Radiation Therapy With or Without Antiandrogen Therapy in Treating Patients With Stage I or Stage II Prostate Cancer
- Conditions
- Prostate Cancer
- Interventions
- Registration Number
- NCT00002597
- Lead Sponsor
- Radiation Therapy Oncology Group
- Brief Summary
RATIONALE: Radiation therapy (RT) uses high-energy x-rays to damage tumor cells. Androgens can stimulate the growth of prostate cancer cells. Hormone therapy using flutamide, goserelin, and leuprolide may fight prostate cancer by reducing the production of androgens. It is not yet known which regimen of antiandrogen therapy is most effective for prostate cancer.
PURPOSE: Randomized phase III trial to study the effectiveness of radiation therapy with or without antiandrogen therapy in treating patients who have stage I or stage II prostate cancer.
- Detailed Description
OBJECTIVES: Primary: To evaluate whether a combination of Zoladex and flutamide used as cytoreductive agents prior to and during definitive radiation therapy improves overall survival over radiation therapy alone in locally confined carcinomas of the prostate; Secondary: To compare the rates of disease-specific survival, clinical relapse (local progression and/or distant failure), freedom from prostate-specific antigen (PSA) failure, freedom from second clinical relapse, freedom from second PSA relapse, and disease-free survival; To compare the prostate re-biopsy at two years; To measure the effect on sexual function.
OUTLINE: This is a randomized, multicenter study. Patients were stratified by PSA level (less than 4 vs 4-20), tumor differentiation (well vs moderate vs poor), nodal status (N0 \[nodes evaluated by surgical sampling\] vs NX \[nodes evaluated negative by imaging methods only\]), and participating center. Patients are randomized to one of two treatment arms. Arm I: Patients receive oral flutamide 3 times a day and goserelin subcutaneously once every 4 weeks, or once as a time release injection (intramuscular leuprolide may be substituted for goserelin), beginning 2 months prior to radiotherapy and continuing until completion of radiotherapy. Patients undergo radiotherapy daily 4-5 days per week for almost 8 weeks. Arm II: Patients undergo radiotherapy only, as in arm I. Patients are followed every 3 months for the remainder of the first year, every 4 months for the second year, every 6 months for the third through fifth years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 1980 patients within 5 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 2028
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Radiation therapy alone radiation therapy Radiation therapy alone Neoadjuvant TAS + RT Zoladex Neoadjuvant total androgen suppression (TAS) - Flutamide and Zoladex or Lupron - two months before and during radiation therapy. Neoadjuvant TAS + RT radiation therapy Neoadjuvant total androgen suppression (TAS) - Flutamide and Zoladex or Lupron - two months before and during radiation therapy. Neoadjuvant TAS + RT flutamide Neoadjuvant total androgen suppression (TAS) - Flutamide and Zoladex or Lupron - two months before and during radiation therapy. Neoadjuvant TAS + RT Lupron Neoadjuvant total androgen suppression (TAS) - Flutamide and Zoladex or Lupron - two months before and during radiation therapy.
- Primary Outcome Measures
Name Time Method Overall Survival Rate (10-year) From date of randomization to 10 years Overall survival (OS) was calculated from randomization to the date of death from any cause and overall survival rates were estimated by the Kaplan-Meier method.
- Secondary Outcome Measures
Name Time Method Disease-specific Survival Rate (10 Years) From registration to 10 years Disease-specific failure is defined as death certified as due to prostate cancer (by central review), death due to complications of treatment (irrespective of malignancy status), death from unknown causes with active malignancy, or death from unknown causes with previously documented relapse (either clinical or biochemical). Survival rates were estimated by means of cumulative incidence functions.
Local Progression Rate (10 Years) From registration to 10 years Local progression defined as documented local progression as determined by clinical exam . Failure rates were estimated by means of cumulative incidence functions.
Distant Failure Rate (10 Years) From registration to 10 years Failure is defined as documented metastatic disease. Failure rates were estimated by means of cumulative incidence functions.
Disease-free Survival Rate (10 Years) From registration to 10 years Disease-free failure is defined as documentation of progression (local progression, distant failure, and biochemical failure) or death from any cause. Disease-free survival rates were estimated by the Kaplan-Meier method.
