsin, United States
Froedtert Menomonee Falls Hospital
🇺🇸
Menomonee Falls, Wisconsin, United States
Froedtert West Bend Hospital/Kraemer Cancer Center
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West Bend, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸
Wisconsin Rapids, Wisconsin, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, United States
Banner MD Anderson Cancer Center
🇺🇸
Gilbert, Arizona, United States
Banner University Medical Center - Tucson
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Tucson, Arizona, United States
Alta Bates Summit Medical Center-Herrick Campus
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Berkeley, California, United States
Mills-Peninsula Medical Center
🇺🇸
Burlingame, California, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
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Cameron Park, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸
Duarte, California, United States
Marin General Hospital
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Greenbrae, California, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸
Los Angeles, California, United States
Memorial Medical Center
🇺🇸
Modesto, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸
Oakland, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸
Orange, California, United States
Palo Alto Medical Foundation Health Care
🇺🇸
Palo Alto, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸
Palo Alto, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸
Rancho Cordova, California, United States
Rohnert Park Cancer Center
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Rohnert Park, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
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Roseville, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
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Roseville, California, United States
Sutter Medical Center Sacramento
🇺🇸
Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
South Sacramento Cancer Center
🇺🇸
Sacramento, California, United States
Saint Helena Hospital
🇺🇸
Saint Helena, California, United States
Naval Medical Center -San Diego
🇺🇸
San Diego, California, United States
UCSF Medical Center-Mount Zion
🇺🇸
San Francisco, California, United States
Stanford Cancer Center South Bay
🇺🇸
San Jose, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸
Santa Clara, California, United States
City of Hope South Pasadena
🇺🇸
South Pasadena, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸
South San Francisco, California, United States
Palo Alto Medical Foundation-Sunnyvale
🇺🇸
Sunnyvale, California, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
🇺🇸
Truckee, California, United States
John Muir Medical Center-Walnut Creek
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Walnut Creek, California, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
Yale University
🇺🇸
New Haven, Connecticut, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
🇺🇸
Hollywood, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸
Miami, Florida, United States
Miami Cancer Institute
🇺🇸
Miami, Florida, United States
Memorial Hospital West
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Pembroke Pines, Florida, United States
Moffitt Cancer Center
🇺🇸
Tampa, Florida, United States
Cleveland Clinic-Weston
🇺🇸
Weston, Florida, United States
Grady Health System
🇺🇸
Atlanta, Georgia, United States
Emory University Hospital Midtown
🇺🇸
Atlanta, Georgia, United States
Piedmont Hospital
🇺🇸
Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸
Atlanta, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise
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Boise, Idaho, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
John H Stroger Jr Hospital of Cook County
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸
Evanston, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸
Glenview, Illinois, United States
NorthShore University HealthSystem-Highland Park Hospital
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Highland Park, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Radiation Oncology Associates PC
🇺🇸
Fort Wayne, Indiana, United States
Parkview Hospital Randallia
🇺🇸
Fort Wayne, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
University of Kansas Cancer Center-Overland Park
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Overland Park, Kansas, United States
Ascension Via Christi Hospitals Wichita
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Wichita, Kansas, United States
The James Graham Brown Cancer Center at University of Louisville
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Louisville, Kentucky, United States
Greater Baltimore Medical Center
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Baltimore, Maryland, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
Lahey Hospital and Medical Center
🇺🇸
Burlington, Massachusetts, United States
University of Michigan Comprehensive Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Henry Ford Cancer Institute-Downriver
🇺🇸
Brownstown, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸
Clinton Township, Michigan, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital
🇺🇸
Saint Cloud, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Siteman Cancer Center at West County Hospital
