Melanoma Margins Trial-II: 1cm v 2cm Wide Surgical Excision Margins for AJCC Stage II Primary Cutaneous Melanoma
- Conditions
- Cutaneous Melanoma, Stage II
- Interventions
- Procedure: Wide Local Excision = 2cm MarginProcedure: Wide Local Excision = 1cm Margin
- Registration Number
- NCT03860883
- Lead Sponsor
- Melanoma and Skin Cancer Trials Limited
- Brief Summary
Patients with a primary invasive melanoma are recommended to undergo excision of the primary lesion with a wide margin. There is evidence that less radical margins of excision may be just as safe. This is a randomised controlled trial of 1 cm versus 2 cm margin of excision of the primary lesion for adult patients with stage II primary invasive cutaneous melanomas (AJCC 8th edition) to determine differences in disease-free survival. A reduction in margins is expected to improve patient quality of life.
- Detailed Description
This study will determine whether there is a difference in disease-free survival rates for patients with primary cutaneous melanoma with Breslow thickness \> 2mm or 1-2mm with ulceration (pT2b-pT4b, AJCC 8th edition), treated with either a 1cm excision margin or 2cm margin. The study is designed to be able to prove or disprove that there is no difference in risk of the tumour recurring around the scar or anywhere else in the body between the two groups of patients. If the study shows no risk of tumour recurrence then we will also be able to determine how much of an impact the narrower excision has on patients in terms of improved quality of life and reduced side effects from the surgery and melanoma disease. This trial will also evaluate and determine the economic impact of narrower excision margins on the health services and society in general.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 2998
Patients may be included in the study if they meet ALL of the following criteria:
-
- Patients must have a Stage II primary invasive cutaneous melanoma (pT2b-pT4b, AJCC 8th edition) with Breslow thickness >1.0mm to 2.0mm; >2.0mm to 4.0mm or >4.0mm with ulceration, or >2.0mm to 4.0mm; or >4.0mm without ulceration (Table 1) as determined by diagnostic biopsy (narrow excision, incision, shave or punch biopsy) and subsequent histopathological analysis.
-
Must have a primary melanoma that is cutaneous (including head, neck, trunk, extremity, scalp, palm or sole).
-
An uninterrupted 2cm margin must be technically feasible around biopsy scar or primary melanoma.
-
- Surgical intervention (which refers to the staging -SLNB and WLE as these are both to be done on the same day) must be completed within 120 days of the original diagnosis. Surgical intervention must also be performed within 28 days of randomisation.
-
Patients must be 18 years or older at time of consent.
-
Patient must be able to give informed consent and comply with the treatment protocol and follow up plan.
-
Life expectancy of at least 5 years from the time of diagnosis, not considering the melanoma in question, as determined by the PI.
-
Patients must have an ECOG performance score between 0 and 1 at screening.
-
A survivor of prior cancer is eligible provided that ALL of the following criteria are met and documented:
- The patient has undergone potentially curative therapy for all prior malignancies,
- There has been no evidence of recurrence of any prior malignancies for at least FIVE years (with the exception of successfully treated uterine/cervical or non-melanoma skin cancers (SCCs/BCCs) with no evidence of recurrence), and
- The patient is deemed by their treating physician to be at low risk of recurrence from previous malignancies.
Patients will be excluded from the study for ANY of the following reasons:
- Uncertain diagnosis of melanoma i.e., so-called 'melanocytic lesion of unknown malignant potential'.
- Patient has already undergone WLE at the site of the primary index lesion.
- Patient unable or ineligible to undergo staging SLNB of the primary index lesion.
- Perineural invasion or neurotropic melanoma: Neurotropism or perineural invasion in any type of melanoma is an exclusion. Perineural invasion does not include entrapment of nerves within the main primary tumour mass.
- Desmoplastic melanoma: with any patient where pathology determines melanoma as PURE desmoplastic (as per WHO definition of >90% desmoplasia), they are not eligible for this study. However melanomas with less than 90% desmoplasia or mixed desmoplastic subtypes are eligible unless there is neurotropism present (perineural invasion).
- Microsatellitosis (a nest of metastatic tumour cells found to be growing away from the primary tumour) as per AJCC 8th edition definition is an exclusion.
- Subungual melanoma
- Patient has already undergone a local flap reconstruction of the defect after excision of the primary and determination of an accurate excision margin is impossible.
- History of previous or concurrent (i.e. >1 primary melanoma) invasive melanoma.
- Melanoma located distal to the metacarpophalangeal joint; on the tip of the nose; the eyelids or on the ear; genitalia, perineum or anus; mucous membranes or internal viscera.