Second Biochemical Relapse Rate (10 Years) From registration to 10 years Second biochemical relapse is as defined as follows (after initiation of salvage hormone therapy): A rise in PSA on at least two consecutive cases above the nadir (after initiation of salvage hormone therapy), with the rises in PSA exceeding 1 ng/ml above the nadir; or failure to reach 4 ng/L or less at 18 months. The rates of second biochemical relapse were estimated by means of cumulative incidence functions.
Biochemical Failure Rate (10 Years) From registration to 10 years The Phoenix definition of biochemical failure was used - an increase in the prostate-specific antigen (PSA) level of \>2 ng per milliliter above the nadir. Failure rates were estimated by means of cumulative incidence functions.
Clinical Relapse Rate (10 Years) From registration to 10 years Clinical relapse is defined as local progression or distant metastases. Failure rates were estimated by means of cumulative incidence functions.
Positive Re-biopsy Rate at Two Years From registration to two years The rate of prostate rebiopsy at two years is defined as the proportion of patients whose results are positive among all eligible patients who had a repeat biopsy at two years. The rate was estimated separately in each arm.
Trial Locations
- Locations (239)
New York Medical College
🇺🇸Valhalla, New York, United States
Wilkes Barre General Hospital
🇺🇸Wilkes-Barre, Pennsylvania, United States
University of Texas - MD Anderson Cancer Center
🇺🇸Houston, Texas, United States
Sylvester Cancer Center, University of Miami
🇺🇸Miami, Florida, United States
Baptist Hospital of Miami
🇺🇸Miami, Florida, United States
Community Hospitals of Indianapolis - Regional Cancer Center
🇺🇸Indianapolis, Indiana, United States
Arizona Cancer Center
🇺🇸Tucson, Arizona, United States
CCOP - Kalamazoo
🇺🇸Kalamazoo, Michigan, United States
MidMichigan Medical Center - Midland
🇺🇸Midland, Michigan, United States
Johns Hopkins Oncology Center
🇺🇸Baltimore, Maryland, United States
Veterans Affairs Medical Center - Boston (Jamaica Plain)
🇺🇸Jamaica Plain, Massachusetts, United States
Harbor Hospital Center
🇺🇸Baltimore, Maryland, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
MBCCOP - LSU Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Romagosa Radiation Oncology Center
🇺🇸Lafayette, Louisiana, United States
CCOP - Ochsner
🇺🇸New Orleans, Louisiana, United States
McLaren Regional Cancer Center
🇺🇸Flint, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
William Beaumont Hospital
🇺🇸Royal Oak, Michigan, United States
North Mississippi Medical Center/Cancer Center
🇺🇸Tupelo, Mississippi, United States
St. Mary's Medical Center
🇺🇸Saginaw, Michigan, United States
CCOP - Southern Nevada Cancer Research Foundation
🇺🇸Las Vegas, Nevada, United States
Trinitas Hospital - Jersey Street Campus
🇺🇸Elizabeth, New Jersey, United States
Norris Cotton Cancer Center
🇺🇸Lebanon, New Hampshire, United States
Elliot Regional Cancer Center
🇺🇸Manchester, New Hampshire, United States
John F. Kennedy Medical Center
🇺🇸Edison, New Jersey, United States
Atlantic City Medical Center
🇺🇸Pomona, New Jersey, United States
Cooper Cancer Institute
🇺🇸Camden, New Jersey, United States
Community Medical Center
🇺🇸Toms River, New Jersey, United States
Veterans Affairs Medical Center - East Orange
🇺🇸East Orange, New Jersey, United States
Fox Chase Cancer Center at Virtua Memorial Hospital Burlington County
🇺🇸Mount Holly, New Jersey, United States
Associated Radiologists, P.A.
