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A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) Versus Partial Breast Irradiation (PBI) for Women With Stage 0, I, or II Breast Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Breast Cancer

Thank you

Trial Information

A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) Versus Partial Breast Irradiation (PBI) for Women With Stage 0, I, or II Breast Cancer


OBJECTIVES:

Primary

- Compare local tumor control in women with ductal carcinoma in situ or stage I or II
breast cancer treated with adjuvant whole breast vs partial breast irradiation
following lumpectomy.

Secondary

- Compare overall survival, recurrence-free survival, and distant disease-free survival
in patients treated with these regimens.

- Compare the cosmetic result in patients treated with these regimens.

- Compare fatigue and treatment-related symptoms in patients treated with these regimens.

- Compare perceived convenience of care in patients treated with these regimens.

- Compare acute and late toxic effects of these regimens in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
disease stage (ductal carcinoma in situ [DCIS] only vs invasive and node negative vs
invasive with 1-3 positive nodes), menopausal status (premenopausal vs postmenopausal),
hormone receptor status (estrogen receptor [ER]-positive and/or progesterone receptor
[PR]-positive vs ER-negative and PR-negative), intention to receive chemotherapy (yes vs
no). Patients are randomized to 1 of 2 treatment arms. (Patients who are 50 years of age and
over with DCIS regardless of hormone receptor status AND patients with invasive breast
cancer meeting all of the following criteria: ≥ 50 years of age, node-negative, and
hormone-receptor positive status will not be enrolled in study after 12/30/2006.)

- Arm I: Patients undergo whole-breast irradiation (WBI) once daily, 5 days a week, for
5-7 weeks.

- Arm II: Patients undergo partial-breast irradiation (PBI) twice daily on 5 days over a
period of 5-10 days. This may be delivered by intracavitary brachytherapy or 3-D
conformal radiotherapy.

Patients in both arms may receive adjuvant chemotherapy at least 2 weeks prior to initiation
of WBI OR at least 2 weeks after completion of PBI at the discretion of the treating
physician. Patients with ER-positive or PR-positive tumors may also receive hormonal
therapy, beginning 3-12 weeks after completion of adjuvant chemotherapy (or before, during,
or after completion of WBI or PBI for patients not receiving adjuvant chemotherapy) and
continuing for at least 5 years.

After completion of study treatment, patients are followed at 1 and 6 months, every 6 months
for 4.5 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 4,300 patients (2,150 per treatment arm) will be accrued for
this study within 4.6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed ductal carcinoma in situ (DCIS*) or invasive* adenocarcinoma
of the breast

- Stage 0, I, or II disease

- Stage II tumors must be ≤ 3 cm

- Gross disease must be unifocal

- Microscopic multifocality allowed provided total pathological tumor size is
≤ 3 cm

- No proven multicentric carcinoma in more than 1 quadrant or separated by ≥ 4 cm

- No non-epithelial breast malignancies (e.g., sarcoma or lymphoma) NOTE:
*Patients who are 50 years of age and over with DCIS regardless of hormone
receptor status AND patients with invasive breast cancer meeting all of the
following criteria: ≥ 50 years of age, node-negative, and hormone-receptor
positive status will not be enrolled in study after 12/30/2006

- Prior axillary staging required for patients with invasive breast cancer, including 1
of the following:

- Sentinel node biopsy alone (if sentinel node is negative)

- Sentinel node biopsy followed by axillary dissection or sampling with ≥ 6
axillary nodes (if sentinel node is positive)

- Axillary dissection alone with ≥ 6 axillary nodes

- No more than 3 positive axillary nodes

- No axillary nodes with definite evidence of microscopic or macroscopic
extracapsular extension

- No positive non-axillary sentinel nodes (intramammary nodes are staged as
axillary nodes)

- No palpable or radiographically suspicious ipsilateral or contralateral
axillary, supraclavicular, infraclavicular, or internal mammary nodes unless
there is histologic confirmation that these nodes are negative for tumor

- Must have undergone lumpectomy

- Resected margins histologically free of tumor

- Re-excision of surgical margins allowed

- Target lumpectomy cavity clearly delineated AND target lumpectomy/whole breast
reference volume ≤ 30% based on postoperative pre-randomization CT scan

- Final surgery (i.e., lumpectomy, re-excision of margins, or axillary staging
procedure) within the past 42 days

