Radiation Therapy With or Without Chemotherapy in Patients With Stage I-IIA Cervical Cancer Who Previously Underwent Surgery
Summary
This randomized phase III trial studies radiation therapy with chemotherapy to see how well they work compared to radiation therapy alone in treating patients with stage I-IIA cervical cancer who previously underwent surgery. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving radiation therapy together with chemotherapy is more effective than radiation therapy alone in treating patients with cervical cancer.
Key Facts
Lead Sponsor
GOG Foundation
Enrollment
340
Start Date
2010-04-12
Completion Date
2024-01-15
Study Type
INTERVENTIONAL
Official Title
Randomized Phase III Clinical Trial of Adjuvant Radiation Versus Chemoradiation in Intermediate Risk, Stage I/IIA Cervical Cancer Treated With Initial Radical Hysterectomy and Pelvic Lymphadenectomy (NCT #01101451)
Interventions
Conditions
Eligibility
Age Range
18 Years+
Sex
FEMALE
Inclusion Criteria:
* Pathologically proven primary cervical cancer I-IIA with squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma initially treated with a standard radical hysterectomy with pelvic lymphadenectomy
* Patients with the following characteristics (depth of stromal invasion and lymphovascular space involvement to be pathologically confirmed):
* Positive capillary-lymphovascular space involvement and one of the following:
* Deep third penetration
* Middle third penetration, clinical tumor \>= 2 cm
* Superficial third penetration, clinical tumor \>= 5 cm
* Negative capillary-lymphatic space involvement
* Middle or deep third penetration, clinical tumor \>= 4 cm
* Absolute neutrophil count (ANC) \>= 1,500/mcl
* Platelets \>= 100,000/mcl
* Creatinine =\< upper limit of normal (ULN) or calculated creatinine clearance \>= 60 mL/min
* Bilirubin =\< 1.5 x normal
* Alkaline phosphate =\< 3 x normal
* Serum glutamic oxaloacetic transaminase (SGOT) =\< 3 x normal
* Gynecologic Oncology Group (GOG) performance status 0, 1, 2
* Patients should not be randomized less than 3 weeks post-surgery but will not be acceptable for randomization more than 8 weeks post-surgery
* Patients who have met the pre-entry requirements
* Patients must have signed an approved informed consent and authorization permitting release of personal health information
Exclusion Criteria:
* Patients with tumor in the parametria, pelvic lymph nodes or any other extra uterine site or with positive surgical margins
* Patients with septicemia or severe infection
* Patients with intestinal obstruction or gastrointestinal bleeding
* Patients with postoperative fistula
* Patients with cervix cancer who have received any previous radiation or chemotherapy
* Patients whose circumstances do not permit completion of the study or the required follow-up
* Patients with renal abnormalities requiring modification of radiation field (pelvic kidney, renal transplant, etc.)
* Patients with GOG performance status of 3 or 4
* Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are excluded if there is any evidence of other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapyOutcome Measures
Primary Outcomes
Recurrence-free Survival (RFS) Rate at 3-years
Estimate for probability of RFS at 3 years using Kaplan-Meier method, where RFS is defined as time from protocol registration (and randomization) to the date of first documented recurrence, death, or the date of last contact, whichever occurs first. Patients without recurrence or death were censored at the date of last contact.
Time frame: 3 years from randomization
Secondary Outcomes
Overall Survival (OS) Rate at 3-years
Estimate for probability of overall survival at 3 years by Kaplan-Meier method, where overall survival is defined as the time from randomization to time of death due to any cause or the date of last contact, whichever occurs first.
Time frame: 3 years from randomization
Number of Participants With Adverse Events (Grade 3 or Higher) During Treatment Period.
Number of participants with a maximum grade of 3 or higher during treatment period. Adverse events are graded and categorized using CTCAE v4.0.
Time frame: During treatment period and up to 21 days after stopping the study treatment. The median treatment duration was 39 days.
Patient Risk-benefit
The reporting group (2) did not demonstrate improved RFS compared to the reporting group (1) at the pre-specified significance level. Per the protocol, patient risk-benefit will be assessed only for a positive study. This is not assessed due to non-positive study per the protocol.
Time frame: up to 11 years
Quality of Life (QOL) as Measured With the FACT-Cx TOI
The patient-reported QOL is assessed with the Trial Outcome Index of the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx TOI). The FACT-Cx TOI is ranged 0-116 and a larger FACT-Cx TOI score suggests a favorable QoL.
Time frame: 1. Pre-treatment (baseline), 2. 3 weeks following the first day of treatment, 3. 7 weeks following the first day of treatment, 4. 36 weeks following the first day of treatment.