🇺🇸Warren, New Jersey, United States
Capital Health System at Mercer
🇺🇸Trenton, New Jersey, United States
Memorial Sloan-Kettering Cancer Center
🇺🇸New York, New York, United States
University Hospitals of Cleveland
🇺🇸Cleveland, Ohio, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Dixie Regional Medical Center
🇺🇸Saint George, Utah, United States
Jackson-Madison County General Hospital
🇺🇸Jackson, Tennessee, United States
University of Tennessee, Memphis Cancer Center
🇺🇸Memphis, Tennessee, United States
British Columbia Cancer Agency
🇨🇦Vancouver, British Columbia, Canada
CCOP - Southwestern Vermont Regional Cancer Center
🇺🇸Bennington, Vermont, United States
Vermont Cancer Center
🇺🇸Burlington, Vermont, United States
University of Wisconsin Comprehensive Cancer Center
🇺🇸Madison, Wisconsin, United States
Nova Scotia Cancer Centre
🇨🇦Halifax, Nova Scotia, Canada
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Foundation
🇺🇸La Crosse, Wisconsin, United States
Community Memorial Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Ottawa Regional Cancer Centre - General Campus
🇨🇦Ottawa, Ontario, Canada
Cancer Care Ontario-London Regional Cancer Centre
🇨🇦London, Ontario, Canada
Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Southeastern Wisconsin Regional Cancer Center
🇺🇸Racine, Wisconsin, United States
Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
Newfoundland Cancer Treatment and Research Foundation
🇨🇦St. Johns, Newfoundland and Labrador, Canada
Cancer Care Ontario-Hamilton Regional Cancer Centre
🇨🇦Hamilton, Ontario, Canada
Northeastern Ontario Regional Cancer Centre, Sudbury
🇨🇦Sudbury, Ontario, Canada
Toronto Sunnybrook Regional Cancer Centre
🇨🇦Toronto, Ontario, Canada
Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
McGill University
🇨🇦Montreal, Quebec, Canada
Radiation Medical Group, Inc.
🇺🇸San Diego, California, United States
Vanderbilt-Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
University of Utah Health Sciences Center
🇺🇸Salt Lake City, Utah, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
CCOP - Metro-Minnesota
🇺🇸Saint Louis Park, Minnesota, United States
Memorial Hospital Cancer Center
🇺🇸Colorado Springs, Colorado, United States
Meritcare Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Northwest Community Hospital
🇺🇸Arlington Heights, Illinois, United States
Huntsville Hospital System
🇺🇸Huntsville, Alabama, United States
Northwestern Memorial Hospital
🇺🇸Chicago, Illinois, United States
Lutheran General Cancer Care Center
🇺🇸Park Ridge, Illinois, United States
Ball Memorial Hospital
🇺🇸Muncie, Indiana, United States
Greater Baltimore Medical Center and Cancer Center
🇺🇸Baltimore, Maryland, United States
Finger Lakes Radiation Oncology, P.C.
🇺🇸Clifton Springs, New York, United States
Merle M. Mahr Cancer Center
🇺🇸Madisonville, Kentucky, United States
Cancer Center of Albany Medical Center
🇺🇸Albany, New York, United States
University of Chicago Cancer Research Center
🇺🇸Chicago, Illinois, United States
Veterans Affairs Medical Center - Indianapolis (Roudebush)
🇺🇸Indianapolis, Indiana, United States
Veterans Affairs Medical Center - Lexington
🇺🇸Lexington, Kentucky, United States
Albert B. Chandler Medical Center, University of Kentucky
🇺🇸Lexington, Kentucky, United States
James Graham Brown Cancer Center
🇺🇸Louisville, Kentucky, United States
Albert Einstein Comprehensive Cancer Center
🇺🇸Bronx, New York, United States
Maine Medical Center
🇺🇸Portland, Maine, United States
St. John's Medical Center
🇺🇸Anderson, Indiana, United States
CCOP - Kansas City
🇺🇸Kansas City, Missouri, United States
Beth Israel Medical Center
🇺🇸New York, New York, United States
Tulane University School of Medicine
🇺🇸New Orleans, Louisiana, United States
Saint Joseph Medical Center
🇺🇸Albuquerque, New Mexico, United States
Vassar Brothers Hospital
🇺🇸Poughkeepsie, New York, United States
New York Methodist Hospital
🇺🇸Brooklyn, New York, United States
Ellis Fischel Cancer Center - Columbia
🇺🇸Columbia, Missouri, United States
Arthur G. James Cancer Hospital - Ohio State University
🇺🇸Columbus, Ohio, United States
Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Lineberger Comprehensive Cancer Center, UNC
🇺🇸Chapel Hill, North Carolina, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
St. Louis University Health Sciences Center
🇺🇸Saint Louis, Missouri, United States
Mallinckrodt Institute of Radiology
🇺🇸Saint Louis, Missouri, United States
