Radiation Therapy With or Without Radiosurgery in Treating Patients With Brain Metastases
- Conditions
- Metastatic Cancer
- Interventions
- Procedure: surgical procedureRadiation: radiation therapyRadiation: stereotactic radiosurgery
- Registration Number
- NCT00002708
- Lead Sponsor
- Radiation Therapy Oncology Group
- Brief Summary
RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known whether giving radiation therapy during surgery is more effective than standard radiation therapy in treating brain metastases.
PURPOSE: Randomized phase III trial to compare the effectiveness of radiation therapy with or without radiosurgery in treating patients with brain metastases that cannot be removed during surgery.
- Detailed Description
OBJECTIVES: I. Compare the overall survival of patients with one unresected brain metastasis treated with conventional whole brain radiotherapy (WBRT) with vs. without a stereotactic radiosurgery (SRS) boost. II. Compare sites of recurrence and cause of death in these patients treated with WBRT followed by SRS vs. WBRT alone.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to center and extracranial disease (yes or no). Patients are randomized to one of two treatment arms. Arm I: Patients receive fractionated external beam whole brain irradiation (WBRT) 5 days each week for 3 weeks. Both portals are treated during each radiotherapy session. Patients who still have a solitary lesion with a diameter no greater than 4.0 cm also receive stereotactic radiosurgery within 7 days of completing WBRT. Arm II: Patients receive WBRT only. Patients are followed every 3 months for 1 year, then every 4 months for 2 years, and then annually.
PROJECTED ACCRUAL: A total of 262 patients will be accrued over 2.5-3.75 years for this study. The study may close early if interim analysis after 33% and 67% of patients have been followed for 6 months produces significant results. After 6/14/99 an additional 46 patients with a solitary brain metastasis only will be accrued.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 333
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm 1 surgical procedure Whole brain radiation therapy (WBRT) to 37.5 Gy/15 fractions/2.5 Gy once daily, 5 days/week followed by radiosurgery to all metastases Arm 1 radiation therapy Whole brain radiation therapy (WBRT) to 37.5 Gy/15 fractions/2.5 Gy once daily, 5 days/week followed by radiosurgery to all metastases Arm 2 radiation therapy WBRT to 37.5 Gy/15 fractions/2.5 Gy once daily, 5 days/week Arm 1 stereotactic radiosurgery Whole brain radiation therapy (WBRT) to 37.5 Gy/15 fractions/2.5 Gy once daily, 5 days/week followed by radiosurgery to all metastases
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (258)
Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Kimmel Cancer Center of Thomas Jefferson University - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Albert Einstein Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Kaiser Permanente Medical Center - Los Angeles
🇺🇸Los Angeles, California, United States
Jonsson Comprehensive Cancer Center, UCLA
🇺🇸Los Angeles, California, United States
Beckman Research Institute, City of Hope
🇺🇸Los Angeles, California, United States
CCOP - Columbus
🇺🇸Columbus, Ohio, United States
University of Pittsburgh Cancer Institute
🇺🇸Pittsburgh, Pennsylvania, United States
Mercy Hospital of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Northwestern Memorial Hospital
🇺🇸Chicago, Illinois, United States
University of Chicago Cancer Research Center
🇺🇸Chicago, Illinois, United States
Greater Baltimore Medical Center and Cancer Center
🇺🇸Baltimore, Maryland, United States
Swedish Cancer Institute
🇺🇸Seattle, Washington, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Veterans Affairs Medical Center - Miami
🇺🇸Miami, Florida, United States
Baptist Hospital of Miami
🇺🇸Miami, Florida, United States
Veterans Affairs Medical Center - Indianapolis (Roudebush)
🇺🇸Indianapolis, Indiana, United States
Clarion Health Partners Inc.
🇺🇸Indianapolis, Indiana, United States
University of Texas - MD Anderson Cancer Center
🇺🇸Houston, Texas, United States
CCOP - Southern Nevada Cancer Research Foundation
🇺🇸Las Vegas, Nevada, United States
Radiation Medical Group, Inc.