Locations
Anchorage Associates in Radiation Medicine, Anchorage, United States
Anchorage Radiation Therapy Center, Anchorage, United States
Alaska Breast Care and Surgery LLC, Anchorage, United States
Alaska Oncology and Hematology LLC, Anchorage, United States
Alaska Regional Hospital, Anchorage, United States
Alaska Women's Cancer Care, Anchorage, United States
Anchorage Oncology Centre, Anchorage, United States
Katmai Oncology Group, Anchorage, United States
Providence Alaska Medical Center, Anchorage, United States
Fairbanks Memorial Hospital, Fairbanks, United States
Cancer Center at Saint Joseph's, Phoenix, United States
Saint Joseph's Hospital and Medical Center, Phoenix, United States
Mercy Hospital Fort Smith, Fort Smith, United States
CHI Saint Vincent Cancer Center Hot Springs, Hot Springs, United States
PCR Oncology, Arroyo Grande, United States
Sutter Auburn Faith Hospital, Auburn, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn, Auburn, United States
Alta Bates Summit Medical Center-Herrick Campus, Berkeley, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, United States
Mills-Peninsula Medical Center, Burlingame, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park, Cameron Park, United States
Mercy San Juan Medical Center, Carmichael, United States
Eden Hospital Medical Center, Castro Valley, United States
John Muir Medical Center-Concord Campus, Concord, United States
Sutter Davis Hospital, Davis, United States
Mercy Cancer Center - Elk Grove, Elk Grove, United States
Loma Linda University Medical Center, Loma Linda, United States
Los Angeles County-USC Medical Center, Los Angeles, United States
USC / Norris Comprehensive Cancer Center, Los Angeles, United States
Cedars Sinai Medical Center, Los Angeles, United States
Memorial Medical Center, Modesto, United States
Palo Alto Medical Foundation-Camino Division, Mountain View, United States
Palo Alto Medical Foundation-Gynecologic Oncology, Mountain View, United States
Sutter Cancer Research Consortium, Novato, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center, Orange, United States
Palo Alto Medical Foundation Health Care, Palo Alto, United States
Pomona Valley Hospital Medical Center, Pomona, United States
Mercy Cancer Center - Rocklin, Rocklin, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville, Roseville, United States
Sutter Roseville Medical Center, Roseville, United States
Mercy Cancer Center - Sacramento, Sacramento, United States
Sutter Medical Center Sacramento, Sacramento, United States
California Pacific Medical Center-Pacific Campus, San Francisco, United States
Pacific Central Coast Health Center-San Luis Obispo, San Luis Obispo, United States
Palo Alto Medical Foundation-Santa Cruz, Santa Cruz, United States
Mission Hope Medical Oncology - Santa Maria, Santa Maria, United States
Sutter Pacific Medical Foundation, Santa Rosa, United States
Palo Alto Medical Foundation-Sunnyvale, Sunnyvale, United States
Olive View-University of California Los Angeles Medical Center, Sylmar, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville, Vacaville, United States
Sutter Solano Medical Center/Cancer Center, Vallejo, United States
John Muir Medical Center-Walnut Creek, Walnut Creek, United States
Woodland Memorial Hospital, Woodland, United States
Rocky Mountain Cancer Centers-Aurora, Aurora, United States
The Medical Center of Aurora, Aurora, United States
Boulder Community Hospital, Boulder, United States
Boulder Community Foothills Hospital, Boulder, United States
Rocky Mountain Cancer Centers-Boulder, Boulder, United States
Penrose-Saint Francis Healthcare, Colorado Springs, United States
Rocky Mountain Cancer Centers-Penrose, Colorado Springs, United States
Porter Adventist Hospital, Denver, United States
Colorado Blood Cancer Institute, Denver, United States
Presbyterian - Saint Lukes Medical Center - Health One, Denver, United States
Rocky Mountain Cancer Centers-Midtown, Denver, United States
SCL Health Saint Joseph Hospital, Denver, United States
Rocky Mountain Cancer Centers-Rose, Denver, United States
Rose Medical Center, Denver, United States
Mercy Medical Center, Durango, United States
Southwest Oncology PC, Durango, United States
Mountain Blue Cancer Care Center - Swedish, Englewood, United States
Swedish Medical Center, Englewood, United States
Mountain Blue Cancer Care Center, Golden, United States
Saint Mary's Hospital and Regional Medical Center, Grand Junction, United States
North Colorado Medical Center, Greeley, United States
Rocky Mountain Cancer Centers-Greenwood Village, Greenwood Village, United States
Rocky Mountain Cancer Centers-Lakewood, Lakewood, United States
Saint Anthony Hospital, Lakewood, United States
Rocky Mountain Cancer Centers-Littleton, Littleton, United States
Littleton Adventist Hospital, Littleton, United States
Rocky Mountain Cancer Centers-Sky Ridge, Lone Tree, United States
Sky Ridge Medical Center, Lone Tree, United States
Longmont United Hospital, Longmont, United States
Rocky Mountain Cancer Centers-Longmont, Longmont, United States
McKee Medical Center, Loveland, United States
Parker Adventist Hospital, Parker, United States
Rocky Mountain Cancer Centers-Parker, Parker, United States
Saint Mary Corwin Medical Center, Pueblo, United States
Rocky Mountain Cancer Centers - Pueblo, Pueblo, United States
Rocky Mountain Cancer Centers-Thornton, Thornton, United States
SCL Health Lutheran Medical Center, Wheat Ridge, United States
Hartford Hospital, Hartford, United States
Smilow Cancer Hospital Care Center at Saint Francis, Hartford, United States
The Hospital of Central Connecticut, New Britain, United States
Yale University, New Haven, United States
Sibley Memorial Hospital, Washington D.C., United States
AdventHealth Altamonte, Altamonte Springs, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach, Deerfield Beach, United States
Holy Cross Hospital, Fort Lauderdale, United States
AdventHealth Kissimmee, Kissimmee, United States
Jackson Memorial Hospital-Holtz Children's Hospital, Miami, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, United States
