Lower-Dose Chemoradiation in Treating Patients With Early-Stage Anal Cancer, the DECREASE Study

Phase 2

Active, not recruiting

Conditions: Stage I Anal Cancer AJCC v8
Stage IIA Anal Cancer AJCC v8
Anal Basaloid Carcinoma
Anal Canal Cloacogenic Carcinoma
Anal Canal Squamous Cell Carcinoma
Anal Margin Squamous Cell Carcinoma

Interventions: Procedure: Biopsy
Procedure: Biospecimen Collection
Drug: Capecitabine
Procedure: Computed Tomography
Other: Fludeoxyglucose F-18
Drug: Fluorouracil
Radiation: Intensity-Modulated Radiation Therapy
Procedure: Magnetic Resonance Imaging
Drug: Mitomycin
Procedure: Positron Emission Tomography
Other: Quality-of-Life Assessment
Other: Questionnaire Administration

Registration Number: NCT04166318

Lead Sponsor: ECOG-ACRIN Cancer Research Group

Brief Summary: This phase II trial studies how well lower-dose chemotherapy plus radiation (chemoradiation) therapy works in comparison to standard-dose chemoradiation in treating patients with early-stage anal cancer. Drugs used in chemotherapy, such as mitomycin, fluorouracil, and capecitabine, 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. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy with radiation therapy may kill more tumor cells. This study may help doctors find out if lower-dose chemoradiation is as effective and has fewer side effects than standard-dose chemoradiation, which is the usual approach for treatment of this cancer type.

Detailed Description: PRIMARY OBJECTIVE:

I. To determine whether de-intensified chemoradiation for early stage squamous cell carcinoma of the anal canal (SCCA) is able to maintain excellent 2-year disease control of 85% or higher while improving anorectal health-related quality of life (HRQL), compared to standard-dose chemoradiation therapy (CRT), as measured by the change in the Fecal Incontinence Quality of Life scale (FIQoL) instrument coping/behavior domain from baseline to 1 year.

SECONDARY OBJECTIVES:

I. To compare changes in patient-reported HRQL (as per Fecal Incontinence Severity Index \[FISI\], Patient Reported Outcomes Measurement Information System \[PROMIS\], International Index of Erectile Function \[IIEF\], Sexual Function-Vaginal Changes Questionnaire \[SVQ\], and Vaginal Assessment Scale \[VAS\]/Vulvar Assessment Scale \[VuAS\] instruments) between the experimental and control arm.

II. To compare patterns of failure (local and regional relapse versus distant; in-field versus out-of-field of radiation), disease control, and overall survival between experimental and control arm.

III. To correlate vaginal dilator use during radiation delivery with sexual function.

IV. To measure changes in serum total testosterone from baseline to up to 12 months after radiation.

V. To validate the utility of imaging features of inguinal and pelvic lymph nodes obtained prior to treatment as a prognostic indicator that can identify patients with early-stage anal squamous cell carcinoma for whom treatment with de-intensified chemoradiation is appropriate.

VI. To determine the incidence of and predictors for cardiovascular toxicity in patients receiving fluorouracil (5-FU) or capecitabine.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A (STANDARD-DOSE CHEMORADIATION): Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin intravenously (IV) over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine orally (PO) twice daily (BID) 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity.

ARM B (DE-INTENSIFIED CHEMORADIATION): Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity.

All patients receive fludeoxyglucose F-18 (FDG) and undergo positron emission tomography (PET)/magnetic resonance imaging (MRI) or receive FDG and undergo PET/computed tomography (CT) during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.

After completion of study treatment, patients are followed up at 6 weeks, every 3 months for years 1-2, every 6 months for year 3, then annually for years 4-5.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 252