- No suspicious microcalcifications, densities, or palpable abnormalities in the
ipsilateral or contralateral breast unless biopsied and found to be benign

- No Paget's disease of the nipple

- No history of invasive breast cancer or DCIS

- Prior lobular carcinoma in situ treated by surgery alone allowed

- No synchronous bilateral invasive or non-invasive breast cancer

- Partial breast irradiation deemed technically deliverable by radiation oncologist at
a credentialed facility

- Must have undergone a history and physical exam within the past 4 months AND a
bilateral mammogram within the past 6 months

- Hormone receptor status:

- Estrogen receptor (ER) status known

- Progesterone status known if ER analysis is negative

- Marginal or borderline results are considered positive

PATIENT CHARACTERISTICS:

Age

- 18 and over

Sex

- Female

Menopausal status

- Premenopausal or postmenopausal

Performance status

- Not specified

Life expectancy

- At least 10 years, excluding diagnosis of breast cancer

Hematopoietic

- Not specified

Hepatic

- Not specified

Renal

- Not specified

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective non-hormonal contraception

- No other malignancy within the past 5 years except previously treated carcinoma in
situ of the cervix or colon, melanoma in situ, or basal cell or squamous cell skin
cancer

- Deemed to be at low risk for recurrence

- No collagen vascular disease (e.g., systemic lupus erythematosus or scleroderma),
specifically dermatomyositis with a CPK level above normal, or active skin rash

- No psychiatric or addictive disorder that would preclude study therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No prior biologic therapy for this malignancy

Chemotherapy

- No prior chemotherapy for this malignancy

- No concurrent chemotherapy during study radiotherapy

Endocrine therapy

- No prior hormonal therapy for this malignancy unless total duration of hormonal
therapy was no more than 28 days before randomization

- Concurrent hormonal therapy allowed provided it is not administered during
chemotherapy

- No concurrent raloxifene, tamoxifen, or other selective estrogen receptor modulating
drugs

- No concurrent hormone replacement therapy

- No concurrent Femring^®

Radiotherapy

- No prior radiotherapy for this malignancy

- No prior breast or thoracic radiotherapy

- No concurrent brachytherapy boosts

- No concurrent intensity modulated radiotherapy

- No concurrent regional nodal irradiation

Surgery

- See Disease Characteristics

- No prior breast implants

- Patients who have had implants removed are eligible

Other

- No other concurrent anticancer therapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

In-breast tumor recurr. (IBTR) at event occurrence, every 6 mo. for 5 yrs; after 175 IBTR events are obs'd at approx. 10 yrs after study init.; after a spec. no. of events are observed at approx. 4.1 yrs after study init.; and annually thereafter

Safety Issue:

No

Principal Investigator

Frank Vicini, MD, FACR

Investigator Role:

Study Chair

Investigator Affiliation:

William Beaumont Hospital - Royal Oak Campus

Authority:

Unspecified

Study ID:

CDR0000409590

NCT ID:

NCT00103181

Start Date:

March 2005

Completion Date:

Related Keywords:

  • Breast Cancer
  • stage II breast cancer
  • ductal breast carcinoma in situ
  • breast cancer in situ
  • stage IA breast cancer
  • stage IB breast cancer
  • Breast Neoplasms
  • Carcinoma in Situ
  • Carcinoma, Intraductal, Noninfiltrating

