Stereotactic Body Radiation Therapy or Intensity-Modulated Radiation Therapy in Treating Patients With Stage IIA-B Prostate Cancer
- Conditions
- Stage II Prostate Adenocarcinoma
- Interventions
- Radiation: Stereotactic Body Radiation Therapy (SBRT)Radiation: Intensity-Modulated Radiation Therapy (IMRT)
- Registration Number
- NCT03367702
- Lead Sponsor
- NRG Oncology
- Brief Summary
This randomized phase III trial studies how well stereotactic body radiation therapy works compared to intensity-modulated radiation therapy in treating patients with stage IIA-B prostate cancer. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Stereotactic body radiation therapy is a specialized radiation therapy that sends x-rays directly to the tumor using smaller doses over several days and may cause less damage to normal tissue. Stereotactic body radiation therapy may work better in treating patients with prostate cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine whether stereotactic body radiation therapy (SBRT) can be shown to be superior to hypofractionated intensity-modulated radiation therapy (IMRT) in terms of genitourinary (GU) and gastrointestinal (GI) toxicity by having fewer patients that experience a minimal important decline (MID) in urinary irritation/obstructive and bowel Health Related Quality of Life (HRQOL) as measured by Expanded Prostate Cancer Index Composite (EPIC)-26 at 24 months post completion of therapy.
SECONDARY OBJECTIVES:
I. To determine if SBRT (5 fractions of 7.25 Gy) is superior to hypofractionated IMRT (28 fractions of 2.5 Gy) as measured by disease free survival (DFS).
II. To determine whether SBRT can be shown to be superior to hypofractionated IMRT at 12 and 24 months post completion of therapy in terms of HRQOL by having fewer patients that experience a minimal important decline (MID) bowel (12 months only) sexual, hormonal, urinary irritation/obstructive (12 months only) and in urinary incontinence HRQOL as measured by EPIC-26.
III. To determine if SBRT (5 fractions of 7.25 Gy) is superior to hypofractionated IMRT (28 fractions of 2.5 Gy) as measured by biochemical failure, overall survival, local failure, prostate cancer specific survival, and distant metastases.
IV. To determine if prostate imaging-reporting and data system (PIRADS)version (v)2 = 4/5 disease is predictive for biochemical failure.
TERTIARY OBJECTIVES:
I. To determine whether a potentially more expensive therapy, SBRT, would be cost-effective than standard hypofractionated IMRT as measured by the European Quality of Life Five Dimension Five Level Scale Questionnaire (EQ-5D-5L).
II. To determine if disease characteristics captured on MRI can be used to predict which patients will respond to SBRT versus hypofractionated IMRT.
III. Collect specimens for future translational research analyses.
OUTLINE: Patients are randomized into 1 of 2 arms.
ARM I: Patients undergo IMRT once daily for 5 fractions per week for 28 fractions over less than 32 business days.
ARM II: Patients undergo SBRT at least every other day for 2-3 fractions per week for 5 fractions over less than 12 business days.
After completion of study treatment, patients are followed up every 6-12 months until death or study termination.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- Male
- Target Recruitment
- 698
-
Previously untreated (no local therapy such as surgery, radiation cryotherapy, HIFU, etc.) localized adenocarcinoma of the prostate with the following clinical findings:
-
Clinical stage by digital rectal exam of either T1c or T2a/b (limited to one side of the gland); (American Joint Committee on Cancer [AJCC], version 7) or cT1a-c or 2a or 2b,
-
Stages T1a-T1b are eligible if patient underwent transurethral prostatic resection (TURP),
-
The patient must meet one of the following 3 criteria: 1) Gleason score must be Gleason 7(3+4) with a PSA < 20 ng/mL, or 2) Gleason 6(3+3) with a PSA > 10 ng/mL and < 20 ng/mL which is considered intermediate risk and eligible for the study. (AJCC, version 7) or 3) Group Grade 1 with a PSA > 10 ng/mL and < 20 ng/mL or 2 with a PSA < 20 ng/mL.