- Physical, clinical, radiographic or pathologic evidence of satellite, in-transit, regional, or distant metastatic melanoma.
- Patient has undergone surgery on a separate occasion to clear the lymph nodes of the probable draining lymphatic field, including -SLNB, of the index melanoma.
- Any additional solid tumour or hematologic malignancy during the past 5 years (with exception of non- melanoma skin cancers (T1 skin lesions of squamous cell carcinoma (SCCs), basal cell carcinoma (BCCs)), or uterine/cervical cancer).
- Melanoma-related operative procedures not corresponding to criteria described in the protocol.
- Planned adjuvant radiotherapy to the primary melanoma site after wide local excision is not permitted as part of the protocol and any patients given this treatment would be excluded from the study.
- History of organ transplantation.
- Oral or parenteral immunosuppressive agents (not topical or inhaled steroids) at enrolment or within 6 months prior to enrolment.
Pregnancy is not a specific exclusion criterion for this trial, though it may not be clinically appropriate to perform a wide excision and SLNB until the pregnancy has been completed, which may exclude the patient due to violation of inclusion criterion 4. We would advise careful counselling of the patient prior to enrolling the patient, which would include a discussion at the treating centre's multidisciplinary team meeting or tumour board. We would strongly advise contacting the central trial office to discuss the case prior to enrolling on the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm B (Wide Local Excision = 2cm Margin) Wide Local Excision = 2cm Margin 2 cm Wide Local Excision margin + Sentinel Lymph Node Biopsy +/- Reconstruction Arm A (Wide Local Excision = 1cm Margin) Wide Local Excision = 1cm Margin 1cm Wide Local Excision margin + Sentinel Lymph Node Biopsy +/- Reconstruction
- Primary Outcome Measures
Name Time Method Disease-Free Survival 0-60 months Time from randomisation until the first clinically, histologically or radiologically confirmed recurrence of melanoma at any body site, or death from any cause.
- Secondary Outcome Measures
Name Time Method Serious Adverse Events from randomisation up to 12-months post-surgery All Serious Adverse events (SAEs), will be recorded from randomisation until 12 months post the surgical intervention or until the patient withdraws or dies.
Surgery Related Adverse Events Up to 12-months from the date of surgery The following surgical-related adverse events will be recorded from the time of surgery to 12-months following surgery (inclusive):
* wound dehiscence
* seroma/haematoma
* haemorrhage
* infection
* skin graft failure
* necrosis of flap used for reconstruction
* deep venous thrombosis
* urinary tract infection
* pneumonia
* cardiac complications
* lymphoedemaLocal Recurrence Day 0-Trial Completion (max. 120 months) Time from randomisation to any clinically, histologically or radiologically confirmed LR of melanoma including satellite lesions and in transit metastases between the primary site and the regional draining lymph nodes or death from any cause.
Distant Disease-Free Survival Day 0-Trial Completion (max. 120 months) Time from randomisation to any clinically, histologically or radiologically confirmed distant recurrence of melanoma or death from any cause
Melanoma-Specific Survival Day 0-Trial Completion (max. 120 months) Time from randomisation to death due to melanoma
Overall Survival Day 0-Trial Completion (max. 120 months) Time from randomisation to death from any cause
Melanoma-specific Quality of Life: FACT-M questionnaire Baseline, 3, 6, 12 & 24 months Measured by FACT-M (Functional Assessment of Cancer Therapy - Melanoma) questionnaire - It consists of two subsections: The FACT-G subsection is a 27-item compilation of general questions divided into four primary QOL domains: Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, and Functional Well-Being. It is considered appropriate for use with patients with any form of cancer. The Melanoma Surgery Subscale evaluates melanoma-specific symptoms such as surgical morbidity and side effects.
Neuropathic Pain: PainDetect questionnaire Baseline, 3, 6, 12 & 24 months Measured by PainDetect questionnaire
Health-related Quality of Life: EQ-5D-5L questionnaire Baseline, 3, 6, 12 & 24 months Measured by EuroQoL EQ-5D-5L questionnaire - This tool contains 5 domains including mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Health Economic Evaluation Baseline, 3, 6, 12 & 24 months Data collected for economic analysis will be from hospital notes, MBS and PBS data (Australia) and patient reported outcome measures (including an employment questionnaire) at baseline, 3, 6, 12 and 24 months and at melanoma recurrence.