AdventHealth Medical Group Urology at Orlando, Orlando, United States
AdventHealth Orlando, Orlando, United States
AdventHealth East Orlando, Orlando, United States
AdventHealth Winter Park, Winter Park, United States
Emory University Hospital Midtown, Atlanta, United States
Piedmont Hospital, Atlanta, United States
Emory University Hospital/Winship Cancer Institute, Atlanta, United States
Emory Saint Joseph's Hospital, Atlanta, United States
Northside Hospital, Atlanta, United States
John B Amos Cancer Center, Columbus, United States
Dekalb Medical Center, Decatur, United States
Northeast Georgia Medical Center-Gainesville, Gainesville, United States
Wellstar Kennestone Hospital, Marietta, United States
Southern Regional Medical Center, Riverdale, United States
Low Country Cancer Care, Savannah, United States
Memorial Health University Medical Center, Savannah, United States
Summit Cancer Care-Memorial, Savannah, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler, Savannah, United States
Queen's Medical Center, Honolulu, United States
University of Hawaii Cancer Center, Honolulu, United States
Saint Alphonsus Cancer Care Center-Boise, Boise, United States
Saint Luke's Cancer Institute - Boise, Boise, United States
Saint Alphonsus Cancer Care Center-Caldwell, Caldwell, United States
Kootenai Health - Coeur d'Alene, Coeur d'Alene, United States
Walter Knox Memorial Hospital, Emmett, United States
Saint Luke's Cancer Institute - Fruitland, Fruitland, United States
Idaho Urologic Institute-Meridian, Meridian, United States
Saint Luke's Cancer Institute - Meridian, Meridian, United States
Saint Alphonsus Medical Center-Nampa, Nampa, United States
Saint Luke's Cancer Institute - Nampa, Nampa, United States
Kootenai Clinic Cancer Services - Post Falls, Post Falls, United States
Kootenai Cancer Clinic, Sandpoint, United States
Saint Luke's Cancer Institute - Twin Falls, Twin Falls, United States
Saint Anthony's Health, Alton, United States
Rush - Copley Medical Center, Aurora, United States
Saint Joseph Medical Center, Bloomington, United States
Illinois CancerCare-Bloomington, Bloomington, United States
Illinois CancerCare-Canton, Canton, United States
Memorial Hospital of Carbondale, Carbondale, United States
SIH Cancer Institute, Carterville, United States
Illinois CancerCare-Carthage, Carthage, United States
Centralia Oncology Clinic, Centralia, United States
Rush University Medical Center, Chicago, United States
University of Illinois, Chicago, United States
Carle on Vermilion, Danville, United States
Cancer Care Specialists of Illinois - Decatur, Decatur, United States
Decatur Memorial Hospital, Decatur, United States
Carle Physician Group-Effingham, Effingham, United States
Crossroads Cancer Center, Effingham, United States
Illinois CancerCare-Eureka, Eureka, United States
Illinois CancerCare-Galesburg, Galesburg, United States
Western Illinois Cancer Treatment Center, Galesburg, United States
Northwestern Medicine Cancer Center Delnor, Geneva, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology, Hinsdale, United States
Illinois CancerCare-Kewanee Clinic, Kewanee, United States
Illinois CancerCare-Macomb, Macomb, United States
Carle Physician Group-Mattoon/Charleston, Mattoon, United States
Loyola University Medical Center, Maywood, United States
Good Samaritan Regional Health Center, Mount Vernon, United States
Cancer Care Center of O'Fallon, O'Fallon, United States
Illinois CancerCare-Ottawa Clinic, Ottawa, United States
Radiation Oncology of Northern Illinois, Ottawa, United States
Illinois CancerCare-Pekin, Pekin, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center, Pekin, United States
Illinois CancerCare-Peoria, Peoria, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center, Peoria, United States
Methodist Medical Center of Illinois, Peoria, United States
OSF Saint Francis Medical Center, Peoria, United States
Illinois CancerCare-Peru, Peru, United States
Valley Radiation Oncology, Peru, United States
Illinois CancerCare-Princeton, Princeton, United States
Central Illinois Hematology Oncology Center, Springfield, United States
Southern Illinois University School of Medicine, Springfield, United States
Springfield Clinic, Springfield, United States
Memorial Medical Center, Springfield, United States
Southwest Illinois Health Services LLP, Swansea, United States
Carle Cancer Center, Urbana, United States
The Carle Foundation Hospital, Urbana, United States
Northwestern Medicine Cancer Center Warrenville, Warrenville, United States
Rush-Copley Healthcare Center, Yorkville, United States
Deaconess Clinic Downtown, Evansville, United States
Radiation Oncology Associates PC, Fort Wayne, United States
Parkview Hospital Randallia, Fort Wayne, United States
Parkview Regional Medical Center, Fort Wayne, United States
Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, United States
Saint Vincent Hospital and Health Care Center, Indianapolis, United States
Memorial Regional Cancer Center Day Road, Mishawaka, United States
Chancellor Center for Oncology, Newburgh, United States
Reid Health, Richmond, United States
Memorial Hospital of South Bend, South Bend, United States
Mary Greeley Medical Center, Ames, United States
McFarland Clinic PC - Ames, Ames, United States
McFarland Clinic PC-Boone, Boone, United States
Saint Anthony Regional Hospital, Carroll, United States
Medical Oncology and Hematology Associates-West Des Moines, Clive, United States
Mercy Cancer Center-West Lakes, Clive, United States
Greater Regional Medical Center, Creston, United States
Iowa Methodist Medical Center, Des Moines, United States
Medical Oncology and Hematology Associates-Des Moines, Des Moines, United States
Broadlawns Medical Center, Des Moines, United States
Medical Oncology and Hematology Associates-Laurel, Des Moines, United States
Mercy Medical Center - Des Moines, Des Moines, United States
Iowa Lutheran Hospital, Des Moines, United States
McFarland Clinic PC-Trinity Cancer Center, Fort Dodge, United States
University of Iowa/Holden Comprehensive Cancer Center, Iowa City, United States
McFarland Clinic PC-Jefferson, Jefferson, United States