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Memorial Sloan-Kettering Cancer CenterNew York, New York  10021
Mayo Clinic ScottsdaleScottsdale, Arizona  85259
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical CenterMaywood, Illinois  60153-5500
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
Cleveland Clinic Cancer CenterCleveland, Ohio  44195
University of Texas Health Science Center at San AntonioSan Antonio, Texas  78284-7811
CCOP - Atlanta RegionalAtlanta, Georgia  30342-1701
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
CCOP - North Shore University HospitalManhasset, New York  11030
CCOP - Illinois Oncology Research AssociationPeoria, Illinois  61602
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
Porter Adventist HospitalDenver, Colorado  80210
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
St. Mary - Corwin Regional Medical CenterPueblo, Colorado  81004
North Suburban Medical CenterThornton, Colorado  80229
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Methodist Cancer Center at Methodist HospitalIndianapolis, Indiana  46202
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical CenterDearborn, Michigan  48123-2500
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
St. John Macomb HospitalWarren, Michigan  48093
MeritCare BemidjiBemidji, Minnesota  56601
Fairview Ridges HospitalBurnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy HospitalCoon Rapids, Minnesota  55433
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
Park Nicollet Cancer CenterSt. Louis Park, Minnesota  55416
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
MeritCare BroadwayFargo, North Dakota  58122
Aultman Cancer Center at Aultman HospitalCanton, Ohio  44710-1799
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
St. Rita's Medical CenterLima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis HospitalTulsa, Oklahoma  74136
Drexel University College of Medicine - Center City Hahnemann CampusPhiladelphia, Pennsylvania  19102
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical CenterWilkes-Barre, Pennsylvania  18711
Sanford Cancer Center at Sanford USD Medical CenterSioux Falls, South Dakota  57117-5039
Vanderbilt-Ingram Cancer CenterNashville, Tennessee  37232-6838
Dean Medical Center - MadisonMadison, Wisconsin  53717
University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadison, Wisconsin  53792-6164
Marshfield Clinic - Marshfield CenterMarshfield, Wisconsin  54449
Medical College of Wisconsin Cancer CenterMilwaukee, Wisconsin  53226
CCOP - OchsnerNew Orleans, Louisiana  70121
Rapid City Regional HospitalRapid City, South Dakota  57709
CCOP - Bay Area Tumor InstituteOakland, California  94609-3305
Bridgeport HospitalBridgeport, Connecticut  06610
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
Cape Cod HospitalHyannis, Massachusetts  02601
Newark Beth Israel Medical CenterNewark, New Jersey  07112
CCOP - ColumbusColumbus, Ohio  43206
Joe Arrington Cancer Research and Treatment CenterLubbock, Texas  79410-1894
LDS HospitalSalt Lake City, Utah  84143
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
CCOP - Grand RapidsGrand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsBaltimore, Maryland  21231-2410
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
Kaiser Permanente Medical Center - VallejoVallejo, California  94589
Utah Valley Regional Medical Center - ProvoProvo, Utah  84604
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical CenterMilwaukee, Wisconsin  53201-2901
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
University of California Davis Cancer CenterSacramento, California  95817
City of Hope Comprehensive Cancer CenterDuarte, California  91010
Queens Cancer Center of Queens HospitalJamaica, New York  11432
Fletcher Allen Health Care - University Health Center CampusBurlington, Vermont  05401
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
James Graham Brown Cancer Center at University of LouisvilleLouisville, Kentucky  40202
Blumenthal Cancer Center at Carolinas Medical CenterCharlotte, North Carolina  28232-2861
Northside Hospital Cancer CenterAtlanta, Georgia  30342-1611
Washington Cancer Institute at Washington Hospital CenterWashington, District of Columbia  20010
Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital CenterBaltimore, Maryland  21237
McDowell Cancer Center at Akron General Medical CenterAkron, Ohio  44307
Central Baptist HospitalLexington, Kentucky  40503