Trial Locations
- Locations (189)
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
🇺🇸Orange, California, United States
Los Angeles General Medical Center
🇺🇸Los Angeles, California, United States
USC Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Huntington Memorial Hospital
🇺🇸Pasadena, California, United States
Stanford Cancer Center South Bay
🇺🇸San Jose, California, United States
University of Miami Sylvester Comprehensive Cancer Center at Aventura
🇺🇸Aventura, Florida, United States
University of Miami Sylvester Comprehensive Cancer Center at Coral Gables
🇺🇸Coral Gables, Florida, United States
University of Miami Sylvester Cancer Center at Coral Springs
🇺🇸Coral Springs, Florida, United States
University of Miami Sylvester Comprehensive Center at Deerfield Beach
🇺🇸Deerfield Beach, Florida, United States
University of Miami Sylvester Comprehensive Center at Hollywood
🇺🇸Hollywood, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Centre
🇺🇸Miami, Florida, United States
University of Miami Comprehensive Cancer Center at Kendall
🇺🇸Miami, Florida, United States
University of Miami Comprehensive Cancer Center at Plantation
🇺🇸Plantation, Florida, United States
Advocate Illinois Masonic Medical Center
🇺🇸Chicago, Illinois, United States
Indiana University - Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Indiana University Melvin and Bren Simon Comprehensive Cancer Center
🇺🇸Indianapolis, Indiana, United States
Franciscan Health Indianapolis
🇺🇸Indianapolis, Indiana, United States
University of Michigan Medical Center
🇺🇸Ann Arbor, Michigan, United States
University of Michigan - Brighton Center for Specialty Care
🇺🇸Brighton, Michigan, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Lovelace Medical Centre-Saint Joseph Square
🇺🇸Albuquerque, New Mexico, United States
Lovelace Women's Hospital
🇺🇸Albuquerque, New Mexico, United States
Northern Westchester Hospital
🇺🇸Mount Kisco, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Phelps Memorial Hospital Center
🇺🇸Sleepy Hollow, New York, United States
University of North Carolina Hospitals - Hillsborough Campus
🇺🇸Hillsborough, North Carolina, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
University of Winsconsin Carbone Cancer Center-Eastpark medical Center
🇺🇸Madison, Wisconsin, United States
Marshfield Medical Center- Weston
🇺🇸Weston, Wisconsin, United States
Oak Valley Health
🇨🇦Markham, Ontario, Canada
Centre Hospitalier de l'Universite de Montreal (CHUM)
🇨🇦Montréal, Quebec, Canada
Cork University Hospital
🇮🇪Cork, Ireland
Mater Misericordiae University Hospital
🇮🇪Dublin, Ireland
St James Hospital
🇮🇪Dublin, Ireland
Maxima Medical Centre, Eindhoven
🇳🇱Eindhoven, Noord-Brabant, Netherlands
Diakonessenhuis
🇳🇱Utrecht, Netherlands
Maxima Medical Center - Veldhoven
🇳🇱Veldhoven, Netherlands
Isala Hospital
🇳🇱Zwolle, Netherlands
Institute of Oncology Ljubljana
🇸🇮Ljubljana, Slovenia
Lancashire Teaching Hospitals NHS Foundation Trust
🇬🇧Preston, Lancashire, United Kingdom
University of South Alabama Mitchell Cancer Institute
🇺🇸Mobile, Alabama, United States
Banner MD Anderson Cancer Center
🇺🇸Gilbert, Arizona, United States
Mayo Clinic Phoenix
🇺🇸Phoenix, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
The Angeles (Cedars-Sinai Medical Center and its Affiliates)
🇺🇸Los Angeles, California, United States
UC Irvine Health - Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Stanford Cancer Institute
🇺🇸Palo Alto, California, United States
Kaiser Permanente - Vallejo Medical Center
🇺🇸Vallejo, California, United States
Kaiser Permanente - Walnut Creek Medical Center
🇺🇸Walnut Creek, California, United States
Smilow Hospital Care Center, Guilford
🇺🇸Guilford, Connecticut, United States
Yale University
🇺🇸New Haven, Connecticut, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
Baptist MD Anderson Cancer Center
🇺🇸Jacksonville, Florida, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
Lakeland Regional Health Hollis Cancer Center
🇺🇸Lakeland, Florida, United States
Moffitt Cancer Center - McKinley Campus
🇺🇸Tampa, Florida, United States
Moffitt Cancer Center, Magnolia Campus
🇺🇸Tampa, Florida, United States
Emory University Hospital Midtown
🇺🇸Atlanta, Georgia, United States
Emory University
🇺🇸Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸Atlanta, Georgia, United States