McFarland Clinic PC-Marshalltown, Marshalltown, United States
Siouxland Regional Cancer Center, Sioux City, United States
Mercy Medical Center-Sioux City, Sioux City, United States
Saint Luke's Regional Medical Center, Sioux City, United States
Abben Cancer Center, Spencer, United States
Methodist West Hospital, West Des Moines, United States
Mercy Medical Center-West Lakes, West Des Moines, United States
Central Care Cancer Center - Garden City, Garden City, United States
Central Care Cancer Center - Great Bend, Great Bend, United States
University of Kansas Cancer Center, Kansas City, United States
Oncology Hematology Care Inc-Crestview, Crestview Hills, United States
Saint Joseph Radiation Oncology Resource Center, Lexington, United States
Saint Joseph Hospital East, Lexington, United States
University of Kentucky/Markey Cancer Center, Lexington, United States
Jewish Hospital, Louisville, United States
Jewish Hospital Medical Center Northeast, Louisville, United States
Pikeville Medical Center, Pikeville, United States
Mary Bird Perkins Cancer Center, Baton Rouge, United States
Woman's Hospital, Baton Rouge, United States
Mary Bird Perkins Cancer Center - Covington, Covington, United States
Women's Cancer Care-Covington, Covington, United States
Louisiana State University Health Science Center, New Orleans, United States
University Medical Center New Orleans, New Orleans, United States
MaineHealth Coastal Cancer Treatment Center, Bath, United States
Maine Medical Center-Bramhall Campus, Portland, United States
MaineHealth Cancer Care Center of York County, Sanford, United States
Maine Medical Center- Scarborough Campus, Scarborough, United States
Greater Baltimore Medical Center, Baltimore, United States
Walter Reed National Military Medical Center, Bethesda, United States
Holy Cross Hospital, Silver Spring, United States
Baystate Medical Center, Springfield, United States
Saint Joseph Mercy Hospital, Ann Arbor, United States
Bronson Battle Creek, Battle Creek, United States
IHA Hematology Oncology Consultants-Brighton, Brighton, United States
Saint Joseph Mercy Brighton, Brighton, United States
IHA Hematology Oncology Consultants-Canton, Canton, United States
Saint Joseph Mercy Canton, Canton, United States
Caro Cancer Center, Caro, United States
IHA Hematology Oncology Consultants-Chelsea, Chelsea, United States
Saint Joseph Mercy Chelsea, Chelsea, United States
Hematology Oncology Consultants-Clarkston, Clarkston, United States
Newland Medical Associates-Clarkston, Clarkston, United States
Beaumont Hospital - Dearborn, Dearborn, United States
Wayne State University/Karmanos Cancer Institute, Detroit, United States
Ascension Saint John Hospital, Detroit, United States
Great Lakes Cancer Management Specialists-Doctors Park, East China Township, United States
Genesee Cancer and Blood Disease Treatment Center, Flint, United States
Genesee Hematology Oncology PC, Flint, United States
Genesys Hurley Cancer Institute, Flint, United States
Hurley Medical Center, Flint, United States
Genesys Regional Medical Center, Grand Blanc, United States
Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, United States
Mercy Health Saint Mary's, Grand Rapids, United States
Spectrum Health at Butterworth Campus, Grand Rapids, United States
Academic Hematology Oncology Specialists, Grosse Pointe Woods, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center, Grosse Pointe Woods, United States
Michigan Breast Specialists-Grosse Pointe Woods, Grosse Pointe Woods, United States
Allegiance Health, Jackson, United States
Bronson Methodist Hospital, Kalamazoo, United States
West Michigan Cancer Center, Kalamazoo, United States
Borgess Medical Center, Kalamazoo, United States
Sparrow Hospital, Lansing, United States
Hope Cancer Clinic, Livonia, United States
Saint Mary Mercy Hospital, Livonia, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus, Macomb, United States
Michigan Breast Specialists-Macomb Township, Macomb, United States
Saint Mary's Oncology/Hematology Associates of Marlette, Marlette, United States
Monroe Cancer Center, Monroe, United States
Mercy Health Mercy Campus, Muskegon, United States
Lakeland Hospital Niles, Niles, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores, Norton Shores, United States
Ascension Providence Hospitals - Novi, Novi, United States
21st Century Oncology-Pontiac, Pontiac, United States
Hope Cancer Center, Pontiac, United States
Newland Medical Associates-Pontiac, Pontiac, United States
Saint Joseph Mercy Oakland, Pontiac, United States
Lake Huron Medical Center, Port Huron, United States
Spectrum Health Reed City Hospital, Reed City, United States
Great Lakes Cancer Management Specialists-Rochester Hills, Rochester Hills, United States
Ascension Saint Mary's Hospital, Saginaw, United States
Oncology Hematology Associates of Saginaw Valley PC, Saginaw, United States
Lakeland Medical Center Saint Joseph, Saint Joseph, United States
Marie Yeager Cancer Center, Saint Joseph, United States
Ascension Providence Hospitals - Southfield, Southfield, United States
Bhadresh Nayak MD PC-Sterling Heights, Sterling Heights, United States
Ascension Saint Joseph Hospital, Tawas City, United States
Munson Medical Center, Traverse City, United States
Advanced Breast Care Center PLLC, Warren, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building, Warren, United States
Macomb Hematology Oncology PC, Warren, United States
Michigan Breast Specialists-Warren, Warren, United States
Saint John Macomb-Oakland Hospital, Warren, United States
Saint Mary's Oncology/Hematology Associates of West Branch, West Branch, United States
Metro Health Hospital, Wyoming, United States
Huron Gastroenterology PC, Ypsilanti, United States
IHA Hematology Oncology Consultants-Ann Arbor, Ypsilanti, United States
Sanford Joe Lueken Cancer Center, Bemidji, United States
Fairview Ridges Hospital, Burnsville, United States
Mercy Hospital, Coon Rapids, United States
Fairview Southdale Hospital, Edina, United States
Unity Hospital, Fridley, United States
Hutchinson Area Health Care, Hutchinson, United States