CCOP - Greenville
🇺🇸Greenville, South Carolina, United States
Cancer Center at the University of Virginia
🇺🇸Charlottesville, Virginia, United States
Joe Arrington Cancer Research and Treatment Center
🇺🇸Lubbock, Texas, United States
Mercy Hospital Cancer Center - Scranton
🇺🇸Scranton, Pennsylvania, United States
CCOP - Upstate Carolina
🇺🇸Spartanburg, South Carolina, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
CCOP - MainLine Health
🇺🇸Wynnewood, Pennsylvania, United States
York Hospital
🇺🇸York, Pennsylvania, United States
Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Julie and Ben Rogers Cancer Institute
🇺🇸Beaumont, Texas, United States
Wilford Hall - 59th Medical Wing
🇺🇸Lackland Air Force Base, Texas, United States
Bayshore Medical Center
🇺🇸Pasadena, Texas, United States
East Texas Medical Center - Cancer Institute
🇺🇸Tyler, Texas, United States
CHUS-Hopital Fleurimont
🇨🇦Fleurimont, Quebec, Canada
University of Colorado Cancer Center
🇺🇸Denver, Colorado, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
St. Anthony Hospital
🇺🇸Oklahoma City, Oklahoma, United States
CCOP - Columbia River Program
🇺🇸Portland, Oregon, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
Green Mountain Oncology Group
🇺🇸Rutland, Vermont, United States
H. Lee Moffitt Cancer Center and Research Institute
🇺🇸Tampa, Florida, United States
Methodist Cancer Center - Omaha
🇺🇸Omaha, Nebraska, United States
St. Joseph's Hospital
🇺🇸Milwaukee, Wisconsin, United States
Columbia Hospital
🇺🇸Milwaukee, Wisconsin, United States
St. Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Veterans Affairs Medical Center - Milwaukee (Zablocki)
🇺🇸Milwaukee, Wisconsin, United States
MBCCOP - Gulf Coast
🇺🇸Mobile, Alabama, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
CCOP - Central Illinois
🇺🇸Decatur, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
University of Rochester Cancer Center
🇺🇸Rochester, New York, United States
Northeast Medical Center
🇺🇸Concord, North Carolina, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
St. Luke's Hospital Regional Cancer Center
🇺🇸Bethlehem, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
University of Pennsylvania Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Veterans Affairs Medical Center - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Mercy Hospital of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Western Pennsylvania Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Deaconess Medical Center
🇺🇸Spokane, Washington, 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 at Wake Forest University
🇺🇸Winston-Salem, North Carolina, United States
CCOP - Columbus
🇺🇸Columbus, Ohio, United States
Wendt Regional Cancer Center of Finley Hospital
🇺🇸Dubuque, Iowa, United States
University of Pittsburgh Cancer Institute
🇺🇸Pittsburgh, Pennsylvania, United States
Holden Comprehensive Cancer Center at The University of Iowa
🇺🇸Iowa City, Iowa, United States
Christ Hospital
🇺🇸Cincinnati, Ohio, United States
Louisville Radiation Oncology
🇺🇸Louisville, Kentucky, United States
Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Kimmel Cancer Center of Thomas Jefferson University - Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Reading Hospital and Medical Center
🇺🇸Reading, Pennsylvania, United States
Roger Williams Medical Center/BUSM
🇺🇸Providence, Rhode Island, United States
University of Alabama at Birmingham Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
Comprehensive Cancer Institute of Huntsville
🇺🇸Huntsville, Alabama, United States
Alabama Oncology, LLC
🇺🇸Montgomery, Alabama, United States
Cancer Center and Beckman Research Institute, City of Hope
🇺🇸Duarte, California, United States
Radiation Oncology Associates of West Alabama
🇺🇸Tuscaloosa, Alabama, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Mount Diablo Medical Center
🇺🇸Concord, California, United States
California Cancer Center
🇺🇸Fresno, California, United States
Saint Agnes Cancer Center
🇺🇸Fresno, California, United States
Glendale Memorial Hospital and Health Center
🇺🇸Glendale, California, United States
University of California San Diego Cancer Center
🇺🇸La Jolla, California, United States
Sutter Health Western Division Cancer Research Group
🇺🇸Greenbrae, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Veterans Affairs Medical Center - Long Beach
🇺🇸Long Beach, California, United States
USC/Norris Comprehensive Cancer Center and Hospital