Northside Hospital Atlanta
🇺🇸Atlanta, Georgia, United States
Northside Hospital Cancer Institute
🇺🇸Atlanta, Georgia, United States
Nancy N and JC Lewis Cancer & Research Pavilion St. Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Northwestern Medicine Cancer Center Kishwaukee
🇺🇸DeKalb, Illinois, United States
Northwestern University
🇺🇸Evanston, Illinois, United States
Northwestern Medicine Cancer Center Delnor
🇺🇸Geneva, Illinois, United States
Northwestern Medicine Cancer Center Lake Forest Hospital
🇺🇸Lake Forest, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸Park Ridge, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸Warrenville, Illinois, United States
University of Kansas Hospital - Indian Creek Campus
🇺🇸Overland Park, Kansas, United States
University of Kansas Hospital- Westwood Cancer Center
🇺🇸Westwood, Kansas, United States
University of Kentucky
🇺🇸Lexington, Kentucky, United States
MedStar Franklin Square Medical Center
🇺🇸Baltimore, Maryland, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
West Michigan Cancer Centre
🇺🇸Kalamazoo, Michigan, United States
Siteman Cancer Centre, Barnes Jewish West County
🇺🇸Creve Coeur, Missouri, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Missouri, United States
Cox South Hospital
🇺🇸Springfield, Missouri, United States
Nebraska Medicine - Bellevue
🇺🇸Bellevue, Nebraska, United States
Nebraska Medicine-Village Pointe
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medicine
🇺🇸Omaha, Nebraska, United States
Cooperman Barnabas Medical Center
🇺🇸Livingston, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸Piscataway, New Jersey, United States
Northwell Health Imbert Cancer Center
🇺🇸Bay Shore, New York, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Northwell Health/Center for Advanced Medicine
🇺🇸Lake Success, New York, United States
NYU Langone Medical Center (Winthrop Hospital)
🇺🇸Mineola, New York, United States
Laura & Isaac Perlmutter Cancer Center at NYU Langone Health
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Vassar Brothers Medical Center
🇺🇸Poughkeepsie, New York, United States
University of Rochester
🇺🇸Rochester, New York, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
State University of New York Upstate Medical Center-Community Campus
🇺🇸Syracuse, New York, United States
Wilmont Cancer Institute at Webster
🇺🇸Webster, New York, United States
University of North Carolina at Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
East Carolina University
🇺🇸Greenville, North Carolina, United States
Sanford Broadway Medical Centre
🇺🇸Fargo, North Dakota, United States
Sanford Roger Maris Cancer Centre
🇺🇸Fargo, North Dakota, United States
University Hospitals Avon Health Center
🇺🇸Avon, Ohio, United States
Miami Valley Hospital South
🇺🇸Centerville, Ohio, United States
University Hospitals Geauga Medical Center
🇺🇸Chardon, Ohio, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
University Hospitals Cleveland Medical Centre
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
University Hospitals Chagrin Highlands Medical Centre
🇺🇸Orange Village, Ohio, United States
West Chester Hospital (OH394)
🇺🇸West Chester, Ohio, United States
University Hospitals St. John Medical Center
🇺🇸Westlake, Ohio, United States
OUHSC Stephenson Cancer Center
🇺🇸Oklahoma City, Oklahoma, United States
Mercy Health Center - Oncology Hematology
🇺🇸Oklahoma City, Oklahoma, United States
Kaiser Sunnyside Medical Center
🇺🇸Clackamas, Oregon, United States
Kaiser Permanente Northwest - Oncology Clinic
🇺🇸Portland, Oregon, United States
St. Luke's University Health Network - Allentown Cancer Center
🇺🇸Allentown, Pennsylvania, United States
St Luke's University Health Network, Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
St Luke's University Health Network, Anderson Campus
🇺🇸Easton, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
St Luke's University Health Network Quakertown Campus
🇺🇸Quakertown, Pennsylvania, United States
St. Luke's University Health Network - Upper Bucks
🇺🇸Quakertown, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸Sayre, Pennsylvania, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
The University of Texas MD Anderson Cancer Center