Fairview Clinics and Surgery Center Maple Grove, Maple Grove, United States
Minnesota Oncology Hematology PA-Maplewood, Maplewood, United States
Saint John's Hospital - Healtheast, Maplewood, United States
Abbott-Northwestern Hospital, Minneapolis, United States
Hennepin County Medical Center, Minneapolis, United States
Health Partners Inc, Minneapolis, United States
Monticello Cancer Center, Monticello, United States
New Ulm Medical Center, New Ulm, United States
North Memorial Medical Health Center, Robbinsdale, United States
Mayo Clinic in Rochester, Rochester, United States
Park Nicollet Clinic - Saint Louis Park, Saint Louis Park, United States
Regions Hospital, Saint Paul, United States
United Hospital, Saint Paul, United States
Saint Francis Regional Medical Center, Shakopee, United States
Lakeview Hospital, Stillwater, United States
Ridgeview Medical Center, Waconia, United States
Rice Memorial Hospital, Willmar, United States
Minnesota Oncology Hematology PA-Woodbury, Woodbury, United States
Fairview Lakes Medical Center, Wyoming, United States
University of Mississippi Medical Center, Jackson, United States
Singing River Hospital, Pascagoula, United States
Central Care Cancer Center - Bolivar, Bolivar, United States
Parkland Health Center-Bonne Terre, Bonne Terre, United States
Cox Cancer Center Branson, Branson, United States
Saint Francis Medical Center, Cape Girardeau, United States
Southeast Cancer Center, Cape Girardeau, United States
University of Missouri - Ellis Fischel, Columbia, United States
Capital Region Southwest Campus, Jefferson City, United States
Freeman Health System, Joplin, United States
Mercy Hospital Joplin, Joplin, United States
Delbert Day Cancer Institute at PCRMC, Rolla, United States
Mercy Clinic-Rolla-Cancer and Hematology, Rolla, United States
Heartland Regional Medical Center, Saint Joseph, United States
Sainte Genevieve County Memorial Hospital, Sainte Genevieve, United States
Mercy Hospital Springfield, Springfield, United States
CoxHealth South Hospital, Springfield, United States
Saint Louis Cancer and Breast Institute-South City, St Louis, United States
Mercy Hospital South, St Louis, United States
Missouri Baptist Medical Center, St Louis, United States
Mercy Hospital Saint Louis, St Louis, United States
Saint Louis-Cape Girardeau CCOP, St Louis, United States
Missouri Baptist Sullivan Hospital, Sullivan, United States
Missouri Baptist Outpatient Center-Sunset Hills, Sunset Hills, United States
Community Hospital of Anaconda, Anaconda, United States
Billings Clinic Cancer Center, Billings, United States
Saint Vincent Healthcare, Billings, United States
Bozeman Deaconess Hospital, Bozeman, United States
Saint James Community Hospital and Cancer Treatment Center, Butte, United States
Benefis Healthcare- Sletten Cancer Institute, Great Falls, United States
Great Falls Clinic, Great Falls, United States
Saint Peter's Community Hospital, Helena, United States
Kalispell Regional Medical Center, Kalispell, United States
Saint Patrick Hospital - Community Hospital, Missoula, United States
Community Medical Hospital, Missoula, United States
CHI Health Saint Francis, Grand Island, United States
CHI Health Good Samaritan, Kearney, United States
Nebraska Methodist Hospital, Omaha, United States
Alegent Health Immanuel Medical Center, Omaha, United States
Alegent Health Bergan Mercy Medical Center, Omaha, United States
Alegent Health Lakeside Hospital, Omaha, United States
Creighton University Medical Center, Omaha, United States
Comprehensive Cancer Centers of Nevada - Henderson, Henderson, United States
OptumCare Cancer Care at Seven Hills, Henderson, United States
OptumCare Cancer Care at Charleston, Las Vegas, United States
Radiation Oncology Centers of Nevada Central, Las Vegas, United States
21st Century Oncology, Las Vegas, United States
Radiation Oncology Centers of Nevada Southeast, Las Vegas, United States
Comprehensive Cancer Centers of Nevada - Northwest, Las Vegas, United States
OptumCare Cancer Care at MountainView, Las Vegas, United States
Alliance for Childhood Diseases/Cure 4 the Kids Foundation, Las Vegas, United States
Comprehensive Cancer Centers of Nevada - Town Center, Las Vegas, United States
Comprehensive Cancer Centers of Nevada-Summerlin, Las Vegas, United States
Comprehensive Cancer Centers of Nevada, Las Vegas, United States
OptumCare Cancer Care at Fort Apache, Las Vegas, United States
Comprehensive Cancer Centers of Nevada - Central Valley, Las Vegas, United States
Women's Cancer Center of Nevada, Las Vegas, United States
Center of Hope at Renown Medical Center, Reno, United States
Renown Regional Medical Center, Reno, United States
Saint Mary's Regional Medical Center, Reno, United States
Radiation Oncology Associates, Reno, United States
Dartmouth Hitchcock Medical Center, Lebanon, United States
Memorial Sloan Kettering Basking Ridge, Basking Ridge, United States
Monmouth Medical Center Southern Campus, Lakewood, United States
Monmouth Medical Center, Long Branch, United States
Memorial Sloan Kettering Monmouth, Middletown, United States
Virtua Samson Cancer Center, Moorestown, United States
Virtua Memorial, Mount Holly, United States
Inspira Medical Center Mullica Hill, Mullica Hill, United States
Rutgers New Jersey Medical School, Newark, United States
The Valley Hospital-Luckow Pavilion, Paramus, United States
Valley Hospital, Ridgewood, United States
Community Medical Center, Toms River, United States
Inspira Medical Center Vineland, Vineland, United States
Virtua Voorhees, Voorhees Township, United States
Valley Health System-Hematology/Oncology, Westwood, United States
Lovelace Medical Center-Saint Joseph Square, Albuquerque, United States
University of New Mexico Cancer Center, Albuquerque, United States
Southwest Gynecologic Oncology Associates Inc, Albuquerque, United States
Lovelace Radiation Oncology, Albuquerque, United States
Memorial Medical Center - Las Cruces, Las Cruces, United States
Presbyterian Rust Medical Center/Jorgensen Cancer Center, Rio Rancho, United States
Women's Cancer Care Associates LLC, Albany, United States