Waukesha Memorial Hospital Regional Cancer CenterWaukesha, Wisconsin  53188
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
Yale Cancer CenterNew Haven, Connecticut  06520-8028
University of Florida Shands Cancer CenterGainesville, Florida  32610-0232
St. Vincent Indianapolis HospitalIndianapolis, Indiana  46260
Breslin Cancer Center at Ingham Regional Medical CenterLansing, Michigan  48910
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Presbyterian Cancer Center at Presbyterian HospitalCharlotte, North Carolina  28233-3549
Medical University of Ohio Cancer CenterToledo, Ohio  43614
Rhode Island Hospital Comprehensive Cancer CenterProvidence, Rhode Island  02903
Hollings Cancer Center at Medical University of South CarolinaCharleston, South Carolina  29425
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - DallasDallas, Texas  75390
Naval Medical Center - PortsmouthPortsmouth, Virginia  23708-2197
Providence Cancer Center at Sacred Heart Medical CenterSpokane, Washington  99220-2555
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Lahey Clinic Medical Center - BurlingtonBurlington, Massachusetts  01805
Saint Peter's University HospitalNew Brunswick, New Jersey  08901-1780
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
Mount Nittany Medical CenterState College, Pennsylvania  16803
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Baptist Cancer Institute - JacksonvilleJacksonville, Florida  32207
Battle Creek Health System Cancer Care CenterBattle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Montana Cancer Center at St. Patrick Hospital and Health Sciences CenterMissoula, Montana  59802
Community Hospital of Springfield and Clark CountySpringfield, Ohio  45505
Utah Cancer Specialists at UCS Cancer CenterSalt Lake City, Utah  84106
University Cancer Center at University of Washington Medical CenterSeattle, Washington  98195
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
Jonsson Comprehensive Cancer Center at UCLALos Angeles, California  90095-1781
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
Advocate Lutheran General Cancer Care CenterPark Ridge, Illinois  60068-1174
Lucille P. Markey Cancer Center at University of KentuckyLexington, Kentucky  40536-0093
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Butterworth Hospital at Spectrum HealthGrand Rapids, Michigan  49503-2560
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
St. Barnabas Medical Center Cancer CenterLivingston, New Jersey  07039
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
Knight Cancer Institute at Oregon Health and Science UniversityPortland, Oregon  97239-3098
Legacy Emanuel Hospital and Health Center and Children's HospitalPortland, Oregon  97227
Geisinger Cancer Institute at Geisinger HealthDanville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of TexasHouston, Texas  77030-4009
Virginia Commonwealth University Massey Cancer CenterRichmond, Virginia  23298-0037
West Virginia University Health Sciences Center - CharlestonCharleston, West Virginia  25302
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
Huntsman Cancer Institute at University of UtahSalt Lake City, Utah  84112
University of Virginia Cancer CenterCharlottesville, Virginia  22908
Helen and Harry Gray Cancer Center at Hartford HospitalHartford, Connecticut  06102-5037
Elkhart General HospitalElkhart, Indiana  46515
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital MarltonMarlton, New Jersey  08053
Hope A Women's Cancer CenterAsheville, North Carolina  28801
Cleveland Clinic Cancer Center at Fairview HospitalCleveland, Ohio  44111
Hillcrest Cancer Center at Hillcrest HospitalMayfield Heights, Ohio  44124
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
Lakeland Regional Cancer Center at Lakeland Regional Medical CenterLakeland, Florida  33805
All Saints Cancer Center at Wheaton Franciscan HealthcareRacine, Wisconsin  53405
Peninsula Medical CenterBurlingame, California  94010
North Bay Cancer CenterFairfield, California  94533
Sutter Health - Western Division Cancer Research GroupGreenbrae, California  94904
Kaiser Permanente Medical Center - HaywardHayward, California  94545
Kaiser Permanente Medical Office -Vandever Medical OfficeSan Diego, California  92120
California Pacific Medical Center - California CampusSan Francisco, California  94118
Sutter Solano Medical CenterVallejo, California  94589
John Muir/Mt. Diablo Comprehensive Cancer CenterWalnut Creek, California  94598
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
