Dose-Escalated Photon IMRT or Proton Beam Radiation Therapy Versus Standard-Dose Radiation Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma
Study Purpose
This randomized phase II trial studies how well dose-escalated photon intensity-modulated radiation therapy (IMRT) or proton beam radiation therapy works compared with standard-dose radiation therapy when given with temozolomide in patients with newly diagnosed glioblastoma. Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells and shrink tumors. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs, such as temozolomide, may make tumor cells more sensitive to radiation therapy. It is not yet known whether dose-escalated photon IMRT or proton beam radiation therapy is more effective than standard-dose radiation therapy with temozolomide in treating glioblastoma.
Recruitment Criteria
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Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
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Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
| Eligible Ages | 18 Years and Over |
| Gender | All |
Inclusion Criteria:
- - PRIOR TO STEP 1 REGISTRATION.
- - A diagnostic contrast-enhanced MRI (no other scan type allowed) of the brain must be performed postoperatively; the residual enhancing tumor and/or resection cavity must have a maximal diameter of 5 cm or less; the tumor diameter will be the greatest diameter as measured on the contrast-enhanced postoperative MRI and will include residual disease and/or the postoperative surgical cavity as appropriate.
- - The postoperative brain MRI should be obtained within 72 hours of resection; if it is not obtained within 72 hours post-resection, then an MRI obtained 2 weeks or longer after surgery is required and can be utilized to ensure maximal diameter of residual tumor and/or resection cavity is 5 cm or less.
- - For cases where a gross total resection of enhancing tumor is performed, but postoperative surgical cavity is NOT identifiable, the patient will be excluded from the trial.
- - Tumor tissue must be available for submission for central pathology review.
- - Timing requirements: - If MGMT has been assessed locally by LabCorps or MD Anderson Cancer Center Molecular Diagnostics Lab (MDACC-MDL): - Tissue for central pathology review and central MGMT assessment and the official LabCorps or MDACC-MDL MGMT result must be received by the NRG Oncology Biospecimen Bank on or before postoperative calendar day 40.
- - The site's local MGMT report from LabCorp or MDACC-MDL will then be used to stratify the patient; a post-stratification MGMT central review will be performed, but step 2 registration and protocol treatment can proceed without central review of MGMT.
- - Patients whose tissue for central pathology review and official LabCorps or MDACC-MDL MGMT result cannot be received by NRG Oncology Biospecimen Bank on or before 40 calendar days after surgery may NOT enroll on this trial, as central pathology review and stratification will not be complete in time for the patient to start treatment within 49 calendar days following surgery.
- - If MGMT has not been assessed locally by LabCorps or MDACC-MDL: - Tissue for central pathology review and central MGMT assessment must be received by the NRG Oncology Biospecimen Bank on or before postoperative calendar day 30.
- - Central MGMT analysis will be performed at MDACC-MDL and used for patient stratification; results will be conveyed to NRG Oncology within 10 business days of receipt of the tissue.
- - Patients who have not had local MGMT assessment by LabCorps or MDACC-MDL and whose tissue for central pathology review cannot be received by NRG Oncology Biospecimen Bank on or before 30 calendar days after surgery may NOT enroll on this trial, as central pathology review and stratification will not be complete in time for the patient to start treatment within 49 calendar days following surgery.
- - Tissue Requirements: - Patients must have at least 1 block of tumor tissue; submission of 2 blocks is strongly encouraged to maximize the chances of eligibility; in total, at least 1 cubic centimeter of tissue composed primarily of tumor must be present.
- - Submission of an accompanying hematoxylin and eosin H&E slide(s) is MANDATORY.
- - Diagnosis must be made by surgical excision, either partial or complete; stereotactic biopsy and cavitronic ultrasonic surgical (CUSA) techniques are not allowed.
- - The tumor must be located in the supratentorial compartment only (any component involving the brain stem or cerebellum is not allowed) - Patients must provide study-specific informed consent prior to step 1 registration.
- - PRIOR TO STEP 2 REGISTRATION.