🇺🇸San Diego, California, United States
Christ Hospital
🇺🇸Cincinnati, Ohio, United States
UCSF Cancer Center and Cancer Research Institute
🇺🇸San Francisco, California, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
St. Anthony Hospital
🇺🇸Oklahoma City, Oklahoma, United States
University of Alabama Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
University of Colorado Cancer Center
🇺🇸Denver, Colorado, United States
CCOP - Columbia River Program
🇺🇸Portland, Oregon, United States
Green Mountain Oncology Group
🇺🇸Rutland, Vermont, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
St. Joseph's Hospital
🇺🇸Milwaukee, Wisconsin, United States
St. Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Methodist Cancer Center - Omaha
🇺🇸Omaha, Nebraska, United States
Nebraska Health System
🇺🇸Omaha, Nebraska, United States
New York Medical College
🇺🇸Valhalla, New York, United States
East Texas Medical Center - Cancer Institute
🇺🇸Tyler, Texas, United States
Bayshore Medical Center
🇺🇸Pasadena, Texas, United States
Fox Chase Cancer Center at Virtua Memorial Hospital Burlington County
🇺🇸Mount Holly, New Jersey, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Huntsville Hospital System
🇺🇸Huntsville, Alabama, United States
Cancer Care Center
🇺🇸Pomona, California, United States
CCOP - Bay Area Tumor Institute
🇺🇸Oakland, California, United States
CCOP - Santa Rosa Memorial Hospital
🇺🇸Santa Rosa, California, United States
MBCCOP - Gulf Coast
🇺🇸Mobile, Alabama, United States
Comprehensive Cancer Institute of Huntsville
🇺🇸Huntsville, Alabama, United States
Mobile Infirmary Medical Center
🇺🇸Mobile, Alabama, United States
Providence Cancer Therapy Center
🇺🇸Anchorage, Alaska, United States
Urology Associates - Mobile AL
🇺🇸Mobile, Alabama, United States
Stanford University
🇺🇸Stanford, California, United States
CCOP - Christiana Care Health Services
🇺🇸Wilmington, Delaware, United States
Halifax Medical Center
🇺🇸Daytona Beach, Florida, United States
Lykes Center for Radiation Therapy
🇺🇸Clearwater, Florida, United States
Health First Holmes Regional Medical Center
🇺🇸Melbourne, Florida, United States
CCOP - Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
West Florida Cancer Institute - Pensacola
🇺🇸Pensacola, Florida, United States
InterCommunity Cancer Center at Rome
🇺🇸Rome, Georgia, United States
CCOP - Central Illinois
🇺🇸Decatur, Illinois, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
Johns Hopkins Oncology Center
🇺🇸Baltimore, Maryland, United States
Cape Cod Hospital
🇺🇸Hyannis, Massachusetts, United States
Peninsula Regional Medical Center
🇺🇸Salisbury, Maryland, United States
Radiation Oncology Affiliates of Maryland, P.A.
🇺🇸Baltimore, Maryland, United States
William Beaumont Hospital
🇺🇸Royal Oak, Michigan, United States
St. Mary's Medical Center
🇺🇸Saginaw, Michigan, United States
John F. Kennedy Medical Center
🇺🇸Edison, New Jersey, United States
State University of New York Health Science Center at Brooklyn
🇺🇸Brooklyn, New York, United States
Monmouth Medical Center
🇺🇸Long Branch, New Jersey, United States
Beth Israel Medical Center
🇺🇸New York, New York, United States
Ireland Cancer Center
🇺🇸Cleveland, Ohio, United States
Catawba Memorial Hospital
🇺🇸Hickory, North Carolina, United States
Akron City Hospital
🇺🇸Akron, Ohio, United States
St. John Medical Center
🇺🇸Tulsa, Oklahoma, United States
Lehigh Valley Hospital
🇺🇸Allentown, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Western Pennsylvania Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
CCOP - MainLine Health
🇺🇸Wynnewood, Pennsylvania, United States
Baptist Regional Cancer Center - Knoxville
🇺🇸Knoxville, Tennessee, United States
CCOP - Baptist Cancer Institute
🇺🇸Memphis, Tennessee, United States
Vanderbilt-Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
Joe Arrington Cancer Research and Treatment Center
🇺🇸Lubbock, Texas, United States
Wilford Hall - 59th Medical Wing
🇺🇸Lackland Air Force Base, Texas, United States
Vermont Cancer Center
🇺🇸Burlington, Vermont, United States
Dixie Regional Medical Center