🇺🇸
Creve Coeur, Missouri, United States
North Kansas City Hospital
🇺🇸
Kansas City, Missouri, United States
The University of Kansas Cancer Center-South
🇺🇸
Kansas City, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸
Rolla, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸
Saint Peters, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Radiation Oncology Centers of Nevada Central
🇺🇸
Las Vegas, Nevada, United States
Renown Regional Medical Center
🇺🇸
Reno, Nevada, United States
Saint Mary's Regional Medical Center
🇺🇸
Reno, Nevada, United States
Wentworth-Douglass Hospital
🇺🇸
Dover, New Hampshire, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸
Basking Ridge, New Jersey, United States
Saint Barnabas Medical Center
🇺🇸
Livingston, New Jersey, United States
Virtua Memorial
🇺🇸
Mount Holly, New Jersey, United States
Virtua Voorhees
🇺🇸
Voorhees, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Memorial Sloan Kettering Commack
🇺🇸
Commack, New York, United States
Memorial Sloan Kettering Westchester
🇺🇸
Harrison, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Memorial Sloan Kettering Nassau
🇺🇸
Uniondale, New York, United States
Dickstein Cancer Treatment Center
🇺🇸
White Plains, New York, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸
Beachwood, Ohio, United States
Geauga Hospital
🇺🇸
Chardon, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, 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
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸
Independence, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸
Mentor, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital
🇺🇸
Middleburg Heights, Ohio, United States
University Hospitals Parma Medical Center
🇺🇸
Parma, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
UH Seidman Cancer Center at Firelands Regional Medical Center
🇺🇸
Sandusky, Ohio, United States
Cleveland Clinic Cancer Center Strongsville
🇺🇸
Strongsville, Ohio, United States
Cleveland Clinic Wooster Family Health and Surgery Center
🇺🇸
Wooster, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
UPMC-Heritage Valley Health System Beaver
🇺🇸
Beaver, Pennsylvania, United States
ProMedica Flower Hospital
🇺🇸
Sylvania, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸
Westlake, Ohio, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸
Greensburg, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸
Hershey, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸
Johnstown, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸
McKeesport, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
UPMC-Saint Margaret
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Spartanburg Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Tennessee Cancer Specialists-Dowell Springs
🇺🇸
Knoxville, Tennessee, United States
MD Anderson in The Woodlands
🇺🇸
Conroe, Texas, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸
Seneca, Pennsylvania, United States
UPMC Uniontown Hospital Radiation Oncology
🇺🇸
Uniontown, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸
Washington, Pennsylvania, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
University of Texas Medical Branch
🇺🇸
Galveston, Texas, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
MD Anderson League City
🇺🇸
League City, Texas, United States
UTMB Cancer Center at Victory Lakes
🇺🇸
League City, Texas, United States
Intermountain Medical Center
🇺🇸
Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸
Ogden, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸
Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
University of Virginia Cancer Center
🇺🇸
Charlottesville, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States
Tacoma/Valley Radiation Oncology Centers-Gig Harbor
🇺🇸
Gig Harbor, Washington, United States
Virginia Mason Medical Center
🇺🇸
Seattle, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Jackson Hall
🇺🇸
Tacoma, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
Tacoma/Valley Radiation Oncology Centers-Saint Joe's
🇺🇸
Tacoma, Washington, United States
Legacy Salmon Creek Hospital
🇺🇸
Vancouver, Washington, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸
Green Bay, Wisconsin, United States
Ascension All Saints Hospital
🇺🇸
Racine, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
Tom Baker Cancer Centre
🇨🇦
Calgary, Alberta, Canada
Cross Cancer Institute
🇨🇦
Edmonton, Alberta, Canada
BCCA-Vancouver Island Cancer Centre
🇨🇦
Victoria, British Columbia, Canada
Juravinski Cancer Centre at Hamilton Health Sciences
🇨🇦
Hamilton, Ontario, Canada
Kingston Health Sciences Centre
🇨🇦
Kingston, Ontario, Canada
Odette Cancer Centre- Sunnybrook Health Sciences Centre
🇨🇦
Toronto, Ontario, Canada
University Health Network-Princess Margaret Hospital
🇨🇦
Toronto, Ontario, Canada
Windsor Regional Cancer Centre
🇨🇦
Windsor, Ontario, Canada
CHUM - Hopital Notre-Dame
🇨🇦
Montreal, Quebec, Canada
McGill University Department of Oncology
🇨🇦
Montreal, Quebec, Canada
Jewish General Hospital
🇨🇦
Montreal, Quebec, Canada
Allan Blair Cancer Centre
🇨🇦
Regina, Saskatchewan, Canada
Saskatoon Cancer Centre
🇨🇦
Saskatoon, Saskatchewan, Canada
Saint Lukes Hospital
🇮🇪
Dublin, Co Dublin, Ireland
King Faisal Specialist Hospital and Research Centre
🇸🇦
Riyadh, Saudi Arabia