Charles B. Eberhart Cancer Center at DeKalb Medical CenterDecatur, Georgia  30033
Kennestone Cancer Center at Wellstar Kennestone HospitalMarietta, Georgia  30060
Edward Hospital Cancer CenterNaperville, Illinois  60540
Community Cancer CenterNormal, Illinois  61761
Oncology Hematology Associates of Central Illinois, PC - OttawaOttawa, Illinois  61350
Cancer Treatment Center at Pekin HospitalPekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - PeoriaPeoria, Illinois  61615
OSF St. Francis Medical CenterPeoria, Illinois  61637
Genesis Regional Cancer Center at Genesis Medical CenterDavenport, Iowa  52803
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Highland Hospital of RochesterRochester, New York  14620
Forsyth Regional Cancer Center at Forsyth Medical CenterWinston-Salem, North Carolina  27103
Lima Memorial HospitalLima, Ohio  45804
Cleveland Clinic - WoosterWooster, Ohio  44691
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Providence Milwaukie HospitalMilwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Legacy Meridian Park HospitalTualatin, Oregon  97062
Delaware County Regional Cancer Center at Delaware County Memorial HospitalDrexel Hill, Pennsylvania  19026
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
Massachusetts General HospitalBoston, Massachusetts  02114-2617
DeCesaris Cancer Institute at Anne Arundel Medical CenterAnnapolis, Maryland  21401
Poudre Valley Radiation OncologyFort Collins, Colorado  80528
California Cancer Center - Woodward Park OfficeFresno, California  93720
Good Shepherd HospitalBarrington, Illinois  60010
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Allegheny Cancer Center at Allegheny General HospitalPittsburgh, Pennsylvania  15212
Western Pennsylvania Cancer Institute at Western Pennsylvania HospitalPittsburgh, Pennsylvania  15224-1791
West Allis Memorial HospitalWest Allis, Wisconsin  53227
UAB Comprehensive Cancer CenterBirmingham, Alabama  35294
Alta Bates Summit Comprehensive Cancer CenterBerkeley, California  94704
Stanford Cancer CenterStanford, California  94305-5824
Ochsner Health Center - BluebonnetBaton Rouge, Louisiana  70809
St. Joseph Mercy OaklandPontiac, Michigan  48341-2985
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
St. Luke's Hospital Cancer Care CenterDuluth, Minnesota  55805
Billings Clinic - DowntownBillings, Montana  59107-7000
Great Falls Clinic - Main FacilityGreat Falls, Montana  59405
Sletten Cancer Institute at Benefis HealthcareGreat Falls, Montana  59405
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
Frederick R. and Betty M. Smith Cancer Treatment CenterSparta, New Jersey  07871
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Barberton Citizens HospitalBarberton, Ohio  44203
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer CenterColumbus, Ohio  43210-1240
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
Salem Hospital Regional Cancer Care ServicesSalem, Oregon  97309-5014
St. Luke's Cancer Network at St. Luke's HospitalBethlehem, Pennsylvania  18015
McGlinn Family Regional Cancer Center at Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
York Cancer Center at Apple Hill Medical CenterYork, Pennsylvania  17405
Sandra L. Maxwell Cancer CenterCedar City, Utah  84720
Val and Ann Browning Cancer Center at McKay-Dee Hospital CenterOgden, Utah  84403
St. Joseph Cancer CenterBellingham, Washington  98225
Schiffler Cancer Center at Wheeling HospitalWheeling, West Virginia  26003
Center for Cancer Treatment & Prevention at Sacred Heart HospitalEau Claire, Wisconsin  54701
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical CenterGreen Bay, Wisconsin  54311
Saint Michael's Hospital Cancer CenterStevens Point, Wisconsin  54481
Aurora Medical CenterSummit, Wisconsin  53066
Diagnostic and Treatment CenterWeston, Wisconsin  54476
Seattle Cancer Care AllianceSeattle, Washington  98109
St. Joseph Hospital Regional Cancer Center - OrangeOrange, California  92868-3849
Arizona Oncology Services FoundationPhoenix, Arizona  85013
Enloe Cancer Center at Enloe Medical CenterChico, California  95926
Robert and Beverly Lewis Family Cancer Care Center at Pomona Valley Hospital Medical CenterPomona, California  91767
Radiological Associates of Sacramento Medical Group, IncorporatedSacramento, California  95815
Ruby L. Golleher Cancer Program at Presbyterian Intercommunity HospitalWhittier, California  90602
Hospital of Saint RaphaelNew Haven, Connecticut  06511