Inclusion Criteria

STEP 0 (PRE-REGISTRATION)
Patient must be ≥ 18 years of age
Patients must be English speaking to participate in the trial. (Please note that this requirement is due to the fact that the quality-of-life studies are mandatory and we currently do not have full translated versions of the questionnaires into other languages)
Patient must have histologically proven T1-2N0M0 invasive anal canal or anal margin squamous cell carcinoma with tumors measuring =< 4 cm. This may include tumors of non-keratinizing histology such as basaloid, transitional cell or cloacogenic histology. Measurable disease is not required
Patients who are status/post local excision or excisional biopsy procedure are eligible provided there was tumor involvement of the anal canal and/or anal verge prior to the reaction, if the margins were positive, and/or if the stage is T2N0 based on tumor size before the procedure. This means that patients with T1N0M0 anal margin squamous cell carcinoma who underwent surgical excision with negative margins and no involvement of the anal verge and/or anal canal are not eligible
Tumor size must be documented based on physical examination including digital rectal exam and/or anoscopy/proctoscopy within 4 weeks prior to Step 0 pre-registration
Patient's human immunodeficiency virus (HIV) status must be known and documented at baseline
- NOTE: For patients without a history of HIV infection, it is recommended (but not required) that updated HIV testing be performed within one year of study enrollment
Patients who are HIV-negative will be registered to Arm R. They must not have lymph nodes that are radiographically-concerning for cancer involvement using computed tomography (CT) and fludeoxyglucose F-18 (FDG) - positron emission tomography (PET)/CT-based criteria
- NOTE: Patients who are HIV-negative and meet the below criteria may proceed directly to Step 1 Randomization
- Patients will be considered to be lymph node (LN) positive and thereby not eligible in this study if the lymph nodes meet any of the following criteria:
  - Mesorectal, presacral, internal iliac or obturator LN with:
    - Short axis measuring > 5 mm based on CT/magnetic resonance imaging (MRI) OR
    - Morphologic features of irregular border or central necrosis if assessed on MRI and LN measures > 3 mm OR
    - FDG uptake > blood pool (Deauville 3-5) based on FDG-PET/CT or PET/MRI
  - Internal Iliac and obturator LN with:
    - Short-axis measuring > 7 mm based on CT/MRI OR
    - Morphologic features of irregular border or central necrosis based on CT/MRI OR
    - FDG uptake > blood pool (Deauville 3-5) based on FDG-PET/CT or PET/MRI
  - External Iliac and common Iliac:
    - Short-axis measuring > 10 mm based on CT/MRI OR
    - Morphologic features of irregular border or central necrosis based on CT/MRI OR
    - FDG uptake > blood pool (Deauville 3-5) based on FDG-PET/CT or PET/MRI
- Inguinal LN (superficial and deep) meeting any of the following criteria will be ineligible unless an fine needle aspiration (FNA) is performed and resulting cytology is negative.
  - Morphologic features of irregular border or central necrosis based on CT/MRI
  - FDG uptake > liver (Deauville 4) based on FDG-PET/CT.
  - Patients who are HIV-negative and have inguinal lymph nodes that do not meet the above criteria must undergo fine needle aspiration and have negative histology to be eligible
Patients who are HIV-positive will be registered to Arm S. They must meet the eligibility criteria below:
- A CD4 count >= 200
- Imaging submitted to ECOG-ACRIN for central review for confirmation of no lymph node involvement
- No history of acquired immunodeficiency syndrome (AIDS)-related complications within past year other than a history of low CD4+ T-cell count (> 200/mm^3) prior to initiation of combination antiretroviral therapy
- Patient must be healthy on the basis of HIV disease with high likelihood of near normal life span were it not for the anal cancer
- Patient MUST receive appropriate care and treatment for HIV infection, including antiretroviral medications when clinically indicated, and should be under the care of a physician experienced in HIV management. Patients will be eligible regardless of antiretroviral medication provided the regimen has been stable for at least 4 weeks
STEP 1 RANDOMIZATION
Patient must have met the eligibility criteria as outlined Step 0 Pre-registration
Patient must have Eastern Cooperative Oncology Group (ECOG) - American College of Radiology Imaging Network (ACRIN) performance status of 0-2
Patient must have no history of prior chemotherapy for this malignancy
Patients must not have undergone previous radiation to the pelvis such that overlapping radiation fields would be expected
Patient must not have had prior potentially curative surgery (i.e. abdominal-perineal resection) for carcinoma of the anus. However, patients who undergo local excision or excisional biopsy are eligible provided they meet inclusion criteria
Patients with T1N0M0 anal margin squamous cell carcinoma must not have undergone surgical excision with negative margins and no involvement of the anal verge and/or anal canal
Patient must not be receiving any other standard anti-cancer therapy or experimental agent concurrently with the study drugs
Patient must not have intercurrent illness including, but not limited to, ongoing or active infection or psychiatric/social situations that, in the judgement of the investigator, would limit compliance with study requirements
Patient must not have had significant cardiovascular disease including myocardial infarction, unstable angina, stroke, transient ischemic attack, symptomatic coronary artery disease, symptomatic congestive heart failure, or uncontrolled cardiac arrhythmia within 6 months of Step 1 randomization
Patient must not have a history of a different malignancy unless they have been disease-free for at least 2 years and are deemed by the investigator to be at low risk of recurrence
- Exceptions to this rule are individuals with cervical cancer in situ, non-melanoma skin cancers, and colon polyps
Patient must not have active inflammatory bowel disease (patients requiring current medical interventions or who are symptomatic)
Patients must not have an active autoimmune or connective tissue disease that has required systemic treatment in the past two years (i.e., with the use of modifying agents, corticosteroids, or immunosuppressive drugs) Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
Patients who are on anti-coagulation with warfarin within 2 weeks prior to Step 1 randomization and are considering the use of capecitabine, must use an alternative anti-coagulant
- NOTE: Low molecular weight heparin is permitted provided the patient's prothrombin time (PT)/international normalized ratio (INR) is < 1.5
Patients who will receive capecitabine and are on Dilantin for a seizure disorder must have Dilantin levels checked weekly
Hemoglobin > 10 g/dL (within 2 weeks prior to Step 1 Randomization)
Platelets >= 100,000/mm^3 (within 2 weeks prior to Step 1 Randomization)
Absolute neutrophil count >= 1500/mm^3 (within 2 weeks prior to Step 1 Randomization)
Serum creatinine must be < 1.5 X upper limit of normal (ULN), or calculated creatinine clearance must be > 50 ml/min (within 2 weeks prior to Step 1 Randomization)
Total bilirubin must be < 2 X ULN (within 2 weeks prior to Step 1 Randomization)
Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 X institutional ULN (within 2 weeks prior to Step 1 Randomization)
Albumin >= 3.0 g/dL (within 2 weeks prior to Step 1 Randomization)
Women must not be pregnant or breast-feeding because the study treatment administered may cause harm to an unborn fetus or breastfeeding child. All females of childbearing potential must have a blood test or urine study within 2 weeks prior to Step 1 Randomization to rule out pregnancy. A female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
Women of childbearing potential and sexually active males must be strongly advised to use accepted and effective method(s) of contraception or to abstain from sexual intercourse for the duration of their participation in the study and for at least 6 months after the completion of treatment