- - Histologically proven diagnosis of glioblastoma (World Health Organization [WHO] grade IV) confirmed by central review prior to step 2 registration.
- - Tumor tissue that is determined by central pathology review prior to step 2 registration to be of sufficient quantity for central analysis of MGMT status.
- - History/physical examination within 28 days prior to step 2 registration.
- - The patient must have recovered from effects of surgery, postoperative infection, and other complications within 28 days prior to step 2 registration.
- - Documentation of steroid doses within 28 days prior to step 2 registration.
- - Karnofsky performance status >= 70 within 28 days prior to step 2 registration.
- - Age >= 18.
- - Complete blood count (CBC)/differential obtained within 28 days prior to step 2 registration.
- - Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (obtained within 28 days prior to step 2 registration) - Platelets >= 100,000 cells/mm^3 (obtained within 28 days prior to step 2 registration) - Hemoglobin >= 10.0 g/dl (obtained within 28 days prior to step 2 registration) (note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 10.0 g/dl is acceptable) - Bilirubin =< 1.5 upper limit of normal (ULN) (within 28 days prior to step 2 registration) - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN (within 28 days prior to step 2 registration) - Negative serum pregnancy test obtained for females of child-bearing potential within 28 days prior to step 2 registration.
- - As of Amendment 2, if the registering site is a photon center (registering patients to group I), the patient must agree to participate in the advanced imaging sub-study.
Exclusion Criteria:
- - Prior invasive malignancy (except non-melanomatous skin cancer) unless disease-free for a minimum of 3 years; (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible) - Recurrent or multifocal malignant gliomas.
- - Any site of distant disease (for example, drop metastases from the GBM tumor site) - Prior chemotherapy or radiosensitizers for cancers of the head and neck region; note that prior chemotherapy for a different cancer is allowable (except temozolomide) - Prior use of Gliadel wafers or any other intratumoral or intracavitary treatment are not permitted.
- - Prior radiotherapy to the head or neck (except for T1 glottic cancer), resulting in overlap of radiation fields.
- - Severe, active co-morbidity, defined as follows: - Unstable angina at step 2 registration.
- - Transmural myocardial infarction within the last 6 months prior to step 2 registration.
- - Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations of >= 2 mm using the analysis of an electrocardiogram (EKG) performed within 28 days prior to step 2 registration (Note: EKG to be performed only if clinical suspicion of cardiac issue) - New York Heart Association grade II or greater congestive heart failure requiring hospitalization within 12 months prior to step 2 registration.
- - Serious and inadequately controlled arrhythmia at step 2 registration.
- - Serious or non-healing wound, ulcer or bone fracture or history of abdominal fistula, intra-abdominal abscess requiring major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to step 2 registration, with the exception of the craniotomy for surgical resection.
- - Acute bacterial or fungal infection requiring intravenous antibiotics at the time of step 2 registration.
- - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for coagulation parameters are not required for entry into this protocol.
- - Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of step 2 registration.
- - Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol; the need to exclude patients with AIDS from this protocol is because the treatments involved in this protocol may be significantly immunosuppressive with potentially fatal outcomes in patients already immunosuppressed.
- - Any other severe immunocompromised condition.
- - Active connective tissue disorders, such as lupus or scleroderma, that in the opinion of the treating physician may put the patient at high risk for radiation toxicity.
- - End-stage renal disease (ie, on dialysis or dialysis has been recommended) - Any other major medical illnesses or psychiatric treatments that in the investigator's opinion will prevent administration or completion of protocol therapy.
- - Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception; this exclusion is necessary because the treatment involved in this study may be significantly teratogenic.
- - Patients treated on any other therapeutic clinical protocols within 30 days prior to step 2 registration.
Trial Details
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Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT02179086 |
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Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 2 |
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Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
NRG Oncology |
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Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Minesh P Mehta |
| Principal Investigator Affiliation | NRG Oncology |
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Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
Other, NIH |
| Overall Status | Active, not recruiting |
| Countries | Canada, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Glioblastoma |
PRIMARY OBJECTIVE:
- I. To determine if dose-escalated and -intensified photon IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves overall survival, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide.