-
If patient is receiving a 5-alpha reductase inhibitor at the time of enrollment the baseline PSA value may be double the initial value and the medication should be discontinued but a washout period is not required to eligible, a PSA drawn while still on the medicine must be:
- < 10 ng/mL if Gleason 7(3+4) (Note: This patient would be on stratification level 1 if PSA < 5 ng/mL and stratification level 2 if less than 10 ng/mL).
- > 5 ng/mL and less than 10 ng/mL for Gleason 6(3+3) (Note: This patients would be on stratification level 3).
-
-
The prostate volume must be < 70 cc as reported at time of biopsy or by separate measure with ultrasound or other imaging modalities including magnetic resonance imaging (MRI) or computed tomography (CT) scan
-
Patients in active surveillance who elect to be treated are eligible if they meet protocol requirements
-
-
History and physical including a digital rectal exam 60 days prior to registration
-
Eastern Cooperative Oncology Group (ECOG) performance status 0-1 60 days prior to registration
-
MRI of the prostate and pelvis (per institutional SOC - should be compliant with PIRADSv2.1 guidelines) within 1 year prior to registration
-
Bone scan or sodium fluoride positron emission tomography (PET) scan within 120 days prior to registration
-
Charlson modified co-morbidity score =< 4 for patients under 60 and =< 5 for patients 60 and over 21 days prior to registration
-
International prostate symptom score (IPSS) of < 15 21 days prior to registration
-
The patient must provide study-specific informed consent prior to study entry
-
Willingness and ability to complete the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire
-
Completion of all items of the EPIC-26 which will be data entered at registration 60 days prior to registration
-
Only English, Spanish, and French-speaking patients are eligible to participate
-
Definitive clinical or radiologic evidence of metastatic disease; no nodal involvement or evidence of metastatic disease allowed as defined by screening of the pelvis and a bone scan or sodium fluoride PET scan
-
Definitive T3 disease on MRI
-
Prior or current invasive malignancy with current evidence of active disease within the past 2 years
- Exceptions: Non-melanomatous skin cancer, carcinoma in situ of the male breast, penis, oral cavity, or stage Ta of the bladder, or stage I completely resected melanoma.
-
Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable; must be off treatment for at least 3 years
-
Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
-
The use of hormonal therapy is not allowed; if the patient in on a 5-alpha reductase inhibitor, then they should be stopped prior to treatment once enrolled onto the study; no washout period is required for this study to participate
-
Severe, active co-morbidity defined as follows:
- Human immunodeficiency virus (HIV) positive with CD4 count < 200 cells/microliter; Note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count >= 200 cells/microliter within 30 days prior to registration; Note also that HIV testing is not required for eligibility for this protocol
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol; (patients on Coumadin or other blood thinning agents are eligible for this study)
-
Contraindication to MRI
- Cardiac pacemaker or defibrillator
- Surgically implanted electrical devices such as spinal stimulation devices or intracranial stimulation devices, cochlear implants, the presence of metallic foreign bodies in the orbits, and incompatible old mechanical heart valves and aneurysm clips
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Stereotactic Body Radiation Therapy (SBRT) Stereotactic Body Radiation Therapy (SBRT) Patients undergo Stereotactic Body Radiation Therapy (SBRT) at least every other day for 2-3 fractions per week for 5 fractions over less than 12 business days. Intensity-Modulated Radiation Therapy (IMRT) Intensity-Modulated Radiation Therapy (IMRT) Patients undergo Intensity-Modulated Radiation Therapy (IMRT) once daily 5 fractions per week for 28 fractions over less than 32 business days.
- Primary Outcome Measures
Name Time Method Incidence of Patients-Reported Gastrointestinal and Genitourinary Toxicity Up to 2 years Will be measured by Expanded Prostate Cancer Index Composite-(EPIC) 26 bowel and urinary irritation domains. Will be compared between treatment arms using a test of proportions with two-sided significance level of 0.05.
Disease Free Survival Time to biochemical failure (Phoenix definition), local failure, regional failure, distant metastasis, or death from any cause, assessed up to 2 years Will be estimated using the Kaplan-Meier method and treatment arms compared using the stratified log-rank test.