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A (standard-dose chemoradiation)	Biopsy	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Biospecimen Collection	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Capecitabine	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Computed Tomography	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Fludeoxyglucose F-18	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Fluorouracil	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Intensity-Modulated Radiation Therapy	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Magnetic Resonance Imaging	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Mitomycin	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Positron Emission Tomography	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Quality-of-Life Assessment	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm A (standard-dose chemoradiation)	Questionnaire Administration	Patients undergo 28 fractions of intensity-modulated radiation therapy (IMRT). Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 and 29-32 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Biopsy	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Biospecimen Collection	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Capecitabine	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Computed Tomography	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Fludeoxyglucose F-18	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Fluorouracil	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Intensity-Modulated Radiation Therapy	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Magnetic Resonance Imaging	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Mitomycin	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Positron Emission Tomography	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Quality-of-Life Assessment	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.
Arm B (de-intensified chemoradiation)	Questionnaire Administration	Patients undergo 20 or 23 fractions of IMRT. Within 24 hours, patients also receive mitomycin IV over 30 minutes or less on day 1 and either fluorouracil IV over 24 hours on days 1-4 or capecitabine PO BID 5 days per week (Monday - Friday) until completion of IMRT in the absence of disease progression or unacceptable toxicity. Patients receive FDG and undergo PET/MRI or receive FDG and undergo PET/CT during baseline. Patients undergo CT or MRI on the trial. Patients also undergo tissue biopsy during screening and at the discretion of the treating physician. Additionally, patients undergo blood sample collection throughout the trial.

Primary Outcome Measures

Name	Time	Method
Disease control in the de-intensified chemoradiation therapy (CRT) arm	Up to 2 years	An event is local-regional failure, distant metastasis and chemoradiation-related death. Will determine if de-intensified chemoradiation achieves 2-year disease control of 85% or higher while improving anorectal health-related quality of life (HRQL), compared to standard-dose CRT, as measured by the change in the Fecal Incontinence Quality of Life scale (FIQoL) instrument coping/behavior domain from baseline to 1 year. The co-primary endpoints of disease control and FIQoL will be formally assessed in a hierarchical manner with disease control being assessed first. Will be estimated for all treatment arms using the Kaplan-Meier method (1958).
Change in FIQoL in the de-intensified CRT arm	Baseline up to 1 year	Quality of life analyses, will be compared between arms using a two-sample independent t-tests at a significance level of 0.05 and appropriate longitudinal models will be evaluated to assess the trajectory of HRQL endpoints over time and to evaluate those trajectories between treatment arms. Overall score and change from baseline will be summarized using mean and standard deviation at each time point for each arm.

Secondary Outcome Measures

Name	Time	Method
Disease control	Up to 5 years	Will be compared between experimental and control arm. Will be estimated for all treatment arms using the Kaplan-Meier method (1958).
Changes in patient-reported outcomes	Baseline up to 5 years	Will compare changes as per Fecal Incontinence Severity Index \[FISI\], Patient Reported Outcomes Measurement Information System \[PROMIS\], International Index of Erectile Function \[IIEF\], Sexual Function-Vaginal Changes Questionnaire \[SVQ\], and Vaginal Assessment Scale \[VAS\]/Vulvar Assessment Scale \[VuAS\] instruments between the experimental and control arm. Quality of life analyses, will be compared between arms using a two-sample independent t-tests at a significance level of 0.05 and appropriate longitudinal models will be evaluated to assess the trajectory of HRQL endpoints over time and to evaluate those trajectories between treatment arms. Overall score and change from baseline will be summarized using mean and standard deviation at each time point for each arm.
Patterns of failure (local and regional relapse versus distant; in-field versus out-of-field of radiation)	Up to 5 years	Will be compared between experimental and control arm. The cumulative incidence method will be used to estimate local-regional and distant failure rates and the failure rates for the experimental treatment will be compared against the control using a failure specific log rank test.
Effect of vaginal dilator use during radiation delivery on sexual function	Up to 5 years	Vaginal dilator use during radiation delivery will be correlated with sexual function.
Change in serum total testosterone	Baseline up to 12 months after radiation
Utility of image features of inguinal and pelvic lymph nodes obtained prior to treatment	Baseline	Will be validated as a prognostic indicator that can identify patients with early-stage anal squamous cell carcinoma for whom treatment with de-intensified CRT is appropriate.
Incidence of and predictors for cardiovascular toxicity in patients receiving fluorouracil or capecitabine	Up to 5 years	Rates of grade 3+ adverse events (Common Terminology Criteria for Adverse Events \[CTCAE\], version \[v.\] 5) will be estimated using a binomial distribution along with their associated 95% confidence intervals and compared using Fisher's exact test between arms.