State University of New York Downstate Medical Center, Brooklyn, United States
New York-Presbyterian/Brooklyn Methodist Hospital, Brooklyn, United States
Memorial Sloan Kettering Commack, Commack, United States
Memorial Sloan Kettering Westchester, Harrison, United States
Mount Sinai Union Square, New York, United States
Mount Sinai West, New York, United States
Memorial Sloan Kettering Cancer Center, New York, United States
Highland Hospital, Rochester, United States
University of Rochester, Rochester, United States
Memorial Sloan Kettering Sleepy Hollow, Sleepy Hollow, United States
Stony Brook University Medical Center, Stony Brook, United States
Montefiore Medical Center-Einstein Campus, The Bronx, United States
Memorial Sloan Kettering Nassau, Uniondale, United States
Randolph Hospital, Asheboro, United States
Cone Health Cancer Center at Alamance Regional, Burlington, United States
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, United States
Carolinas Medical Center/Levine Cancer Institute, Charlotte, United States
Novant Health Presbyterian Medical Center, Charlotte, United States
Oncology Specialists of Charlotte, Charlotte, United States
Southern Oncology Specialists-Charlotte, Charlotte, United States
Sampson Radiation Oncology, Clinton, United States
Southeastern Medical Oncology Center-Clinton, Clinton, United States
Southeastern Medical Oncology Center-Goldsboro, Goldsboro, United States
Wayne Memorial Hospital, Goldsboro, United States
Wayne Radiation Oncology, Goldsboro, United States
Cone Health Cancer Center, Greensboro, United States
Novant Health Cancer Institute - Huntersville, Huntersville, United States
Southern Oncology Specialists-Huntersville, Huntersville, United States
Onslow Memorial Hospital, Jacksonville, United States
Southeastern Medical Oncology Center-Jacksonville, Jacksonville, United States
Matthews Radiation Oncology Center, Matthews, United States
Novant Health Cancer Specialists-Matthews, Matthews, United States
Cone Heath Cancer Center at Mebane, Mebane, United States
Novant Health Cancer Institute - Mooresville, Mooresville, United States
Annie Penn Memorial Hospital, Reidsville, United States
Mid Dakota Clinic, Bismarck, United States
Saint Alexius Medical Center, Bismarck, United States
Sanford Bismarck Medical Center, Bismarck, United States
Sanford Broadway Medical Center, Fargo, United States
Sanford Roger Maris Cancer Center, Fargo, United States
Summa Health System - Akron Campus, Akron, United States
Cleveland Clinic Akron General, Akron, United States
Strecker Cancer Center-Belpre, Belpre, United States
Dayton Physicians LLC-Miami Valley South, Centerville, United States
Miami Valley Hospital South, Centerville, United States
Adena Regional Medical Center, Chillicothe, United States
Oncology Hematology Care Inc-Eden Park, Cincinnati, United States
Oncology Hematology Care Inc-Mercy West, Cincinnati, United States
University of Cincinnati Cancer Center-UC Medical Center, Cincinnati, United States
Good Samaritan Hospital - Cincinnati, Cincinnati, United States
Oncology Hematology Care Inc-Anderson, Cincinnati, United States
Oncology Hematology Care Inc-Kenwood, Cincinnati, United States
Bethesda North Hospital, Cincinnati, United States
Oncology Hematology Care Inc-Blue Ash, Cincinnati, United States
Case Western Reserve University, Cleveland, United States
MetroHealth Medical Center, Cleveland, United States
Cleveland Clinic Cancer Center/Fairview Hospital, Cleveland, United States
Cleveland Clinic Foundation, Cleveland, United States
Ohio State University Comprehensive Cancer Center, Columbus, United States
Mount Carmel East Hospital, Columbus, United States
Columbus Oncology and Hematology Associates Inc, Columbus, United States
Riverside Methodist Hospital, Columbus, United States
Grant Medical Center, Columbus, United States
The Mark H Zangmeister Center, Columbus, United States
Mount Carmel Health Center West, Columbus, United States
Doctors Hospital, Columbus, United States
Grandview Hospital, Dayton, United States
Good Samaritan Hospital - Dayton, Dayton, United States
Miami Valley Hospital, Dayton, United States
Dayton Physician LLC-Miami Valley Hospital North, Dayton, United States
Miami Valley Hospital North, Dayton, United States
Delaware Health Center-Grady Cancer Center, Delaware, United States
Delaware Radiation Oncology, Delaware, United States
Grady Memorial Hospital, Delaware, United States
Dublin Methodist Hospital, Dublin, United States
Oncology Hematology Care Inc-Healthplex, Fairfield, United States
Armes Family Cancer Center, Findlay, United States
Blanchard Valley Hospital, Findlay, United States
Orion Cancer Care, Findlay, United States
Atrium Medical Center-Middletown Regional Hospital, Franklin, United States
Dayton Physicians LLC-Atrium, Franklin, United States
Dayton Physicians LLC-Wayne, Greenville, United States
Wayne Hospital, Greenville, United States
Mount Carmel Grove City Hospital, Grove City, United States
Greater Dayton Cancer Center, Kettering, United States
Kettering Medical Center, Kettering, United States
Fairfield Medical Center, Lancaster, United States
Lancaster Radiation Oncology, Lancaster, United States
Saint Rita's Medical Center, Lima, United States
OhioHealth Mansfield Hospital, Mansfield, United States
Marietta Memorial Hospital, Marietta, United States
OhioHealth Marion General Hospital, Marion, United States
Hillcrest Hospital Cancer Center, Mayfield Heights, United States
UH Seidman Cancer Center at Lake Health Mentor Campus, Mentor, United States
Dayton Physicians LLC-Signal Point, Middletown, United States
Knox Community Hospital, Mount Vernon, United States
Licking Memorial Hospital, Newark, United States
Newark Radiation Oncology, Newark, United States
Mercy Health Perrysburg Cancer Center, Perrysburg, United States
Southern Ohio Medical Center, Portsmouth, United States
Dayton Physicians LLC-Wilson, Sidney, United States
Springfield Regional Cancer Center, Springfield, United States
Springfield Regional Medical Center, Springfield, United States
ProMedica Flower Hospital, Sylvania, United States