- Secondary Outcome Measures
Name Time Method Incidence of adverse events (AEs) Up to 2 years Will be assessed by Common Terminology Criteria for Adverse Events version 4. Counts of all AEs by grade will be provided by treatment arm. Counts and frequencies will be provided for the worst grade AE experienced by the patient by treatment arm. The number of patients with at least 1 grade 3 or higher AE will be compared between the treatment arms. A comparison between treatment arms of grade 3 and higher genitourinary (GU) and gastrointestinal (GI) events related to treatment (separately) will also be tested. There are 5 pre-specified AEs, dysuria, hematuria, incontinence, rectal bleeding,
Biochemical Failure yearsFrom the date of randomization to the date of biochemical failure, date of precluding death, or last known follow-up, assessed up to 5 years. Will be assessed by Phoenix definition.
Distant Metastasis From the time of randomization to the date of distant metastasis, date of precluding death, or last known follow-up date , assessed for up to 5 years Will be assessed.
Health Related Quality of Life Up to 2 years Will be measured by EPIC-26 urinary incontinence, sexual, and hormonal domains.
Prostate Cancer Specific Survival yearsFrom the date of randomization to the date of prostate cancer death, date of precluding death, or last known follow-up date, assessed up to 5 years Will be assessed.
Local Failure From the time of randomization to the date of local failure, date of precluding death, or last known follow-up date, assessed for up to 5 years Will be assessed.
Overall Survival From the date of randomization to the date of death or last known follow-up date, assessed up to 5 years Will be estimated using the Kaplan-Meier method and treatment arms compared using the stratified log-rank test.
Presence of Prostate Imaging-Reporting and Data System version (PIRADSv) 2 = 4/5 disease Baseline Will be assessed by magnetic resonance imaging (MRI).
Regional Failure From the time of randomization to the date of local failure, date of precluding death, or last known follow-up date, assessed for up to 5 years Will be assessed.
Trial Locations
- Locations (293)
Stanford Cancer Institute Palo Alto
🇺🇸Palo Alto, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸Rancho Cordova, California, United States
Mercy Cancer Center - Rocklin
🇺🇸Rocklin, California, United States
Rohnert Park Cancer Center
🇺🇸Rohnert Park, California, United States
CIUSSSEMTL-Hopital Maisonneuve-Rosemont
🇨🇦Montreal, Quebec, Canada
Mobile Infirmary Medical Center
🇺🇸Mobile, Alabama, United States
Lewis and Faye Manderson Cancer Center
🇺🇸Tuscaloosa, Alabama, United States
Arizona Center for Cancer Care - Gilbert
🇺🇸Gilbert, Arizona, United States
Arizona Center for Cancer Care-Peoria
🇺🇸Peoria, Arizona, United States
Arizona Center for Cancer Care - Scottsdale
🇺🇸Scottsdale, Arizona, United States
Arizona Center for Cancer Care-Surprise
🇺🇸Surprise, Arizona, United States
Arizona Oncology Associates-West Orange Grove
🇺🇸Tucson, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
Mercy Cancer Center - Carmichael
🇺🇸Carmichael, California, United States
Kaiser Permanente Dublin
🇺🇸Dublin, California, United States
Kaiser Permanente-Anaheim
🇺🇸Anaheim, California, United States
Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Los Angeles General Medical Center
🇺🇸Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Mercy Cancer Center - Elk Grove
🇺🇸Elk Grove, California, United States
Fresno Cancer Center
🇺🇸Fresno, California, United States
Marin General Hospital
🇺🇸Greenbrae, California, United States
Memorial Medical Center
🇺🇸Modesto, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸Oakland, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸Roseville, California, United States
Mercy Cancer Center - Sacramento
🇺🇸Sacramento, California, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Salinas Valley Memorial
🇺🇸Salinas, California, United States
Stanford Cancer Center South Bay
🇺🇸San Jose, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸South San Francisco, California, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