Trial Locations

Locations (656): Saint Elizabeth Hospital
🇺🇸
Enumclaw, Washington, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Commonwealth Cancer Center-Corbin
🇺🇸
Corbin, Kentucky, United States
Saint Joseph Hospital
🇺🇸
Lexington, Kentucky, United States
Saint Joseph London
🇺🇸
London, Kentucky, United States
Jewish Hospital
🇺🇸
Louisville, Kentucky, United States
Norton Hospital Pavilion and Medical Campus
🇺🇸
Louisville, Kentucky, United States
Saints Mary and Elizabeth Hospital
🇺🇸
Louisville, Kentucky, United States
Norton Audubon Hospital and Medical Campus
🇺🇸
Louisville, Kentucky, United States
Norton Brownsboro Hospital and Medical Campus
🇺🇸
Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸
Louisville, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸
Shepherdsville, Kentucky, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, United States
Anchorage Associates in Radiation Medicine
🇺🇸
Anchorage, Alaska, United States
Anchorage Radiation Therapy Center
🇺🇸
Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸
Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸
Anchorage, Alaska, United States
Alaska Women's Cancer Care
🇺🇸
Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸
Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸
Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸
Anchorage, Alaska, United States
Fairbanks Memorial Hospital
🇺🇸
Fairbanks, Alaska, United States
Kingman Regional Medical Center
🇺🇸
Kingman, Arizona, United States
Cancer Center at Saint Joseph's
🇺🇸
Phoenix, Arizona, United States
Mercy Hospital Fort Smith
🇺🇸
Ft. Smith, Arkansas, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸
Hot Springs, Arkansas, United States
University of Arkansas for Medical Sciences
🇺🇸
Little Rock, Arkansas, United States
Mission Hope Medical Oncology - Arroyo Grande
🇺🇸
Arroyo Grande, California, United States
PCR Oncology
🇺🇸
Arroyo Grande, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
Mercy Cancer Center - Carmichael
🇺🇸
Carmichael, California, United States
Mercy San Juan Medical Center
🇺🇸
Carmichael, California, United States
Mercy Cancer Center - Elk Grove
🇺🇸
Elk Grove, California, United States
UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
🇺🇸
Irvine, California, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
Mercy Cancer Center
🇺🇸
Merced, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸
Orange, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸
Palo Alto, California, United States
Mercy Cancer Center - Rocklin
🇺🇸
Rocklin, California, United States
Mercy Cancer Center - Sacramento
🇺🇸
Sacramento, California, United States
UC San Diego Medical Center - Hillcrest
🇺🇸
San Diego, California, United States
Pacific Central Coast Health Center-San Luis Obispo
🇺🇸
San Luis Obispo, California, United States
Mission Hope Medical Oncology - Santa Maria
🇺🇸
Santa Maria, California, United States
Woodland Memorial Hospital
🇺🇸
Woodland, California, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸
Aurora, Colorado, United States
UCHealth University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸
Colorado Springs, Colorado, United States
UCHealth Memorial Hospital Central
🇺🇸
Colorado Springs, Colorado, United States
Memorial Hospital North
🇺🇸
Colorado Springs, Colorado, United States
Saint Francis Cancer Center
🇺🇸
Greenville, South Carolina, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Mercy Medical Center
🇺🇸
Durango, Colorado, United States
Southwest Oncology PC
🇺🇸
Durango, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸
Englewood, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
The Melanoma and Skin Cancer Institute
🇺🇸
Englewood, Colorado, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Cancer Care and Hematology-Fort Collins
🇺🇸
Fort Collins, Colorado, United States
UCHealth Greeley Hospital
🇺🇸
Greeley, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸
Littleton, Colorado, United States
Littleton Adventist Hospital
🇺🇸
Littleton, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸
Longmont, Colorado, United States
Medical Center of the Rockies
🇺🇸
Loveland, Colorado, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸
Thornton, Colorado, United States
Smilow Cancer Hospital-Derby Care Center
🇺🇸
Derby, Connecticut, United States
Smilow Cancer Hospital Care Center-Fairfield
🇺🇸
Fairfield, Connecticut, United States
Smilow Cancer Hospital Care Center at Greenwich
🇺🇸
Greenwich, Connecticut, United States
Smilow Cancer Hospital Care Center - Guilford
🇺🇸
Guilford, Connecticut, United States
Smilow Cancer Center/Yale-New Haven Hospital
🇺🇸
New Haven, Connecticut, United States
Yale University
🇺🇸
New Haven, Connecticut, United States
Yale-New Haven Hospital North Haven Medical Center
🇺🇸
North Haven, Connecticut, United States
Smilow Cancer Hospital Care Center at Long Ridge
🇺🇸
Stamford, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull
🇺🇸
Trumbull, Connecticut, United States
Smilow Cancer Hospital Care Center - Waterford
🇺🇸
Waterford, Connecticut, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Beebe South Coastal Health Campus
🇺🇸
Millville, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸
Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸
Seaford, Delaware, United States
MedStar Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
UM Sylvester Comprehensive Cancer Center at Aventura
🇺🇸
Aventura, Florida, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
🇺🇸
Coral Gables, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
🇺🇸
Deerfield Beach, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸
Miami, Florida, United States
Miami Cancer Institute
🇺🇸
Miami, Florida, United States
Health Central
🇺🇸
Ocoee, Florida, United States
Orlando Health Cancer Institute
🇺🇸
Orlando, Florida, United States
UM Sylvester Comprehensive Cancer Center at Plantation
🇺🇸
Plantation, Florida, United States
Tampa General Hospital
🇺🇸
Tampa, Florida, United States
Cleveland Clinic-Weston
🇺🇸
Weston, Florida, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Saint Luke's Cancer Institute - Boise
🇺🇸
Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸
Coeur D'Alene, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸
Fruitland, Idaho, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸
Meridian, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa
🇺🇸
Nampa, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸
Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸
Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - Sandpoint
🇺🇸
Sandpoint, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸
Twin Falls, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Advocate Good Shepherd Hospital
🇺🇸
Barrington, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
SIH Cancer Institute
🇺🇸
Carterville, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Saint Mary's Hospital
🇺🇸
Centralia, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
University of Illinois
🇺🇸
Chicago, Illinois, United States
Advocate Illinois Masonic Medical Center
🇺🇸
Chicago, Illinois, United States
AMG Crystal Lake - Oncology
🇺🇸
Crystal Lake, Illinois, United States
Carle at The Riverfront
🇺🇸
Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Northwestern Medicine Cancer Center Kishwaukee
🇺🇸
DeKalb, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸
Dixon, Illinois, United States
Advocate Good Samaritan Hospital
🇺🇸
Downers Grove, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Advocate Sherman Hospital
🇺🇸
Elgin, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Northwestern Medicine Cancer Center Delnor
🇺🇸
Geneva, Illinois, United States
Advocate South Suburban Hospital
🇺🇸
Hazel Crest, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Northwestern Medicine Lake Forest Hospital
🇺🇸
Lake Forest, Illinois, United States
AMG Libertyville - Oncology
🇺🇸
Libertyville, Illinois, United States
Condell Memorial Hospital
🇺🇸
Libertyville, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸
Mount Vernon, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸
O'Fallon, Illinois, United States
HSHS Saint Elizabeth's Hospital
🇺🇸
O'Fallon, Illinois, United States
Advocate Christ Medical Center
🇺🇸
Oak Lawn, Illinois, United States
Advocate High Tech Medical Park
🇺🇸
Palos Heights, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸
Park Ridge, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Southwest Illinois Health Services LLP
🇺🇸
Swansea, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸
Warrenville, Illinois, United States
Illinois CancerCare - Washington
🇺🇸
Washington, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
Mary Greeley Medical Center
🇺🇸
Ames, Iowa, United States
McFarland Clinic - Ames
🇺🇸
Ames, Iowa, United States
Mission Cancer and Blood - Ankeny
🇺🇸
Ankeny, Iowa, United States
McFarland Clinic - Boone
🇺🇸
Boone, Iowa, United States
Saint Anthony Regional Hospital
🇺🇸
Carroll, Iowa, United States
Physicians' Clinic of Iowa PC
🇺🇸
Cedar Rapids, Iowa, United States
Saint Luke's Hospital
🇺🇸
Cedar Rapids, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
Mission Cancer and Blood - West Des Moines
🇺🇸
Clive, Iowa, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Heartland Oncology and Hematology LLP
🇺🇸
Council Bluffs, Iowa, United States
Methodist Jennie Edmundson Hospital
🇺🇸
Council Bluffs, Iowa, United States
Greater Regional Medical Center
🇺🇸
Creston, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Mission Cancer and Blood - Des Moines
🇺🇸
Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Mission Cancer and Blood - Laurel
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
McFarland Clinic - Trinity Cancer Center
🇺🇸
Fort Dodge, Iowa, United States
Trinity Regional Medical Center
🇺🇸
Fort Dodge, Iowa, United States
McFarland Clinic - Jefferson
🇺🇸
Jefferson, Iowa, United States
McFarland Clinic - Marshalltown
🇺🇸
Marshalltown, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, United States
University of Kansas Clinical Research Center
🇺🇸
Fairway, Kansas, United States
Central Care Cancer Center - Garden City
🇺🇸
Garden City, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸
Great Bend, Kansas, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
The University of Kansas Cancer Center - Olathe
🇺🇸
Olathe, Kansas, United States
University of Kansas Cancer Center-Overland Park
🇺🇸
Overland Park, Kansas, United States
Ascension Via Christi - Pittsburg
🇺🇸
Pittsburg, Kansas, United States
Salina Regional Health Center
🇺🇸
Salina, Kansas, United States
University of Kansas Health System Saint Francis Campus
🇺🇸
Topeka, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸
Westwood, Kansas, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸
Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
Ochsner Medical Center Jefferson
🇺🇸
New Orleans, Louisiana, United States
MaineHealth Coastal Cancer Treatment Center
🇺🇸
Bath, Maine, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
🇺🇸
Biddeford, Maine, United States
LincolnHealth - Miles Campus and Hospital
🇺🇸
Damariscotta, Maine, United States
Maine Medical Center-Bramhall Campus
🇺🇸
Portland, Maine, United States
Penobscot Bay Medical Center
🇺🇸
Rockport, Maine, United States
MaineHealth Cancer Care Center of York County
🇺🇸
Sanford, Maine, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
🇺🇸
Sanford, Maine, United States
Maine Medical Center- Scarborough Campus
🇺🇸
Scarborough, Maine, United States
Maine Medical Partners - South Portland
🇺🇸
South Portland, Maine, United States
Luminis Health Anne Arundel Medical Center
🇺🇸
Annapolis, Maryland, United States
Greater Baltimore Medical Center
🇺🇸
Baltimore, Maryland, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
University of Michigan Comprehensive Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
McLaren Cancer Institute-Bay City
🇺🇸
Bay City, Michigan, United States
University of Michigan - Brighton Center for Specialty Care
🇺🇸
Brighton, Michigan, United States
Henry Ford Cancer Institute-Downriver
🇺🇸
Brownstown, Michigan, United States
McLaren Cancer Institute-Clarkston
🇺🇸
Clarkston, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸
Clinton Township, Michigan, United States
Corewell Health Dearborn Hospital
🇺🇸
Dearborn, Michigan, United States
Henry Ford Medical Center-Fairlane
🇺🇸
Dearborn, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Weisberg Cancer Treatment Center