🇺🇸Saint George, Utah, United States
Virginia Baptist Hospital
🇺🇸Lynchburg, Virginia, United States
Naval Medical Center, Portsmouth
🇺🇸Portsmouth, Virginia, United States
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Kingston Regional Cancer Centre
🇨🇦Kingston, Ontario, Canada
Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Tom Baker Cancer Center - Calgary
🇨🇦Calgary, Alberta, Canada
Nova Scotia Cancer Centre
🇨🇦Halifax, Nova Scotia, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Provena St. Joseph Hospital- Regional Cancer Care Center
🇺🇸Elgin, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Veterans Affairs Medical Center - Milwaukee (Zablocki)
🇺🇸Milwaukee, Wisconsin, United States
Southeastern Wisconsin Regional Cancer Center
🇺🇸Racine, Wisconsin, United States
USC/Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Radiation Oncology Associates of West Alabama
🇺🇸Tuscallosa, Alabama, United States
Arizona Cancer Center
🇺🇸Tucson, Arizona, United States
Glendale Memorial Hospital and Health Center
🇺🇸Glendale, California, United States
Sutter Health Western Division Cancer Research Group
🇺🇸Greenbrae, California, United States
University of California San Diego Cancer Center
🇺🇸La Jolla, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Veterans Affairs Medical Center - Long Beach
🇺🇸Long Beach, California, United States
O'Connor Hospital
🇺🇸San Jose, California, United States
Whittingham Cancer Center
🇺🇸Norwalk, Connecticut, United States
Walter Reed Army Medical Center
🇺🇸Washington, District of Columbia, United States
Bridgeport Hospital
🇺🇸Bridgeport, Connecticut, United States
Radiation Therapy Associates - Fort Myers
🇺🇸Fort Myers, Florida, United States
Florida Radiation Oncology Group
🇺🇸Orange Park, Florida, United States
Bayfront Medical Center
🇺🇸Saint Petersburg, Florida, United States
Sarasota Radiation and Medical Oncology Center
🇺🇸Sarasota, Florida, United States
Tallahassee Memorial Healthcare
🇺🇸Tallahassee, Florida, United States
Emory University Hospital - Atlanta
🇺🇸Atlanta, Georgia, United States
CCOP - Atlanta Regional
🇺🇸Atlanta, Georgia, United States
Northwest Community Hospital
🇺🇸Arlington Heights, Illinois, United States
Lutheran General Cancer Care Center
🇺🇸Park Ridge, Illinois, United States
St. John's Medical Center
🇺🇸Anderson, Indiana, United States
Community Hospitals of Indianapolis - Regional Cancer Center
🇺🇸Indianapolis, Indiana, United States
Ball Memorial Hospital
🇺🇸Muncie, Indiana, United States
University of Iowa Hospitals and Clinics
🇺🇸Iowa City, Iowa, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
St. Joseph's Radiation Oncology Center
🇺🇸South Bend, Indiana, United States
Merle M. Mahr Cancer Center
🇺🇸Madisonville, Kentucky, United States
Mary Bird Perkins Cancer Center
🇺🇸Baton Rouge, Louisiana, United States
Western Baptist Hospital
🇺🇸Paducah, Kentucky, United States
Maine Medical Center
🇺🇸Portland, Maine, United States
Anne Arundel Oncology Center
🇺🇸Annapolis, Maryland, United States
Harbor Hospital Center
🇺🇸Baltimore, Maryland, United States
Veterans Affairs Medical Center - Boston (Jamaica Plain)
🇺🇸Jamaica Plain, Massachusetts, United States
Sparrow Regional Cancer Center
🇺🇸Lansing, Michigan, United States
Marquette General Hospital
🇺🇸Marquette, Michigan, United States
MidMichigan Medical Center - Midland
🇺🇸Midland, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
Ellis Fischel Cancer Center - Columbia
🇺🇸Columbia, Missouri, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
Norris Cotton Cancer Center
🇺🇸Lebanon, New Hampshire, United States
Elliot Regional Cancer Center
🇺🇸Manchester, New Hampshire, United States
Cooper Cancer Institute
🇺🇸Camden, New Jersey, United States
Veterans Affairs Medical Center - East Orange
🇺🇸East Orange, New Jersey, United States
South Jersey Hospital - Millville
🇺🇸Millville, New Jersey, United States
Atlantic City Medical Center
🇺🇸Pomona, New Jersey, United States
Community Medical Center
🇺🇸Toms River, New Jersey, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
Associated Radiologists, P.A.