🇺🇸Truckee, California, United States
Woodland Memorial Hospital
🇺🇸Woodland, California, United States
UCHealth University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
UCHealth Memorial Hospital Central
🇺🇸Colorado Springs, Colorado, United States
Memorial Hospital North
🇺🇸Colorado Springs, Colorado, United States
AdventHealth Porter
🇺🇸Denver, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Valley View Hospital Cancer Center
🇺🇸Glenwood Springs, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Smilow Cancer Hospital Care Center - Guilford
🇺🇸Guilford, Connecticut, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull
🇺🇸Trumbull, Connecticut, United States
Smilow Cancer Hospital Care Center - Waterford
🇺🇸Waterford, Connecticut, United States
Beebe South Coastal Health Campus
🇺🇸Millville, Delaware, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Broward Health North
🇺🇸Deerfield Beach, Florida, United States
Broward Health Medical Center
🇺🇸Fort Lauderdale, Florida, United States
GenesisCare USA - Key West
🇺🇸Key West, Florida, United States
GenesisCare USA - Lakewood Ranch
🇺🇸Lakewood Ranch, Florida, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
John Fitzgerald Kennedy Medical Center
🇺🇸Atlantis, Florida, United States
Mount Sinai Comprehensive Cancer Center at Aventura
🇺🇸Aventura, Florida, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
GenesisCare USA - Plantation
🇺🇸Plantation, Florida, United States
Grady Health System
🇺🇸Atlanta, Georgia, United States
Emory University Hospital Midtown
🇺🇸Atlanta, Georgia, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸Atlanta, Georgia, United States
Piedmont Fayette Hospital
🇺🇸Fayetteville, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa
🇺🇸Nampa, Idaho, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Edward Hines Jr VA Hospital
🇺🇸Hines, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Franciscan Health Indianapolis
🇺🇸Indianapolis, Indiana, United States
Franciscan Health Mooresville
🇺🇸Mooresville, Indiana, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
MaineHealth Cancer Care Center of York County
🇺🇸Sanford, Maine, United States
Springfield Memorial Hospital
🇺🇸Springfield, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Midwestern Regional Medical Center
🇺🇸Zion, Illinois, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
UM Baltimore Washington Medical Center/Tate Cancer Center
🇺🇸Glen Burnie, Maryland, United States
TidalHealth Richard A Henson Cancer Institute
🇺🇸Ocean Pines, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Mass General/North Shore Cancer Center
🇺🇸Danvers, Massachusetts, United States
Weisberg Cancer Treatment Center
🇺🇸Farmington Hills, Michigan, United States
McLaren Cancer Institute-Flint
🇺🇸Flint, Michigan, United States
McLaren Cancer Institute-Macomb
🇺🇸Mount Clemens, Michigan, United States
McLaren-Port Huron
🇺🇸Port Huron, Michigan, United States
Corewell Health William Beaumont University Hospital
🇺🇸Royal Oak, Michigan, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Parkview Regional Medical Center
🇺🇸Fort Wayne, Indiana, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
LSU Healthcare Network / Metairie Multi-Specialty Clinic
🇺🇸Metairie, Louisiana, United States
Tulane University School of Medicine
🇺🇸New Orleans, Louisiana, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸Ann Arbor, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
McLaren Cancer Institute-Northern Michigan
🇺🇸Petoskey, Michigan, United States
Corewell Health Beaumont Troy Hospital
🇺🇸Troy, Michigan, United States
University of Michigan Health - West
🇺🇸Wyoming, Michigan, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Bozeman Health Deaconess Hospital
🇺🇸Bozeman, Montana, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
East Jefferson General Hospital
🇺🇸Metairie, Louisiana, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
Luminis Health Anne Arundel Medical Center
🇺🇸Annapolis, Maryland, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Central Maryland Radiation Oncology in Howard County
🇺🇸Columbia, Maryland, United States
TidalHealth Peninsula Regional
🇺🇸Salisbury, Maryland, United States