🇺🇸
Farmington Hills, Michigan, United States
Corewell Health Farmington Hills Hospital
🇺🇸
Farmington Hills, Michigan, United States
McLaren Cancer Institute-Flint
🇺🇸
Flint, Michigan, United States
Singh and Arora Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
🇺🇸
Grand Rapids, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
🇺🇸
Grand Rapids, Michigan, United States
Trinity Health Grand Rapids Hospital
🇺🇸
Grand Rapids, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Ascension Borgess Hospital
🇺🇸
Kalamazoo, Michigan, United States
Karmanos Cancer Institute at McLaren Greater Lansing
🇺🇸
Lansing, Michigan, United States
Mid-Michigan Physicians-Lansing
🇺🇸
Lansing, Michigan, United States
McLaren Cancer Institute-Lapeer Region
🇺🇸
Lapeer, Michigan, United States
McLaren Cancer Institute-Macomb
🇺🇸
Mount Clemens, Michigan, United States
Trinity Health Muskegon Hospital
🇺🇸
Muskegon, Michigan, United States
Corewell Health Lakeland Hospitals - Niles Hospital
🇺🇸
Niles, Michigan, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores
🇺🇸
Norton Shores, Michigan, United States
Henry Ford Health Providence Novi Hospital
🇺🇸
Novi, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸
Novi, Michigan, United States
McLaren Cancer Institute-Northern Michigan
🇺🇸
Petoskey, Michigan, United States
McLaren-Port Huron
🇺🇸
Port Huron, Michigan, United States
Corewell Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Corewell Health William Beaumont University Hospital
🇺🇸
Royal Oak, Michigan, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
🇺🇸
Saint Joseph, Michigan, United States
Henry Ford Macomb Health Center - Shelby Township
🇺🇸
Shelby Township, Michigan, United States
Henry Ford Health Providence Southfield Hospital
🇺🇸
Southfield, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Corewell Health Beaumont Troy Hospital
🇺🇸
Troy, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
University of Michigan Health - West
🇺🇸
Wyoming, Michigan, United States
Riverwood Healthcare Center
🇺🇸
Aitkin, Minnesota, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Minnesota Oncology - Burnsville
🇺🇸
Burnsville, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Essentia Health - Deer River Clinic
🇺🇸
Deer River, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
🇺🇸
Detroit Lakes, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Essentia Health - Fosston
🇺🇸
Fosston, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Essentia Health Hibbing Clinic
🇺🇸
Hibbing, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Essentia Health - Park Rapids
🇺🇸
Park Rapids, Minnesota, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, 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
Essentia Health Sandstone
🇺🇸
Sandstone, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Sanford Thief River Falls Medical Center
🇺🇸
Thief River Falls, Minnesota, United States
Essentia Health Virginia Clinic
🇺🇸
Virginia, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Sanford Cancer Center Worthington
🇺🇸
Worthington, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
Siteman Cancer Center at West County Hospital
🇺🇸
Creve Coeur, Missouri, United States
Parkland Health Center - Farmington
🇺🇸
Farmington, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
University of Kansas Cancer Center - North
🇺🇸
Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
University of Kansas Cancer Center at North Kansas City Hospital
🇺🇸
North Kansas City, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸
Rolla, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸
Rolla, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital South
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center-South County
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center at Christian Hospital
🇺🇸
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
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Mercy Hospital Washington
🇺🇸
Washington, Missouri, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Bozeman Health Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Logan Health Medical Center
🇺🇸
Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Community Medical Center
🇺🇸
Toms River, New Jersey, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸
Grand Island, Nebraska, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
🇺🇸
Omaha, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Oncology Associates PC
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Carson Tahoe Regional Medical Center
🇺🇸
Carson City, Nevada, United States
Cancer and Blood Specialists-Henderson
🇺🇸
Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada - Henderson
🇺🇸
Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Horizon Ridge
🇺🇸
Henderson, Nevada, United States
Las Vegas Cancer Center-Henderson
🇺🇸
Henderson, Nevada, United States
OptumCare Cancer Care at Seven Hills
🇺🇸
Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson
🇺🇸
Henderson, Nevada, United States
GenesisCare USA - Henderson
🇺🇸
Henderson, Nevada, United States
Las Vegas Urology - Green Valley
🇺🇸
Henderson, Nevada, United States
Las Vegas Urology - Pebble
🇺🇸
Henderson, Nevada, United States
Urology Specialists of Nevada - Green Valley
🇺🇸
Henderson, Nevada, United States
Las Vegas Urology - Pecos
🇺🇸
Las Vegas, Nevada, United States
Desert West Surgery
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Charleston
🇺🇸
Las Vegas, Nevada, United States
University Medical Center of Southern Nevada
🇺🇸
Las Vegas, Nevada, United States
Hope Cancer Care of Nevada
🇺🇸
Las Vegas, Nevada, United States
Cancer and Blood Specialists-Shadow
🇺🇸
Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Central
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Central
🇺🇸
Las Vegas, Nevada, United States
GenesisCare USA - Las Vegas
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
🇺🇸
Las Vegas, Nevada, United States
Sunrise Hospital and Medical Center
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-San Martin
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Prostate Cancer Center
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Sunset
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Southwest