- I. To indirectly compare dose-escalated and -intensified photon IMRT to dose-escalated and -intensified proton beam therapy in terms of overall survival.
- II. To indirectly compare and record toxicities of dose-escalated and -intensified photon IMRT versus dose-escalated and -intensified proton beam therapy and directly compare the toxicities of these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide.
- III. To determine if dose-escalated and -intensified IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves perceived cognitive symptom severity, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide.
- IV. To determine if dose-escalated and -intensified photon IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves neurocognitive function, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide.
- V. To indirectly determine if dose-escalated and -intensified proton beam therapy with concomitant and adjuvant temozolomide improves perceived cognitive symptom severity, as compared to dose-escalated and -intensified photon IMRT, and to directly compare symptom burden with these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide.
- VI. To indirectly determine if dose-escalated and -intensified proton beam therapy with concomitant and adjuvant temozolomide improves neurocognitive function, as compared to dose-escalated and -intensified photon IMRT, and to directly compare neurocognitive function with these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide.
- I. Tissue banking for future translational science projects that will be determined based on the state of the science at the time the primary endpoint is reported and will be submitted to National Cancer Institute (NCI) for review and approval.
- II. To prospectively compare CD4 lymphopenia between dose-escalated and intensified proton beam therapy, dose-escalated and -intensified photon IMRT, and standard-dose photon irradiation and determine whether CD4 lymphopenia impacts overall survival.
- III. To explore the most appropriate and clinically relevant technological parameters to ensure quality and effectiveness throughout radiation therapy processes, including imaging, simulation, patient immobilization, target and critical structure definition, treatment planning, image guidance and delivery.
- IV. To explore the most appropriate and clinically relevant advanced and standard magnetic resonance imaging (MRI) imaging parameters.
Arms
Active Comparator: Arm A1 (control)
Patients undergo standard-dose photon irradiation using 3D-CRT or IMRT QD, 5 days a week for 23 fractions plus a boost of 7 additional fractions. In all treatment arms, patients receive temozolomide PO QD on days 1-49 of radiation therapy. Beginning 4 weeks later, patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
Active Comparator: Arm A2 (control)
Patients undergo standard-dose photon irradiation using 3D-CRT or IMRT as in Arm A1. In all treatment arms, patients receive temozolomide PO QD on days 1-49 of radiation therapy. Beginning 4 weeks later, patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
Experimental: Arm B (photon IMRT)
Patients undergo dose-escalated and -intensified photon IMRT QD, 5 days a week for a total of 30 fractions. In all treatment arms, patients receive temozolomide PO QD on days 1-49 of radiation therapy. Beginning 4 weeks later, patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
Experimental: Arm C (proton beam radiation therapy)
Patients undergo dose-escalated and -intensified proton beam therapy QD, 5 days a week for a total of 30 fractions. In all treatment arms, patients receive temozolomide PO QD on days 1-49 of radiation therapy. Beginning 4 weeks later, patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
Interventions
Radiation: - 3-Dimensional Conformal Radiation Therapy
Undergo standard-dose 3D-CRT
Radiation: - Intensity-Modulated Radiation Therapy
Undergo standard-dose IMRT
Radiation: - Intensity-Modulated Radiation Therapy
Undergo dose-escalated and -intensified photon IMRT
Other: - Laboratory Biomarker Analysis
Correlative studies
Radiation: - Photon Beam Radiation Therapy
Undergo dose-escalated and -intensified photon IMRT
Radiation: - Proton Beam Radiation Therapy
Undergo dose-escalated and -intensified proton beam radiation therapy
Other: - Quality-of-Life Assessment
Ancillary studies
Other: - Questionnaire Administration
Ancillary studies
Drug: - Temozolomide
Given PO
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
Address
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
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Saint Joseph's Hospital and Medical Center
Phoenix, Arizona, 85013
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Mayo Clinic Hospital in Arizona
Phoenix, Arizona, 85054
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Mayo Clinic in Arizona
Scottsdale, Arizona, 85259
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Arizona Oncology Associates-West Orange Grove
Tucson, Arizona, 85704
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Banner University Medical Center - Tucson
Tucson, Arizona, 85719
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University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
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Address
Sutter Cancer Centers Radiation Oncology Services-Auburn
Auburn, California, 95603
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AIS Cancer Center at San Joaquin Community Hospital
Bakersfield, California, 93301
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Alta Bates Summit Medical Center-Herrick Campus
Berkeley, California, 94704
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Address
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
Cameron Park, California, 95682
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Eden Hospital Medical Center
Castro Valley, California, 94546
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Fresno Cancer Center