Michigan Healthcare Professionals Troy
🇺🇸Troy, Michigan, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
SSM Health Saint Louis University Hospital
🇺🇸Saint Louis, Missouri, United States
Logan Health Medical Center
🇺🇸Kalispell, Montana, United States
Community Medical Center
🇺🇸Missoula, Montana, United States
MaineHealth Coastal Cancer Treatment Center
🇺🇸Bath, Maine, United States
Maine Medical Center-Bramhall Campus
🇺🇸Portland, Maine, United States
University of Maryland Shore Medical Center at Easton
🇺🇸Easton, Maryland, United States
McLaren Cancer Institute-Bay City
🇺🇸Bay City, Michigan, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Michigan Healthcare Professionals Farmington
🇺🇸Farmington Hills, Michigan, United States
Saint Agnes Hospital
🇺🇸Baltimore, Maryland, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
McLaren Cancer Institute-Clarkston
🇺🇸Clarkston, Michigan, United States
Michigan Healthcare Professionals Clarkston
🇺🇸Clarkston, Michigan, United States
Corewell Health Dearborn Hospital
🇺🇸Dearborn, Michigan, United States
Corewell Health Farmington Hills Hospital
🇺🇸Farmington Hills, Michigan, United States
Karmanos Cancer Institute at McLaren Greater Lansing
🇺🇸Lansing, Michigan, United States
Siteman Cancer Center at West County Hospital
🇺🇸Creve Coeur, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸Saint Peters, Missouri, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
🇺🇸Grand Rapids, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸Lansing, Michigan, United States
Michigan Healthcare Professionals Macomb
🇺🇸Macomb, Michigan, United States
Michigan Healthcare Professionals Madison Heights
🇺🇸Madison Heights, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Siteman Cancer Center-South County
🇺🇸Saint Louis, Missouri, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Exeter Hospital
🇺🇸Exeter, New Hampshire, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
🇺🇸Lebanon, New Hampshire, United States
The Valley Hospital - Luckow Pavilion
🇺🇸Paramus, New Jersey, United States
Capital Health Medical Center-Hopewell
🇺🇸Pennington, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Lovelace Radiation Oncology
🇺🇸Albuquerque, New Mexico, United States
New Mexico Oncology Hematology Consultants
🇺🇸Albuquerque, New Mexico, United States
Saint Peter's Health Partners
🇺🇸Albany, New York, United States
New York-Presbyterian/Brooklyn Methodist Hospital
🇺🇸Brooklyn, New York, United States
Sands Cancer Center
🇺🇸Canandaigua, New York, United States
Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
Garnet Health Medical Center
🇺🇸Middletown, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
Highland Hospital
🇺🇸Rochester, 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
Durham VA Medical Center
🇺🇸Durham, North Carolina, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Scotland Memorial Hospital-Laurinburg Cancer Center
🇺🇸Laurinburg, North Carolina, United States
Duke Raleigh Hospital
🇺🇸Raleigh, North Carolina, United States
Novant Cancer Institute Radiation Oncology - Supply
🇺🇸Supply, North Carolina, United States
Novant Health Cancer Institute Radiation Oncology - Wilmington
🇺🇸Wilmington, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
Geauga Hospital
🇺🇸Chardon, Ohio, United States
The Christ Hospital
🇺🇸Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸Elyria, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸Independence, Ohio, United States
Cleveland Clinic Cancer Center Mansfield
🇺🇸Mansfield, 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
University Hospitals Portage Medical Center
🇺🇸Ravenna, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Legacy Mount Hood Medical Center
🇺🇸Gresham, Oregon, United States
Christiana Care Health System-Concord Health Center
🇺🇸Chadds Ford, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
ProMedica Flower Hospital
🇺🇸Sylvania, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Cleveland Clinic Wooster Family Health and Surgery Center
🇺🇸Wooster, Ohio, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸Portland, Oregon, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸Allentown, Pennsylvania, United States