🇺🇸Warren, New Jersey, United States
New York Methodist Hospital
🇺🇸Brooklyn, New York, United States
Finger Lakes Radiation Oncology, P.C.
🇺🇸Clifton Springs, New York, United States
NYU School of Medicine's Kaplan Comprehensive Cancer Center
🇺🇸New York, New York, United States
CCOP - North Shore University Hospital
🇺🇸Manhasset, New York, United States
Memorial Sloan-Kettering Cancer Center
🇺🇸New York, New York, United States
University of Rochester Cancer Center
🇺🇸Rochester, New York, United States
Vassar Brothers Hospital
🇺🇸Poughkeepsie, New York, United States
Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
East Carolina University School of Medicine
🇺🇸Greenville, North Carolina, United States
UNIMED Medical Center
🇺🇸Minot, North Dakota, United States
Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
St. Luke's Hospital Regional Cancer Center
🇺🇸Bethlehem, Pennsylvania, United States
Penn State Geisinger Cancer Center
🇺🇸Hershey, Pennsylvania, United States
Hahnemann University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
University of Pennsylvania Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Veterans Affairs Medical Center - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Wilkes Barre General Hospital
🇺🇸Wilkes-Barre, Pennsylvania, United States
University of Tennessee, Memphis Cancer Center
🇺🇸Memphis, Tennessee, United States
Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Martha Jefferson Hospital
🇺🇸Charlottesville, Virginia, United States
RMH Regional Canter Center
🇺🇸Harrisonburg, Virginia, United States
Community Memorial Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Columbia Hospital
🇺🇸Milwaukee, Wisconsin, United States
Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
BC Cancer Agency
🇨🇦Vancouver, British Columbia, Canada
Doctor Leon Richard Oncology Centre
🇨🇦Moncton, New Brunswick, Canada
Newfoundland Cancer Treatment and Research Foundation
🇨🇦St. Johns, Newfoundland and Labrador, Canada
Cancer Care Ontario-London Regional Cancer Centre
🇨🇦London, Ontario, Canada
Ottawa Regional Cancer Centre - General Campus
🇨🇦Ottawa, Ontario, Canada
McGill University Department of Oncology
🇨🇦Montreal, Quebec, Canada
Centre Universitaire de Sante de l'Estrie - Site Fleurimont
🇨🇦Fleurimont, Quebec, Canada
Saint Agnes Cancer Center
🇺🇸Fresno, California, United States
Mount Diablo Medical Center
🇺🇸Concord, California, United States
CCOP - Kalamazoo
🇺🇸Kalamazoo, Michigan, United States
Memorial Hospital Cancer Center
🇺🇸Colorado Springs, Colorado, United States
Sylvester Cancer Center, University of Miami
🇺🇸Miami, Florida, United States
Alabama Oncology, LLC
🇺🇸Montgomery, Alabama, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
California Cancer Center
🇺🇸Fresno, California, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Gulf Coast Cancer Treatment Center
🇺🇸Panama City, Florida, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
North Mississippi Medical Center/Cancer Center
🇺🇸Tupelo, Mississippi, United States
McLaren Regional Cancer Center
🇺🇸Flint, Michigan, United States
Romagosa Radiation Oncology Center
🇺🇸Lafayette, Louisiana, United States
Wendt Regional Cancer Center of Finley Hospital
🇺🇸Dubuque, Iowa, United States
St. Louis University Health Sciences Center
🇺🇸Saint Louis, Missouri, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Mallinckrodt Institute of Radiology
🇺🇸Saint Louis, Missouri, United States
Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
St. Francis Medical Center
🇺🇸Trenton, New Jersey, United States
CCOP - Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Northeast Medical Center
🇺🇸Concord, North Carolina, United States
Cancer Center of Albany Medical Center
🇺🇸Albany, New York, United States
Trinitas Hospital - Jersey Street Campus
🇺🇸Elizabeth, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