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Parkview Regional Cancer Center at Parkview HealthFort Wayne, Indiana  46805
MetroWest Medical Center - Framingham Union HospitalFramingham, Massachusetts  01702
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Dizzy Gillespie Cancer Institute at Englewood Hospital and Medical CenterEnglewood, New Jersey  07631
Pardee Memorial HospitalHendersonville, North Carolina  28791
Three Rivers Community HospitalGrants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical CenterMedford, Oregon  97504
Community Memorial Hospital Cancer Care CenterMenomonee Falls, Wisconsin  53051
Regional Cancer Center at Oconomowoc Memorial HospitalOconomowoc, Wisconsin  53066
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Duke Cancer InstituteDurham, North Carolina  27710
Regional Cancer Center - ErieErie, Pennsylvania  16505
MedCentral - Mansfield HospitalMansfield, Ohio  44903
Cancer Institute at St. John's HospitalSpringfield, Illinois  62701
Crozer-Chester Medical CenterUpland, Pennsylvania  19013
PinnacleHealth Regional Cancer Center at Polyclinic HospitalHarrisburg, Pennsylvania  17105
Roper St. Francis Cancer Center at Roper HospitalCharleston, South Carolina  29401
University of Wisconcin Cancer Center at Aspirus Wausau HospitalWausau, Wisconsin  54401
Solano Radiation Oncology CenterVacaville, California  95687
Integrated Community Oncology NetworkJacksonville Beach, Florida  32250
Baptist Medical Center SouthJascksonville, Florida  32258
Florida Cancer Center - PalatkaPalatka, Florida  32177
Flagler Cancer CenterSaint Augustine, Florida  32086
Lipson Cancer and Blood Center at Rochester General HospitalRochester, New York  14621
Louisville Oncology at Norton Cancer Institute - LouisvilleLouisville, Kentucky  40202
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
Boston University Cancer Research CenterBoston, Massachusetts  02118
Desert Regional Medical Center Comprehensive Cancer CenterPalm Springs, California  92262
Mercy General HospitalSacramento, California  95819
Connecticut Oncology & Hematology - TorringtonTorrington, Connecticut  06790
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
Illinois CancerCare - BloomingtonBloomington%, Illinois  61701
Illinois CancerCare - CantonCanton, Illinois  61520
Illinois CancerCare - CarthageCarthage, Illinois  62321
Alexian Brothers Radiation OncologyElk Grove Village, Illinois  60007
Illinois CancerCare - EurekaEureka, Illinois  61530
Illinois CancerCare - GalesburgGalesburg, Illinois  61401
Illinois CancerCare - HavanaHavana, Illinois  62644
Illinois CancerCare - Kewanee ClinicKewanee, Illinois  61443
Illinois CancerCare - MacombMacomb, Illinois  61455
Trinity Cancer Center at Trinity Medical Center - 7th Street CampusMoline, Illinois  61265
OSF Holy Family Medical CenterMonmouth, Illinois  61462
Illinois CancerCare - MonmouthMonmouth, Illinois  61462
Illinois CancerCare - Community Cancer CenterNormal, Illinois  61761
Illinois CancerCare - PekinPekin, Illinois  61603
Illinois CancerCare - PeruPeru, Illinois  61354
Illinois CancerCare - PrincetonPrinceton, Illinois  61356
Illinois CancerCare - Spring ValleySpring Valley, Illinois  61362
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
Franciscan Skemp Healthcare - La Crosse CampusLa Crosse, Wisconsin  54601
University of Colorado Cancer Center at UC Health Sciences CenterAurora, Colorado  80045
Center for Cancer Care at Goshen General HospitalGoshen, Indiana  46526
St. Mary's Regional Cancer Center at St. Mary's Medical CenterHuntington, West Virginia  25702
J. Phillip Citta Regional Cancer Center at Community Medical CenterToms River, New Jersey  08755
High Point Regional HospitalHigh Point, North Carolina  27261
Providence Cancer Center at PMCCMedford, Oregon  97504
Central Maryland Oncology CenterColumbia, Maryland  21044
Saint Mary's Regional Medical CenterReno, Nevada  89503
Cancer Centers of North Carolina - RaleighRaleigh, North Carolina  27607
Mercy Regional Cancer Center at Mercy Medical CenterRedding, California  96049
Memorial Hospital Cancer Center - Colorado SpringsColorado Springs, Colorado  80909
Integrated Community Oncology Network - Orange ParkOrange Park, Florida  32073
NSMC Cancer Center - PeabodyPeabody, Massachusetts  01960
Immanuel St. Joseph'sMankato, Minnesota  56002
Columbia Saint Mary's Hospital - OzaukeeMequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care CenterMilwaukee, Wisconsin  53211
Frankford Hospital Cancer Center - Torresdale CampusPhiladelphia, Pennsylvania  19114