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital, Toledo, United States
Saint Vincent Mercy Medical Center, Toledo, United States
Mercy Health - Saint Anne Hospital, Toledo, United States
Dayton Physicians LLC-Upper Valley, Troy, United States
Upper Valley Medical Center, Troy, United States
University of Cincinnati Cancer Center-West Chester, West Chester, United States
Saint Ann's Hospital, Westerville, United States
Wright-Patterson Medical Center, Wright-Patterson Air Force Base, United States
Genesis Healthcare System Cancer Care Center, Zanesville, United States
University of Oklahoma Health Sciences Center, Oklahoma City, United States
Mercy Hospital Oklahoma City, Oklahoma City, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa, Tulsa, United States
Saint Alphonsus Medical Center-Baker City, Baker City, United States
Saint Charles Health System, Bend, United States
Clackamas Radiation Oncology Center, Clackamas, United States
Providence Cancer Institute Clackamas Clinic, Clackamas, United States
Bay Area Hospital, Coos Bay, United States
Legacy Mount Hood Medical Center, Gresham, United States
Providence Newberg Medical Center, Newberg, United States
Saint Alphonsus Medical Center-Ontario, Ontario, United States
Providence Willamette Falls Medical Center, Oregon City, United States
Legacy Good Samaritan Hospital and Medical Center, Portland, United States
Providence Portland Medical Center, Portland, United States
Providence Saint Vincent Medical Center, Portland, United States
Compass Oncology Rose Quarter, Portland, United States
Legacy Meridian Park Hospital, Tualatin, United States
Jefferson Abington Hospital, Abington, United States
Lehigh Valley Hospital-Cedar Crest, Allentown, United States
Saint Luke's University Hospital-Bethlehem Campus, Bethlehem, United States
Lehigh Valley Hospital - Muhlenberg, Bethlehem, United States
Geisinger Medical Center, Danville, United States
Pocono Medical Center, East Stroudsburg, United States
Easton Hospital, Easton, United States
Ephrata Cancer Center, Ephrata, United States
Adams Cancer Center, Gettysburg, United States
Sechler Family Cancer Center, Lebanon, United States
Geisinger Medical Oncology-Lewisburg, Lewisburg, United States
Lewistown Hospital, Lewistown, United States
Drexel University School of Medicine, Philadelphia, United States
University of Pennsylvania/Abramson Cancer Center, Philadelphia, United States
Thomas Jefferson University Hospital, Philadelphia, United States
Fox Chase Cancer Center, Philadelphia, United States
Temple University Hospital, Philadelphia, United States
West Penn Hospital, Pittsburgh, United States
Geisinger Cancer Services-Pottsville, Pottsville, United States
Reading Hospital, West Reading, United States
Geisinger Wyoming Valley/Henry Cancer Center, Wilkes-Barre, United States
Asplundh Cancer Pavilion, Willow Grove, United States
WellSpan Health-York Cancer Center, York, United States
WellSpan Health-York Hospital, York, United States
Women and Infants Hospital, Providence, United States
Prisma Health Cancer Institute - Spartanburg, Boiling Springs, United States
Prisma Health Cancer Institute - Easley, Easley, United States
Greenville Health System Cancer Institute-Andrews, Greenville, United States
Saint Francis Hospital, Greenville, United States
Prisma Health Cancer Institute - Butternut, Greenville, United States
Prisma Health Cancer Institute - Faris, Greenville, United States
Prisma Health Greenville Memorial Hospital, Greenville, United States
Saint Francis Cancer Center, Greenville, United States
Prisma Health Cancer Institute - Eastside, Greenville, United States
Prisma Health Cancer Institute - Greer, Greer, United States
Prisma Health Cancer Institute - Seneca, Seneca, United States
Black Hills Obstetrics and Gynecology, Rapid City, United States
Rapid City Regional Hospital, Rapid City, United States
Sanford Cancer Center Oncology Clinic, Sioux Falls, United States
Avera Cancer Institute, Sioux Falls, United States
Sanford USD Medical Center - Sioux Falls, Sioux Falls, United States
University of Tennessee - Knoxville, Knoxville, United States
Dell Seton Medical Center at The University of Texas, Austin, United States
Austin Cancer Centers-Central Austin, Austin, United States
Austin Cancer Centers-North, Austin, United States
Saint Joseph Regional Cancer Center, Bryan, United States
Parkland Memorial Hospital, Dallas, United States
UT Southwestern/Simmons Cancer Center-Dallas, Dallas, United States
University of Texas Medical Branch, Galveston, United States
Houston Methodist Hospital, Houston, United States
M D Anderson Cancer Center, Houston, United States
Memorial Hermann Texas Medical Center, Houston, United States
Methodist Willowbrook Hospital, Houston, United States
UTMB Cancer Center at Victory Lakes, League City, United States
Houston Methodist Sugar Land Hospital, Sugar Land, United States
American Fork Hospital / Huntsman Intermountain Cancer Center, American Fork, United States
Sandra L Maxwell Cancer Center, Cedar City, United States
Logan Regional Hospital, Logan, United States
Intermountain Medical Center, Murray, United States
McKay-Dee Hospital Center, Ogden, United States
Utah Valley Regional Medical Center, Provo, United States
Riverton Hospital, Riverton, United States
Utah Cancer Specialists-Salt Lake City, Salt Lake City, United States
Huntsman Cancer Institute/University of Utah, Salt Lake City, United States
LDS Hospital, Salt Lake City, United States
Dixie Medical Center Regional Cancer Center, St. George, United States
Naval Medical Center - Portsmouth, Portsmouth, United States
Virginia Commonwealth University/Massey Cancer Center, Richmond, United States
Providence Regional Cancer System-Aberdeen, Aberdeen, United States
Cancer Care Center at Island Hospital, Anacortes, United States
MultiCare Auburn Medical Center, Auburn, United States
Virginia Mason Bainbridge Island Medical Center, Bainbridge Island, United States
Overlake Medical Center, Bellevue, United States
Swedish Cancer Institute-Eastside Oncology Hematology, Bellevue, United States
PeaceHealth Saint Joseph Medical Center, Bellingham, United States