🇺🇸Los Angeles, California, United States
CCOP - Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Jonsson Comprehensive Cancer Center, UCLA
🇺🇸Los Angeles, California, United States
Cancer Care Center
🇺🇸Pomona, California, United States
Radiation Oncology Center - Sacramento
🇺🇸Sacramento, California, United States
UCSF Cancer Center and Cancer Research Institute
🇺🇸San Francisco, California, United States
O'Connor Hospital
🇺🇸San Jose, California, United States
CCOP - Santa Rosa Memorial Hospital
🇺🇸Santa Rosa, California, United States
Lykes Center for Radiation Therapy
🇺🇸Clearwater, Florida, United States
Walter Reed Army Medical Center
🇺🇸Washington, District of Columbia, United States
CCOP - Christiana Care Health Services
🇺🇸Wilmington, Delaware, United States
Halifax Medical Center
🇺🇸Daytona Beach, Florida, United States
University of Florida Health Science Center
🇺🇸Gainesville, Florida, United States
Radiation Therapy Associates - Fort Myers
🇺🇸Fort Myers, Florida, United States
CCOP - Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Health First Holmes Regional Medical Center
🇺🇸Melbourne, Florida, United States
Florida Radiation Oncology Group
🇺🇸Orange Park, Florida, United States
dVeterans Affairs Medical Center - Miami
🇺🇸Miami, Florida, United States
MD Anderson Cancer Center Orlando
🇺🇸Orlando, Florida, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
Gulf Coast Cancer Treatment Center
🇺🇸Panama City, 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
Medical Center/John B. Amos Community Cancer Center
🇺🇸Columbus, Georgia, United States
InterCommunity Cancer Center at Rome
🇺🇸Rome, Georgia, United States
Provena St. Joseph Hospital- Regional Cancer Care Center
🇺🇸Elgin, Illinois, United States
Clarion Health Partners Inc.
🇺🇸Indianapolis, Indiana, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Mary Bird Perkins Cancer Center
🇺🇸Baton Rouge, Louisiana, United States
Anne Arundel Oncology Center
🇺🇸Annapolis, Maryland, United States
Radiation Oncology Affiliates of Maryland, P.A.
🇺🇸Baltimore, Maryland, United States
Peninsula Regional Medical Center
🇺🇸Salisbury, Maryland, United States
Cape Cod Hospital
🇺🇸Hyannis, Massachusetts, United States
Marquette General Hospital
🇺🇸Marquette, Michigan, United States
CCOP - Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
Nebraska Health System
🇺🇸Omaha, Nebraska, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
Monmouth Medical Center
🇺🇸Long Branch, New Jersey, United States
Tom Baker Cancer Center - Calgary
🇨🇦Calgary, Alberta, Canada
Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
South Jersey Regional Cancer Center
🇺🇸Millville, New Jersey, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
State University of New York Health Science Center at Brooklyn
🇺🇸Brooklyn, New York, United States
Champlain Valley Physicians Hospital Medical Center
🇺🇸Plattsburgh, New York, United States
CCOP - North Shore University Hospital
🇺🇸Manhasset, New York, United States
Akron City Hospital
🇺🇸Akron, Ohio, United States
Catawba Memorial Hospital
🇺🇸Hickory, North Carolina, United States
East Carolina University School of Medicine
🇺🇸Greenville, North Carolina, United States
Ireland Cancer Center
🇺🇸Cleveland, Ohio, United States
CCOP - Toledo Community Hospital Oncology Program
🇺🇸Toledo, Ohio, United States
CCOP - Dayton
🇺🇸Kettering, Ohio, United States
Albert Einstein Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
St. John Health System
🇺🇸Tulsa, Oklahoma, United States
Mercy Catholic Medical Center, Mercy Fitzgerald Divison
🇺🇸Darby, Pennsylvania, United States
Lehigh Valley Hospital
🇺🇸Allentown, Pennsylvania, United States
Hahnemann University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Penn State Geisinger Cancer Center
🇺🇸Hershey, Pennsylvania, United States
Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
Martha Jefferson Hospital
🇺🇸Charlottesville, Virginia, United States
Southern Wisconsin Radiotherapy Center
🇺🇸Madison, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
RMH Regional Canter Center
🇺🇸Harrisonburg, Virginia, United States
Schiffler Cancer Center
🇺🇸Wheeling, West Virginia, United States
Kingston Regional Cancer Centre
🇨🇦Kingston, Ontario, Canada
Northwestern Ontario Regional Cancer Centre, Thunder Bay
🇨🇦Thunder Bay, Ontario, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
St. Francis Medical Center
🇺🇸Trenton, New Jersey, United States