Fresno, California, 93720
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Marin General Hospital
Greenbrae, California, 94904
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Address
Loma Linda University Medical Center
Loma Linda, California, 92354
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Los Angeles General Medical Center
Los Angeles, California, 90033
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USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
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Cedars Sinai Medical Center
Los Angeles, California, 90048
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Fremont - Rideout Cancer Center
Marysville, California, 95901
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Memorial Medical Center
Modesto, California, 95355
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Address
Kaiser Permanente Oakland-Broadway
Oakland, California, 94611
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Address
Saint Joseph Hospital - Orange
Orange, California, 92868
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Address
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, 92868
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Address
Palo Alto Medical Foundation Health Care
Palo Alto, California, 94301
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Pomona Valley Hospital Medical Center
Pomona, California, 91767
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Address
Kaiser Permanente-Rancho Cordova Cancer Center
Rancho Cordova, California, 95670
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Address
Rohnert Park Cancer Center
Rohnert Park, California, 94928
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Address
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California, 95661
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Address
The Permanente Medical Group-Roseville Radiation Oncology
Roseville, California, 95678
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Address
Sutter Medical Center Sacramento
Sacramento, California, 95816
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Address
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
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South Sacramento Cancer Center
Sacramento, California, 95823
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Address
California Pacific Medical Center-Pacific Campus
San Francisco, California, 94115
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Address
Palo Alto Medical Foundation-Santa Cruz
Santa Cruz, California, 95065
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Kaiser Permanente Cancer Treatment Center
South San Francisco, California, 94080
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Address
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale, California, 94086
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John Muir Medical Center-Walnut Creek
Walnut Creek, California, 94598
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Address
UCHealth Memorial Hospital Central
Colorado Springs, Colorado, 80909
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Address
Poudre Valley Hospital
Fort Collins, Colorado, 80524
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Address
Hartford Hospital
Hartford, Connecticut, 06102
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Address
Boca Raton Regional Hospital
Boca Raton, Florida, 33486
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Address
University of Florida Health Science Center - Gainesville
Gainesville, Florida, 32610
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Baptist MD Anderson Cancer Center
Jacksonville, Florida, 32207
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Address
University of Florida Health Science Center - Jacksonville
Jacksonville, Florida, 32209
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Baptist Medical Center South
Jacksonville, Florida, 32258
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Address
Miami Cancer Institute
Miami, Florida, 33176
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Address
Moffitt Cancer Center
Tampa, Florida, 33612
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Address
Emory Proton Therapy Center
Atlanta, Georgia, 30308
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Address
Emory University Hospital Midtown
Atlanta, Georgia, 30308
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Address
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
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Address
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
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Address
Saint Alphonsus Cancer Care Center-Boise
Boise, Idaho, 83706
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Address
Northwestern University
Chicago, Illinois, 60611
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Address
John H Stroger Jr Hospital of Cook County
Chicago, Illinois, 60612
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Address
Rush University Medical Center
Chicago, Illinois, 60612
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Address
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
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Address
Decatur Memorial Hospital
Decatur, Illinois, 62526
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Address
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
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Address
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
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Address
UC Comprehensive Cancer Center at Silver Cross
New Lenox, Illinois, 60451
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Address
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
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Address
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