PeaceHealth Medical Group PC, Bellingham, United States
Harrison HealthPartners Hematology and Oncology-Bremerton, Bremerton, United States
Harrison Medical Center, Bremerton, United States
Highline Medical Center-Main Campus, Burien, United States
Providence Regional Cancer System-Centralia, Centralia, United States
Swedish Cancer Institute-Edmonds, Edmonds, United States
Providence Regional Cancer Partnership, Everett, United States
Virginia Mason Federal Way Medical Center, Federal Way, United States
Tacoma/Valley Radiation Oncology Centers-Gig Harbor, Gig Harbor, United States
MultiCare Gig Harbor Medical Park, Gig Harbor, United States
Swedish Cancer Institute-Issaquah, Issaquah, United States
Kadlec Clinic Hematology and Oncology, Kennewick, United States
Northwest Cancer Clinic, Kennewick, United States
Tri-Cities Cancer Center, Kennewick, United States
EvergreenHealth Medical Center, Kirkland, United States
Seattle Cancer Care Alliance at EvergreenHealth, Kirkland, United States
Providence Regional Cancer System-Lacey, Lacey, United States
PeaceHealth Saint John Medical Center, Longview, United States
Virginia Mason Lynnwood Medical Center, Lynnwood, United States
Skagit Valley Hospital Regional Cancer Care Center, Mount Vernon, United States
Skagit Valley Hospital, Mount Vernon, United States
Olympic Medical Center, Port Angeles, United States
Jefferson Healthcare, Port Townsend, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo, Poulsbo, United States
Peninsula Cancer Center, Poulsbo, United States
MultiCare Good Samaritan Hospital, Puyallup, United States
Tacoma/Valley Radiation Oncology Centers-Puyallup, Puyallup, United States
Valley Medical Center, Renton, United States
Virginia Mason Medical Center, Seattle, United States
Minor and James Medical PLLC, Seattle, United States
Pacific Gynecology Specialists, Seattle, United States
Swedish Medical Center-Ballard Campus, Seattle, United States
Fred Hutchinson Cancer Research Center, Seattle, United States
Seattle Cancer Care Alliance, Seattle, United States
Kaiser Permanente Washington, Seattle, United States
Swedish Medical Center-First Hill, Seattle, United States
Swedish Medical Center-Cherry Hill, Seattle, United States
University of Washington Medical Center - Northwest, Seattle, United States
Women's Cancer Center of Seattle, Seattle, United States
University of Washington Medical Center - Montlake, Seattle, United States
Olympic Medical Cancer Care Center, Sequim, United States
Providence Regional Cancer System-Shelton, Shelton, United States
Cancer Care Northwest - Spokane South, Spokane, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Downtown, Spokane, United States
Cancer Care Northwest-Valley, Spokane, United States
Cancer Care Northwest-North Spokane, Spokane, United States
Evergreen Hematology and Oncology PS, Spokane, United States
MultiCare Deaconess Cancer and Blood Specialty Center - North, Spokane, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Valley, Spokane Valley, United States
Tacoma/Valley Radiation Oncology Centers-Jackson Hall, Tacoma, United States
Mary Bridge Children's Hospital and Health Center, Tacoma, United States
MultiCare Tacoma General Hospital, Tacoma, United States
Northwest Medical Specialties PLLC, Tacoma, United States
Saint Joseph Medical Center, Tacoma, United States
Tacoma/Valley Radiation Oncology Centers-Saint Joe's, Tacoma, United States
PeaceHealth Southwest Medical Center, Vancouver, United States
Legacy Salmon Creek Hospital, Vancouver, United States
Providence Saint Mary Regional Cancer Center, Walla Walla, United States
Wenatchee Valley Hospital and Clinics, Wenatchee, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, United States
Providence Regional Cancer System-Yelm, Yelm, United States
Wheeling Hospital/Schiffler Cancer Center, Wheeling, United States
Aurora Health Center-Fond du Lac, Fond du Lac, United States
Aurora Cancer Care-Grafton, Grafton, United States
Saint Vincent Hospital Cancer Center Green Bay, Green Bay, United States
Aurora BayCare Medical Center, Green Bay, United States
Gundersen Lutheran Medical Center, La Crosse, United States
University of Wisconsin Hospital and Clinics, Madison, United States
Aurora Bay Area Medical Group-Marinette, Marinette, United States
Aurora Saint Luke's Medical Center, Milwaukee, United States
Medical College of Wisconsin, Milwaukee, United States
Aurora Sinai Medical Center, Milwaukee, United States
Cancer Center of Western Wisconsin, New Richmond, United States
Vince Lombardi Cancer Clinic - Oshkosh, Oshkosh, United States
Vince Lombardi Cancer Clinic-Sheboygan, Sheboygan, United States
Aurora Medical Center in Summit, Summit, United States
Vince Lombardi Cancer Clinic-Two Rivers, Two Rivers, United States
Aurora West Allis Medical Center, West Allis, United States
Cheyenne Regional Medical Center-West, Cheyenne, United States
Big Horn Basin Cancer Center, Cody, United States
Billings Clinic-Cody, Cody, United States
Welch Cancer Center, Sheridan, United States
Tohoku University School of Medicine, Sendai, Japan
Kure National Hospital, Kure, Japan
Iwate Medical University Hospital, Shiwa-gun, Japan
Kagoshima City Hospital, Kagoshima, Japan
Niigata University Medical and Dental Hospital, Niigata, Japan
Shizuoka Cancer Center, Shizuoka, Japan
Shikoku Cancer Center, Matsuyama, Japan
Kindai University, Osaka, Japan
Keimyung University-Dongsan Medical Center, Dalseo-gu, South Korea
National Cancer Center-Korea, Goyang-si, South Korea
Inha University, Jung-gu, South Korea
Samsung Medical Center, Seoul, South Korea
Catholic University of Korea-Seoul Saint Mary's Hospital, Seoul, South Korea
Seoul National University Bundang Hospital, Seongnam, South Korea
Gachon University Gil Hospital, Incheon, South Korea
Asan Medical Center, Seoul, South Korea
Gangnam Severance Hospital, Seoul, South Korea
Seoul National University Hospital, Seoul, South Korea
Yonsei University Health System-Severance Hospital, Seoul, South Korea
Kyung Hee University Hospital at Gangdong, Seoul, South Korea
Korea Cancer Center Hospital, Seoul, South Korea