University Hospitals of Cleveland
🇺🇸Cleveland, Ohio, United States
Meritcare Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Champlain Valley Physicians Hospital Medical Center
🇺🇸Plattsburgh, New York, United States
CCOP - Greenville
🇺🇸Greenville, South Carolina, United States
Julie and Ben Rogers Cancer Institute
🇺🇸Beaumont, Texas, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
Arthur G. James Cancer Hospital - Ohio State University
🇺🇸Columbus, Ohio, United States
Mercy Catholic Medical Center, Mercy Fitzgerald Divison
🇺🇸Darby, Pennsylvania, United States
CCOP - Dayton
🇺🇸Kettering, Ohio, United States
CCOP - Toledo Community Hospital Oncology Program
🇺🇸Toledo, Ohio, United States
Jackson-Madison County General Hospital
🇺🇸Jackson, Tennessee, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Roger Williams Medical Center/BUSM
🇺🇸Providence, Rhode Island, United States
Mercy Hospital Cancer Center - Scranton
🇺🇸Scranton, Pennsylvania, United States
Reading Hospital and Medical Center
🇺🇸Reading, Pennsylvania, United States
Cancer Center, University of Virginia HSC
🇺🇸Charlottesville, Virginia, United States
York Hospital
🇺🇸York, Pennsylvania, United States
CCOP - Upstate Carolina
🇺🇸Spartanburg, South Carolina, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
University of Utah Health Sciences Center
🇺🇸Salt Lake City, Utah, United States
Northeastern Ontario Regional Cancer Centre, Sudbury
🇨🇦Sudbury, Ontario, Canada
CCOP - Southwestern Vermont Regional Cancer Center
🇺🇸Bennington, Vermont, United States
Deaconess Medical Center
🇺🇸Spokane, Washington, United States
Schiffler Cancer Center
🇺🇸Wheeling, West Virginia, United States
Gundersen Lutheran Medical Foundation
🇺🇸La Crosse, Wisconsin, United States
Cancer Care Ontario-Hamilton Regional Cancer Centre
🇨🇦Hamilton, Ontario, Canada
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Northwestern Ontario Regional Cancer Centre, Thunder Bay
🇨🇦Thunder Bay, Ontario, Canada
Toronto Sunnybrook Regional Cancer Centre
🇨🇦Toronto, Ontario, Canada
Radiation Oncology Center - Sacramento
🇺🇸Sacramento, California, United States
H. Lee Moffitt Cancer Center and Research Institute
🇺🇸Tampa, Florida, United States
CCOP - Ann Arbor Regional
🇺🇸Ann Arbor, Michigan, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
CCOP - Southeast Cancer Control Consortium
🇺🇸Winston-Salem, North Carolina, United States
Comprehensive Cancer Center of Wake Forest University Baptist Medical Center
🇺🇸Winston-Salem, North Carolina, United States
MD Anderson Cancer Center Orlando
🇺🇸Orlando, Florida, United States
James Graham Brown Cancer Center
🇺🇸Louisville, Kentucky, United States
Louisville Radiation Oncology
🇺🇸Louisville, Kentucky, United States
University of Florida Health Science Center
🇺🇸Gainesville, Florida, United States
Veterans Affairs Medical Center - Lexington
🇺🇸Lexington, Kentucky, United States
CCOP - Kansas City
🇺🇸Kansas City, Missouri, United States
Albert B. Chandler Medical Center, University of Kentucky
🇺🇸Lexington, Kentucky, United States
MBCCOP - LSU Medical Center
🇺🇸New Orleans, Louisiana, United States
Albert Einstein Comprehensive Cancer Center
🇺🇸Bronx, New York, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Tulane University School of Medicine
🇺🇸New Orleans, Louisiana, United States
CCOP - Ochsner
🇺🇸New Orleans, Louisiana, United States
Saint Joseph Medical Center
🇺🇸Albuquerque, New Mexico, United States
Lineberger Comprehensive Cancer Center, UNC
🇺🇸Chapel Hill, North Carolina, United States
Southern Wisconsin Radiotherapy Center
🇺🇸Madison, Wisconsin, United States
University of Wisconsin Comprehensive Cancer Center
🇺🇸Madison, Wisconsin, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Medical Center/John B. Amos Community Cancer Center
🇺🇸Columbus, Georgia, United States