Fox Chase Cancer Center - East Norriton Hospital Outpatient Center
🇺🇸East Norriton, Pennsylvania, United States
Fox Chase Cancer Center Buckingham
🇺🇸Furlong, Pennsylvania, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸Lewisburg, Pennsylvania, United States
Lewistown Hospital
🇺🇸Lewistown, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Jefferson Torresdale Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Temple University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Asplundh Cancer Pavilion
🇺🇸Willow Grove, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
WellSpan Health-York Cancer Center
🇺🇸York, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
Self Regional Healthcare
🇺🇸Greenwood, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
The Radiation Oncology Center-Hilton Head/Bluffton
🇺🇸Hilton Head Island, South Carolina, United States
Carolina Regional Cancer Center
🇺🇸Myrtle Beach, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
Texas Cancer Center
🇺🇸Abilene, Texas, United States
Texas Oncology-McKinney
🇺🇸McKinney, Texas, United States
Texas Oncology-Plano West
🇺🇸Plano, Texas, United States
Texas Oncology Cancer Center Sugar Land
🇺🇸Sugar Land, Texas, United States
Deke Slayton Cancer Center
🇺🇸Webster, Texas, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Saint George Regional Medical Center
🇺🇸Saint George, Utah, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸Berlin, Vermont, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Dartmouth Cancer Center - North
🇺🇸Saint Johnsbury, Vermont, United States
Sentara Cancer Institute at Sentara CarePlex Hospital
🇺🇸Hampton, Virginia, United States
Bon Secours DePaul Medical Center
🇺🇸Norfolk, Virginia, United States
Sentara Norfolk General Hospital
🇺🇸Norfolk, Virginia, United States
Bon Secours Cancer Institute at Reynolds Crossing
🇺🇸Richmond, Virginia, United States
Oncology and Hematology Associates of Southwest Virginia
🇺🇸Roanoke, Virginia, United States
Sentara Obici Hospital
🇺🇸Suffolk, Virginia, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Legacy Salmon Creek Hospital
🇺🇸Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
West Virginia University Charleston Division
🇺🇸Charleston, West Virginia, United States
West Virginia University Healthcare
🇺🇸Morgantown, West Virginia, United States
Ascension Saint Elizabeth Hospital
🇺🇸Appleton, Wisconsin, United States
Ascension Southeast Wisconsin Hospital - Elmbrook Campus
🇺🇸Brookfield, Wisconsin, United States
Ascension Saint Francis - Reiman Cancer Center
🇺🇸Franklin, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Froedtert Menomonee Falls Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
Ascension Mercy Hospital
🇺🇸Oshkosh, Wisconsin, United States
Tom Baker Cancer Centre
🇨🇦Calgary, Alberta, Canada
Juravinski Cancer Centre at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Centre De Sante Et De Services Sociaux De Chicoutimi
🇨🇦Chicoutimi, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
🇨🇦Sherbrooke, Quebec, Canada
Ascension Columbia Saint Mary's Hospital Ozaukee
🇺🇸Mequon, Wisconsin, United States
CHUM - Centre Hospitalier de l'Universite de Montreal
🇨🇦Montreal, Quebec, Canada
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
🇨🇦Quebec City, Quebec, Canada
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Tata Memorial Hospital
🇮🇳Mumbai, India
Beacon Hospital
🇮🇪Dublin, Co Dublin, Ireland
Saint Lukes Hospital
🇮🇪Dublin, Co Dublin, Ireland
Ascension Columbia Saint Mary's Hospital - Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Zablocki Veterans Administration Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Drexel Town Square Health Center
🇺🇸Oak Creek, Wisconsin, United States
Ascension All Saints Hospital
🇺🇸Racine, Wisconsin, United States
Froedtert West Bend Hospital/Kraemer Cancer Center
🇺🇸West Bend, Wisconsin, United States
Ottawa Hospital and Cancer Center-General Campus
🇨🇦Ottawa, Ontario, Canada
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
The Research Institute of the McGill University Health Centre (MUHC)
🇨🇦Montreal, Quebec, Canada
Pamela Youde Nethersole Eastern Hospital
ðŸ‡ðŸ‡°Chai Wan, Hong Kong
Kantonsspital Aarau
🇨ðŸ‡Aarau, Switzerland