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Address
Springfield Memorial Hospital
Springfield, Illinois, 62781
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Address
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
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Address
Radiation Oncology Associates PC
Fort Wayne, Indiana, 46804
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Address
Parkview Hospital Randallia
Fort Wayne, Indiana, 46805
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Address
Parkview Regional Medical Center
Fort Wayne, Indiana, 46845
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Address
IU Health Methodist Hospital
Indianapolis, Indiana, 46202
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Address
Community Cancer Center East
Indianapolis, Indiana, 46219
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Address
Community Cancer Center South
Indianapolis, Indiana, 46227
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Address
Community Cancer Center North
Indianapolis, Indiana, 46256
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Address
IU Health Ball Memorial Hospital
Muncie, Indiana, 47303
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Address
Mercy Hospital
Cedar Rapids, Iowa, 52403
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Address
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
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Address
University of Kansas Cancer Center
Kansas City, Kansas, 66160
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Address
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, 66210
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Address
Norton Hospital Pavilion and Medical Campus
Louisville, Kentucky, 40202
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Address
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
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Address
Willis-Knighton Medical and Cancer Center
Shreveport, Louisiana, 71103
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Address
Maryland Proton Treatment Center
Baltimore, Maryland, 21201
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Address
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
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Address
UM Upper Chesapeake Medical Center
Bel Air, Maryland, 21014
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Address
Central Maryland Radiation Oncology in Howard County
Columbia, Maryland, 21044
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Address
UM Baltimore Washington Medical Center/Tate Cancer Center
Glen Burnie, Maryland, 21061
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Address
Tufts Medical Center
Boston, Massachusetts, 02111
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Address
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
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Address
Boston Medical Center
Boston, Massachusetts, 02118
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Address
Mass General/North Shore Cancer Center
Danvers, Massachusetts, 01923
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Address
Lowell General Hospital
Lowell, Massachusetts, 01854
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Address
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
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Address
University of Michigan Comprehensive Cancer Center
Ann Arbor, Michigan, 48109
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Address
McLaren Cancer Institute-Bay City
Bay City, Michigan, 48706
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Address
Corewell Health Dearborn Hospital
Dearborn, Michigan, 48124
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Address
Henry Ford Hospital
Detroit, Michigan, 48202
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Address
McLaren Cancer Institute-Flint
Flint, Michigan, 48532
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Address
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
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Address
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan, 49503
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Address
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
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Address
McLaren Cancer Institute-Lapeer Region
Lapeer, Michigan, 48446
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Address
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
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Address
McLaren Cancer Institute-Macomb
Mount Clemens, Michigan, 48043
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McLaren Cancer Institute-Central Michigan
Mount Pleasant, Michigan, 48858
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McLaren Cancer Institute-Owosso
Owosso, Michigan, 48867
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McLaren Cancer Institute-Northern Michigan
Petoskey, Michigan, 49770
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Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan, 48341
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Address
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan, 48073
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Address
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
Saint Joseph, Michigan, 49085
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Address
Corewell Health Beaumont Troy Hospital
Troy, Michigan, 48085
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Address
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
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Address
Saint Luke's Hospital of Duluth
Duluth, Minnesota, 55805
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Mayo Clinic in Rochester
Rochester, Minnesota, 55905
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Address