🇺🇸
Las Vegas, Nevada, United States
Cancer and Blood Specialists-Tenaya
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Southeast
🇺🇸
Las Vegas, Nevada, United States
Ann M Wierman MD LTD
🇺🇸
Las Vegas, Nevada, United States
GenesisCare USA - Vegas Tenaya
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Cathedral Rock
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Smoke Ranch
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at MountainView
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Town Center
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada-Summerlin
🇺🇸
Las Vegas, Nevada, United States
Summerlin Hospital Medical Center
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Cancer Center-Medical Center
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸
Las Vegas, Nevada, United States
GenesisCare USA - Fort Apache
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley
🇺🇸
Las Vegas, Nevada, United States
University Cancer Center
🇺🇸
Las Vegas, Nevada, United States
Hope Cancer Care of Nevada-Pahrump
🇺🇸
Pahrump, Nevada, United States
Renown Regional Medical Center
🇺🇸
Reno, Nevada, United States
Saint Mary's Regional Medical Center
🇺🇸
Reno, Nevada, United States
Radiation Oncology Associates
🇺🇸
Reno, Nevada, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
🇺🇸
Lebanon, New Hampshire, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸
Basking Ridge, New Jersey, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Monmouth Medical Center
🇺🇸
Long Branch, New Jersey, United States
Memorial Sloan Kettering Monmouth
🇺🇸
Middletown, New Jersey, United States
Memorial Sloan Kettering Bergen
🇺🇸
Montvale, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
Rutgers New Jersey Medical School
🇺🇸
Newark, New Jersey, United States
MD Anderson Cancer Center at Cooper-Voorhees
🇺🇸
Voorhees, New Jersey, United States
Lovelace Medical Center-Saint Joseph Square
🇺🇸
Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Lovelace Radiation Oncology
🇺🇸
Albuquerque, New Mexico, United States
Lovelace Women's Hospital
🇺🇸
Albuquerque, New Mexico, United States
Montefiore Medical Center-Einstein Campus
🇺🇸
Bronx, New York, United States
Montefiore Medical Center-Weiler Hospital
🇺🇸
Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸
Bronx, New York, United States
Sands Cancer Center
🇺🇸
Canandiaqua, New York, United States
Memorial Sloan Kettering Commack
🇺🇸
Commack, New York, United States
Mary Imogene Bassett Hospital
🇺🇸
Cooperstown, New York, United States
Noyes Memorial Hospital/Myers Cancer Center
🇺🇸
Dansville, New York, United States
Northwell Health/Center for Advanced Medicine
🇺🇸
Lake Success, New York, United States
Northern Westchester Hospital
🇺🇸
Mount Kisco, New York, United States
Mount Sinai Union Square
🇺🇸
New York, New York, United States
Mount Sinai Chelsea
🇺🇸
New York, New York, United States
Mount Sinai West
🇺🇸
New York, New York, United States
Mount Sinai Hospital
🇺🇸
New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸
New York, New York, United States
Manhattan Eye Ear and Throat Hospital
🇺🇸
New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Lenox Hill Hospital
🇺🇸
New York, New York, United States
Wilmot Cancer Institute Radiation Oncology at Greece
🇺🇸
Rochester, New York, United States
Highland Hospital
🇺🇸
Rochester, New York, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Phelps Memorial Hospital Center
🇺🇸
Sleepy Hollow, New York, United States
Memorial Sloan Kettering Nassau
🇺🇸
Uniondale, New York, United States
Wilmot Cancer Institute at Webster
🇺🇸
Webster, New York, United States
Memorial Sloan Kettering Westchester
🇺🇸
West Harrison, New York, United States
FirstHealth of the Carolinas-Moore Regional Hospital
🇺🇸
Pinehurst, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸
Fargo, North Dakota, United States
Sanford South University Medical Center
🇺🇸
Fargo, North Dakota, United States
Southpointe-Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Essentia Health - Jamestown Clinic
🇺🇸
Jamestown, North Dakota, United States
UH Seidman Cancer Center at UH Avon Health Center
🇺🇸
Avon, Ohio, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸
Beachwood, Ohio, United States
Indu and Raj Soin Medical Center
🇺🇸
Beavercreek, Ohio, United States
Saint Elizabeth Boardman Hospital
🇺🇸
Boardman, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸
Centerville, Ohio, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
Geauga Hospital
🇺🇸
Chardon, Ohio, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸
Cincinnati, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸
Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸
Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
MetroHealth Medical Center
🇺🇸
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
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Premier Blood and Cancer Center
🇺🇸
Dayton, Ohio, United States
Dayton Physician LLC - Englewood
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
Armes Family Cancer Center
🇺🇸
Findlay, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Orion Cancer Care
🇺🇸
Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸
Greenville, Ohio, United States
Miami Valley Cancer Care and Infusion
🇺🇸
Greenville, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸
Independence, Ohio, United States
Greater Dayton Cancer Center
🇺🇸
Kettering, Ohio, United States
First Dayton Cancer Care
🇺🇸
Kettering, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, 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
University Hospitals Portage Medical Center
🇺🇸
Ravenna, Ohio, United States
UH Seidman Cancer Center at Firelands Regional Medical Center
🇺🇸
Sandusky, Ohio, United States
Springfield Regional Cancer Center
🇺🇸
Springfield, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Cleveland Clinic Cancer Center Strongsville
🇺🇸
Strongsville, Ohio, United States
Dayton Physicians LLC - Troy
🇺🇸
Troy, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Saint Joseph Warren Hospital
🇺🇸
Warren, Ohio, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸
West Chester, Ohio, United States
UH Seidman Cancer Center at Saint John Medical Center
🇺🇸