Cancer Care Center at John Muir Health - Concord CampusConcord, California  94524-4110
Central Maine Comprehensive Cancer Center at Central Maine Medical CenterLewiston, Maine  04240
Shore Regional Cancer Center at Memorial Hospital - EastonEaston, Maryland  21601
Minnesota Oncology - MaplewoodMaplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Minnesota Oncology - WoodburyWoodbury, Minnesota  55125
Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main CampusBoca Raton, Florida  33486
Community Hospital of the Monterey Peninsula Comprehensive Cancer CenterMonterey, California  93940
UPMC Cancer Center at Beaver Medical CenterBeaver, Pennsylvania  15009
UPMC - ShadysidePittsburgh, Pennsylvania  15213-2582
Holy Cross HospitalSilver Spring, Maryland  20910
New York Oncology Hematology, PC at Albany Regional Cancer CareAlbany, New York  12208
Auburn Radiation OncologyAuburn, California  95603
Radiation Oncology Centers - Cameron ParkCameron Park, California  95682
Radiation Oncology Center - RosevilleRoseville, California  95661
Saint John's Cancer Center at Saint John's Medical CenterAnderson, Indiana  46016
Hudson Valley Oncology AssociatesPoughkeepsie, New York  12601
Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett HospitalCooperstown, New York  13326
Mercy Cancer Center at Mercy San Juan Medical CenterCarmichael, California  95608
CCOP - Kansas CityPrairie Village, Kansas  66208
St. Agnes Hospital Cancer CenterBaltimore, Maryland  21229
Renown Institute for Cancer at Renown Regional Medical CenterReno, Nevada  89502
Sands Cancer CenterCanandiaqua, New York  14424
University Radiation Oncology at Parkridge HospitalRochester, New York  14626
Coastal Carolina Radiation Oncology CenterWilmington, North Carolina  28401
Norwalk HospitalNorwalk, Connecticut  06856
Vince Lombardi Cancer Clinic - OshkoshOshkosh, Wisconsin  54904
Kootenai Cancer Center - Coeur d'AleneCoeur d'Alene, Idaho  83814
Integrated Community Oncology Network at Southside Cancer CenterJacksonville, Florida  32207
Central Dupage Cancer CenterWarrenville, Illinois  60555
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
St. Francis Regional Cancer CenterTrenton, New Jersey  08629
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
Texas Oncology, PA at Texas Cancer Center Round RockRound Rock, Texas  78681
Sharp Memorial Hospital Cancer CenterSan Diego, California  92123
Norristown Regional Cancer CenterNorristown, Pennsylvania  19401
Arizona Center for Cancer Care - PeoriaPeoria, Arizona  85381
Arizona Breast Cancer SpecialistsScottsdale, Arizona  85258
Feather River Hospital Cancer CenterParadise, California  95969
Good Samaritan Cancer Care Center at Advocate Good Samaritan HospitalDowners Grove, Illinois  60515-1500
Illinois CancerCare - CottageGalesburg, Illinois  61401
Radiation Oncology Associates SouthwestFort Wayne, Indiana  46804
Central Indiana Cancer Centers - EastIndianapolis, Indiana  46219
Henry Ford Macomb HospitalClinton Township, Michigan  48038
McLaren Cancer InstituteFlint, Michigan  48532
Kansas City Cancer Centers - NorthKansas City, Missouri  64154
Payson Center for Cancer Care at Concord HospitalConcord, New Hampshire  03301
Seacoast Cancer Center at Wentworth - Douglass HospitalDover, New Hampshire  03820
Trinitas Comprehensive Cancer Center at Trinitas HospitalElizabeth, New Jersey  07207
Cayuga Medical Center of IthacaIthaca, New York  14850
Saint Francis Hospital Cancer CenterPoughkeepsie, New York  12601
Willamette Valley Cancer Center - EugeneEugene, Oregon  97401
Intercommunity Cancer CenterMonroeville, Pennsylvania  15146
Northmain Radiation OncologyProvidence, Rhode Island  02904
Georgetown Memorial HospitalGeorgetown, South Carolina  29440
Texas Oncology, PA at Harris Center HEBBedford, Texas  76022
Texas Oncology, PA at Texas Cancer Center - Denton SouthDenton, Texas  76210
Klabzuba Cancer Center at Harris Methodist Fort Worth HospitalFort Worth, Texas  76104
Baylor Medical Center at IrvingIrving, Texas  75061
Texas Oncology, PA at Lake Vista Cancer CenterLewisville, Texas  75067
Cancer Care Centers of South Texas - NortheastSan Antonio, Texas  78217
Texas Oncology, PA at Texas Cancer Center - ShermanSherman, Texas  75090
Texas Oncology, PA at Texas Oncology Cancer Center Sugar LandSugar Land, Texas  77479
Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital CenterSleepy Hollow, New York  10591
Memorial Sloan-Kettering Cancer Center - Basking RidgeBasking Ridge, New Jersey  07920