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
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Address
Regions Hospital
Saint Paul, Minnesota, 55101
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Address
University of Mississippi Medical Center
Jackson, Mississippi, 39216
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Address
North Kansas City Hospital
Kansas City, Missouri, 64116
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Address
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
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Address
Washington University School of Medicine
Saint Louis, Missouri, 63110
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Address
Billings Clinic Cancer Center
Billings, Montana, 59101
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Address
Comprehensive Cancer Centers of Nevada
Las Vegas, Nevada, 89148
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Address
Renown Regional Medical Center
Reno, Nevada, 89502
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Address
Saint Mary's Regional Medical Center
Reno, Nevada, 89503
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Address
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
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Address
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey, 07920
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Address
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
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Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
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Capital Health Medical Center-Hopewell
Pennington, New Jersey, 08534
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ProCure Proton Therapy Center-Somerset
Somerset, New Jersey, 08873
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Virtua Voorhees
Voorhees, New Jersey, 08043
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Montefiore Medical Center - Moses Campus
Bronx, New York, 10467
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New York-Presbyterian/Brooklyn Methodist Hospital
Brooklyn, New York, 11215
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Address
Memorial Sloan Kettering Commack
Commack, New York, 11725
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Address
Memorial Sloan Kettering Westchester
Harrison, New York, 10604
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Address
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
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Address
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
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Address
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
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Address
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
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Address
Mission Hospital
Asheville, North Carolina, 28801
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Address
Novant Health Forsyth Medical Center
Winston-Salem, North Carolina, 27103
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Address
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
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Address
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
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Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
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Address
Cleveland Clinic Akron General
Akron, Ohio, 44307
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Address
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio, 44122
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Geauga Hospital
Chardon, Ohio, 44024
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Address
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
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Address
Case Western Reserve University
Cleveland, Ohio, 44106
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Cleveland Clinic Cancer Center/Fairview Hospital
Cleveland, Ohio, 44111
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Address
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
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Address
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210
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Address
Riverside Methodist Hospital
Columbus, Ohio, 43214
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Address
Mercy Cancer Center-Elyria
Elyria, Ohio, 44035
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Address
Cleveland Clinic Cancer Center Independence
Independence, Ohio, 44131
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Address
Hillcrest Hospital Cancer Center
Mayfield Heights, Ohio, 44124
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Address
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor, Ohio, 44060
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Address
UH Seidman Cancer Center at Southwest General Hospital
Middleburg Heights, Ohio, 44130
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Address
University Hospitals Parma Medical Center
Parma, Ohio, 44129
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Address
North Coast Cancer Care
Sandusky, Ohio, 44870
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Address
UH Seidman Cancer Center at Firelands Regional Medical Center
Sandusky, Ohio, 44870
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Address
Cleveland Clinic Cancer Center Strongsville
Strongsville, Ohio, 44136
Status
Address
University of Toledo
Toledo, Ohio, 43614
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Address
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
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Address
UHHS-Westlake Medical Center
Westlake, Ohio, 44145
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Address