🇺🇸Houston, Texas, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Huntsman Cancer Institute (The University of Utah)
🇺🇸Salt Lake City, Utah, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
University of Vermount and Sate Agricultural College
🇺🇸Burlington, Vermont, United States
University of Virginia Health System
🇺🇸Charlottesville, Virginia, United States
VCU Massey Cancer Center Peninsula Cancer Institute
🇺🇸Newport News, Virginia, United States
VCU Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Carilion Roanoke Memorial Hospital
🇺🇸Roanoke, Virginia, United States
VCU Massey Cancer Center Affiliate Valley Health
🇺🇸Winchester, Virginia, United States
University of Wisconsin Carbone Cancer Center
🇺🇸Madison, Wisconsin, United States
Marshfield Medical Center - Marshfield
🇺🇸Marshfield, Wisconsin, United States
Aurora St Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Calvary Public Hospital Bruce
🇦🇺Bruce, Australian Capital Territory, Australia
The Canberra Hospital
🇦🇺Garran, Australian Capital Territory, Australia
Westmead Hospital
🇦🇺Sydney, New South Wales, Australia
Melanoma Institute Australia
🇦🇺Sydney, New South Wales, Australia
Royal Prince Alfred Hospital
🇦🇺Sydney, New South Wales, Australia
Princess Alexandra Hospital
🇦🇺Brisbane, Queensland, Australia
Robina Hospital
🇦🇺Gold Coast, Queensland, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, South Australia, Australia
Peter MacCallum Cancer Centre
🇦🇺Melbourne, Victoria, Australia
The Alfred Hospital
🇦🇺Melbourne, Victoria, Australia
Tom Baker Cancer Centre
🇨🇦Calgary, Alberta, Canada
BCCA - Cancer Centre for the Southern Interior
🇨🇦Kelowna, British Columbia, Canada
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Royal Victoria Regional Health Centre
🇨🇦Barrie, Ontario, Canada
Hamilton Health Sciences Centre
🇨🇦Hamilton, Ontario, Canada
Ottawa Hospital Research Institute
🇨🇦Ottawa, Ontario, Canada
Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
UHN - Princess Margaret Cancer Centre
🇨🇦Toronto, Ontario, Canada
Hopital Maisonneuve-Rosemont
🇨🇦Montreal, Quebec, Canada
Hotel-Dieu de Quebec
🇨🇦Québec City, Quebec, Canada
IOV Istituto Oncologico Veneto IRCCS-Padova
🇮🇹Padova, Italy
Fondazione IRCCS Policlinico San Matteo
🇮🇹Pavia, Italy
AOU Città della Salute e della Scienza di Torino
🇮🇹Torino, Italy
Flevo Hospital
🇳🇱Almere, Flevoland, Netherlands
Ziekenhuis Gelderse Vallei
🇳🇱Ede, Gelderland, Netherlands
Gelre Hospital
🇳🇱Zutphen, Gelderland, Netherlands
University Medical Centre Groningen
🇳🇱Groningen, Netherlands
Zuyderland Medical Center
🇳🇱Heerlen, Netherlands
Maastricht University Medical Center
🇳🇱Maastricht, Netherlands
North Shore Hospital
🇳🇿Auckland, New Zealand
Sahlgrenska University Hospital
🇸🇪Gothenburg, Sweden
Central Hospital Kristianstad
🇸🇪Kristianstad, Sweden
University Hospitals Birmingham NHS Foundation Trust
🇬🇧Edgbaston, Birmingham, United Kingdom
Royal Cornwall Hospital NHS Trust
🇬🇧Truro, Cornwall, United Kingdom
Hull University Teaching Hospitals NHS Trust
🇬🇧Hull, East Yorkshire, United Kingdom
MID & South Essex NHS Foundation Trust
🇬🇧Westcliff on Sea, Essex, United Kingdom
Oxford University Hospitals NHS Foundation Trust
🇬🇧Headington, Oxford, United Kingdom
Imperial College Healthcare NHS Trust
🇬🇧London, The Bays, United Kingdom
Queen Victoria Hospital NHS Foundation Trust
🇬🇧East Grinstead, West Sussex, United Kingdom
North Bristol NHS Trust
🇬🇧Bristol, United Kingdom
Cambridge University Hospitals NHS Foundation Trust
🇬🇧Cambridge, United Kingdom
The Leeds Teaching Hospitals NHS Trust
🇬🇧Leeds, United Kingdom
St. Helens & Knowsley Teaching Hospitals NHS Trust
🇬🇧Liverpool, United Kingdom
The Royal Marsden Hospital NHS Foundation Trust
🇬🇧London,, United Kingdom
Royal Free London NHS Foundation Trust
🇬🇧London, United Kingdom
Guy's and St Thomas's NHS Foundation Trust, of St Thomas' Hospital
🇬🇧London, United Kingdom
St George's University Hospitals NHS Foundation Trust
🇬🇧London, United Kingdom
The Christie NHS Foundation Trust
🇬🇧Manchester, United Kingdom
South Tees Hospitals NHS Foundation Trust of The James Cook University Hospital
🇬🇧Middlesbrough, United Kingdom
Norfolk and Norwich University Hospital NHS Trust
🇬🇧Norwich, United Kingdom
Nottingham University Hospitals, NHS Trust, Trust HQ, City Hospital
🇬🇧Nottingham, United Kingdom