Westlake, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸
Westlake, Ohio, United States
Saint Elizabeth Youngstown Hospital
🇺🇸
Youngstown, Ohio, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸
Lawton, Oklahoma, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Saint Alphonsus Cancer Care Center-Baker City
🇺🇸
Baker City, Oregon, United States
Saint Charles Health System
🇺🇸
Bend, Oregon, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸
Clackamas, Oregon, United States
Bay Area Hospital
🇺🇸
Coos Bay, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Saint Alphonsus Cancer Care Center-Ontario
🇺🇸
Ontario, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸
Oregon City, Oregon, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Oregon Health and Science University
🇺🇸
Portland, Oregon, United States
Saint Charles Health System-Redmond
🇺🇸
Redmond, Oregon, United States
UPMC Altoona
🇺🇸
Altoona, Pennsylvania, United States
UPMC-Heritage Valley Health System Beaver
🇺🇸
Beaver, Pennsylvania, United States
Carlisle Regional Cancer Center
🇺🇸
Carlisle, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸
Chadds Ford, Pennsylvania, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
UPMC Hillman Cancer Center Erie
🇺🇸
Erie, Pennsylvania, United States
UPMC Cancer Center at UPMC Horizon
🇺🇸
Farrell, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸
Greensburg, Pennsylvania, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸
Harrisburg, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸
Johnstown, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸
Lewisburg, Pennsylvania, United States
Lewistown Hospital
🇺🇸
Lewistown, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸
McKeesport, Pennsylvania, United States
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
🇺🇸
Mechanicsburg, Pennsylvania, United States
UPMC Cancer Center - Monroeville
🇺🇸
Monroeville, Pennsylvania, United States
UPMC Hillman Cancer Center in Coraopolis
🇺🇸
Moon Township, Pennsylvania, United States
UPMC Hillman Cancer Center - New Castle
🇺🇸
New Castle, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Saint Margaret
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center
🇺🇸
Pittsburgh, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸
Pottsville, Pennsylvania, 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
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
UPMC Susquehanna
🇺🇸
Williamsport, Pennsylvania, United States
Divine Providence Hospital
🇺🇸
Williamsport, Pennsylvania, United States
UPMC Memorial
🇺🇸
York, Pennsylvania, United States
Smilow Cancer Hospital Care Center - Westerly
🇺🇸
Westerly, Rhode Island, United States
AnMed Health Cancer Center
🇺🇸
Anderson, South Carolina, United States
Gibbs Cancer Center-Gaffney
🇺🇸
Gaffney, South Carolina, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Gibbs Cancer Center-Pelham
🇺🇸
Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Spartanburg Medical Center
🇺🇸
Spartanburg, South Carolina, United States
MGC Hematology Oncology-Union
🇺🇸
Union, South 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
Vanderbilt University/Ingram Cancer Center
🇺🇸
Nashville, Tennessee, United States
Saint Joseph Regional Cancer Center
🇺🇸
Bryan, Texas, United States
MD Anderson in The Woodlands
🇺🇸
Conroe, Texas, United States
Parkland Memorial Hospital
🇺🇸
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Fort Worth
🇺🇸
Fort Worth, Texas, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
MD Anderson West Houston
🇺🇸
Houston, Texas, United States
MD Anderson League City
🇺🇸
League City, Texas, United States
UT Southwestern Clinical Center at Richardson/Plano
🇺🇸
Richardson, Texas, United States
MD Anderson in Sugar Land
🇺🇸
Sugar Land, Texas, United States
Farmington Health Center
🇺🇸
Farmington, Utah, United States
University of Utah Sugarhouse Health Center
🇺🇸
Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸
Berlin, Vermont, United States
University of Vermont Medical Center
🇺🇸
Burlington, Vermont, United States
University of Vermont and State Agricultural College
🇺🇸
Burlington, Vermont, United States
Dartmouth Cancer Center - North
🇺🇸
Saint Johnsbury, Vermont, United States
Providence Regional Cancer System-Aberdeen
🇺🇸
Aberdeen, Washington, United States
Overlake Medical Center
🇺🇸
Bellevue, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸
Centralia, Washington, United States
Swedish Cancer Institute-Edmonds
🇺🇸
Edmonds, Washington, United States
Providence Regional Cancer Partnership
🇺🇸
Everett, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸
Issaquah, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸
Kennewick, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸
Lacey, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸
Longview, Washington, United States
Skagit Regional Health Cancer Care Center
🇺🇸
Mount Vernon, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Valley Medical Center
🇺🇸
Renton, Washington, United States
Pacific Gynecology Specialists
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-Cherry Hill
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
PeaceHealth United General Medical Center
🇺🇸
Sedro-Woolley, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸
Shelton, Washington, United States
Saint Michael Cancer Center
🇺🇸
Silverdale, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸
Tacoma, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸
Walla Walla, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸
Yakima, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸
Yelm, Washington, United States
ThedaCare Regional Cancer Center
🇺🇸
Appleton, Wisconsin, United States
Duluth Clinic Ashland
🇺🇸
Ashland, Wisconsin, United States
Northwest Wisconsin Cancer Center
🇺🇸
Ashland, Wisconsin, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸
Burlington, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Aurora Health Care Germantown Health Center
🇺🇸
Germantown, Wisconsin, United States
Aurora Cancer Care-Grafton
🇺🇸
Grafton, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸
Green Bay, Wisconsin, United States
Essentia Health-Hayward Clinic
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