Cleveland Clinic Wooster Family Health and Surgery Center
Wooster, Ohio, 44691
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Address
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
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Address
Willamette Valley Cancer Center
Eugene, Oregon, 97401
Status
Address
Legacy Mount Hood Medical Center
Gresham, Oregon, 97030
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Address
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon, 97210
Status
Address
Saint Luke's University Hospital-Bethlehem Campus
Bethlehem, Pennsylvania, 18015
Status
Address
Northeast Radiation Oncology Center
Dunmore, Pennsylvania, 18512
Status
Address
Ephrata Cancer Center
Ephrata, Pennsylvania, 17522
Status
Address
Adams Cancer Center
Gettysburg, Pennsylvania, 17325
Status
Address
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
Harrisburg, Pennsylvania, 17109
Status
Address
Sechler Family Cancer Center
Lebanon, Pennsylvania, 17042
Status
Address
University of Pennsylvania/Abramson Cancer Center
Philadelphia, Pennsylvania, 19104
Status
Address
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Status
Address
Jefferson Torresdale Hospital
Philadelphia, Pennsylvania, 19114
Status
Address
Reading Hospital
West Reading, Pennsylvania, 19611
Status
Address
WellSpan Health-York Cancer Center
York, Pennsylvania, 17403
Status
Address
Prisma Health Cancer Institute - Spartanburg
Boiling Springs, South Carolina, 29316
Status
Address
Medical University of South Carolina
Charleston, South Carolina, 29425
Status
Address
Prisma Health Cancer Institute - Faris
Greenville, South Carolina, 29605
Status
Address
Prisma Health Cancer Institute - Eastside
Greenville, South Carolina, 29615
Status
Address
Self Regional Healthcare
Greenwood, South Carolina, 29646
Status
Address
Prisma Health Cancer Institute - Greer
Greer, South Carolina, 29650
Status
Address
Prisma Health Cancer Institute - Seneca
Seneca, South Carolina, 29672
Status
Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Status
Address
Tennessee Cancer Specialists-Dowell Springs
Knoxville, Tennessee, 37909
Status
Address
Dell Seton Medical Center at The University of Texas
Austin, Texas, 78701
Status
Address
Austin Cancer Centers-Central Austin
Austin, Texas, 78702
Status
Address
Texas Oncology-Austin Midtown
Austin, Texas, 78705
Status
Address
Texas Oncology - Central Austin Cancer Center
Austin, Texas, 78731
Status
Address
Texas Oncology - South Austin Cancer Center
Austin, Texas, 78745
Status
Address
Austin Cancer Centers-North
Austin, Texas, 78758
Status
Address
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
Status
Address
Texas Oncology - Denison Cancer Center
Denison, Texas, 75020
Status
Address
Texas Oncology-Flower Mound
Flower Mound, Texas, 75028
Status
Address
Texas Oncology - Fort Worth Cancer Center
Fort Worth, Texas, 76104
Status
Address
University of Texas Medical Branch
Galveston, Texas, 77555-0565
Status
Address
Memorial Hermann Memorial City Medical Center
Houston, Texas, 77024
Status
Address
M D Anderson Cancer Center
Houston, Texas, 77030
Status
Address
UTMB Cancer Center at Victory Lakes
League City, Texas, 77573
Status
Address
Covenant Medical Center-Lakeside
Lubbock, Texas, 79410
Status
Address
Texas Oncology-Seton Williamson
Round Rock, Texas, 78665
Status
Address
Texas Oncology - Round Rock Cancer Center
Round Rock, Texas, 78681
Status
Address
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
Status
Address
Texas Oncology Cancer Center Sugar Land
Sugar Land, Texas, 77479
Status
Address
Texas Oncology - Tyler
Tyler, Texas, 75702
Status
Address
Logan Regional Hospital
Logan, Utah, 84321
Status
Address
Intermountain Medical Center
Murray, Utah, 84107
Status
Address
McKay-Dee Hospital Center
Ogden, Utah, 84403
Status
Address
Utah Valley Regional Medical Center
Provo, Utah, 84604
Status
Address
Saint George Regional Medical Center
Saint George, Utah, 84770
Status
Address
Huntsman Cancer Institute/University of Utah
Salt Lake City, Utah, 84112
Status
Address
Central Vermont Medical Center/National Life Cancer Treatment
Berlin, Vermont, 05602
Status
Address
University of Vermont Medical Center
Burlington, Vermont, 05401
Status
Address
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont, 05819
Status
Address
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia, 23298
Status
Address
FHCC at Northwest Hospital
Seattle, Washington, 98133
Status
Address
FHCC Proton Therapy Center
Seattle, Washington, 98133
Status
Address
University of Washington Medical Center - Montlake
Seattle, Washington, 98195
Status
Address
Compass Oncology Vancouver
Vancouver, Washington, 98684
Status
Address
Legacy Salmon Creek Hospital
Vancouver, Washington, 98686
Status
Address
Wheeling Hospital/Schiffler Cancer Center
Wheeling, West Virginia, 26003
Status
Address
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
Status
Address
Gundersen Lutheran Medical Center
La Crosse, Wisconsin, 54601
Status
Address
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Status
Address
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin, 53051
Status
Address
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Status
Address
UW Cancer Center at ProHealth Care
Waukesha, Wisconsin, 53188
Status
Address
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
International Sites
Status
Address
BCCA-Vancouver Island Cancer Centre
Victoria, British Columbia, V8R 6V5
Status
Address
Ottawa Hospital and Cancer Center-General Campus
Ottawa, Ontario, K1H 8L6
Status
Address
Windsor Regional Cancer Centre
Windsor, Ontario, N8W 2X3
Status
Address
CHUM - Centre Hospitalier de l'Universite de Montreal
Montreal, Quebec, H2X 3E4
Status
Address
The Research Institute of the McGill University Health Centre (MUHC)
Montreal, Quebec, H3H 2R9
Status
Address
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
Quebec City, Quebec, G1R 2J6
Status
Address
Saskatoon Cancer Centre
Saskatoon, Saskatchewan, S7N 4H4
