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A Randomized Phase III Trial of Concurrent Accelerated Radiation and Cisplatin Versus Concurrent Accelerated Radiation, Cisplatin, and Cetuximab (C225) [Followed by Surgery for Selected Patients] for Stage III and IV Head and Neck Carcinomas


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Head and Neck Cancer

Thank you

Trial Information

A Randomized Phase III Trial of Concurrent Accelerated Radiation and Cisplatin Versus Concurrent Accelerated Radiation, Cisplatin, and Cetuximab (C225) [Followed by Surgery for Selected Patients] for Stage III and IV Head and Neck Carcinomas


OBJECTIVES:

Primary

- Evaluate whether the addition of cetuximab to a concurrent radiation-cisplatin regimen
will improve disease-free survival in patients with stage III or IV squamous cell
carcinoma of the oropharynx, hypopharynx, or larynx.

Secondary

- Determine the impact of the addition of cetuximab to a concurrent radiation-cisplatin
regimen on overall survival, local-regional control, acute and late toxic effects,
quality of life, and health utilities in these patients.

- Correlate the expression of epidermal growth factor receptor (EGFR) and its down-stream
molecules with outcome in patients participating in this component of the trial.

- Correlate pre-treatment PET scan findings with disease-free survival, overall survival,
and local-regional control in patients participating in this component of the trial.

- Correlate post-treatment PET scan findings with nodal response and nodal relapse in
patients participating in this component of the trial.

OUTLINE: This is a randomized, controlled, multicenter study. Patients are stratified
according to primary site (larynx vs non-larynx), nodal stage (N0 vs N1, N2a, N2b vs N2c,
N3), Zubrod performance status (0 vs 1), use of intensity modulated radiotherapy (IMRT) (no
vs yes), and pre-treatment PET/CT scan (no vs yes). Patients are randomized to 1 of 2
treatment arms.

- Arm I: Patients undergo either 3D-conformal radiotherapy or IMRT once or twice a day, 5
or 6 days a week, for 6 weeks. Patients also receive cisplatin IV over 1 hour on days 1
and 22 (weeks 1 and 4) during radiotherapy.

- Arm II: Patients receive cetuximab IV over 1-2 hours once in weeks 0-7. Beginning in
week 1, patients also undergo radiotherapy and receive cisplatin as in arm I.

In both arms, patients with persistent nodal disease (any stage) (i.e., a residual palpable
or radiographic abnormality) undergo neck dissection* approximately 9-10 weeks after
completion of treatment.

NOTE: *A neck dissection is optional for patients with multiple lymph nodes or lymph nodes >
3 cm in diameter who achieve a complete clinical and radiographic response in the neck.

Quality of life is assessed at baseline, once during the last 2 weeks of treatment, at 3 and
12 months from the start of treatment, and then annually for 4 years.

After completion of study treatment, patients are followed periodically for 5 years and then
annually thereafter.

PROJECTED ACCRUAL: Approximately 720 patients will be accrued for this study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically proven (from primary lesion and/or lymph nodes) squamous cell
carcinoma of the oropharynx, hypopharynx, or larynx

- Stage III or IV disease (T2, N2-3, M0; T3-4, any N, M0)

- No distant metastases

- The following primary tumor sites are excluded:

- Oral cavity

- Nasopharynx

- Sinuses

- Salivary glands

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- Absolute neutrophil count (ANC) ≥ 1,800/mm^3

- Platelets ≥ 100,000/mm^3

- Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve Hgb ≥ 8.0 g/dL is
acceptable)

- Bilirubin ≤ 1.5 mg/dL (Gilbert's disease as the sole cause of elevated bilirubin may
be allowed at the discretion of the principal investigator)

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤ 2 times the
upper limit of normal

- Serum creatinine ≤ 1.5 mg/dL

- Creatinine clearance ≥ 50 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Women of childbearing potential and male participants must agree to use a medically
effective means of birth control throughout their participation in the treatment
phase of the study (until at least 60 days following the last study treatment)

- No prior invasive malignancy (except non-melanomatous skin cancer) unless disease
free for a minimum of 3 years

- No unstable angina and/or congestive heart failure requiring hospitalization in past
6 months

- Left ventricular ejection fraction ≥ 45%

- No transmural myocardial infarction within the last 6 months

- No acute bacterial or fungal infection requiring intravenous antibiotics

- No chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- No acquired immune deficiency syndrome (AIDS)

- HIV testing is not required for entry into this protocol

- Protocol-specific requirements may also exclude immuno-compromised patients

- No prior allergic reaction to the study drug(s)

- No other uncontrolled condition, which in the opinion of the investigator, would
interfere in the safe and timely completion of study procedures

- No comorbidity of uncontrolled diabetes (i.e., symptomatic hyperglycemia)

- No other severe active comorbidity

PRIOR CONCURRENT THERAPY:

- No prior systemic chemotherapy for the study cancer

- Prior chemotherapy for a different cancer is allowed

- No prior radiotherapy to the region of the study cancer that would result in overlap
of radiation therapy fields

- No initial surgical treatment (excluding diagnostic biopsy of the primary site or
nodal sampling of neck disease)

- No radical or modified neck dissection

- No prior therapy that specifically and directly targets the EGFR pathway

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Disease-free survival (DFS)

Outcome Time Frame:

From randomization to date of failure (local, regional or distant progression or death) or last follow-up. Analysis occurs after 434 failures have been reported.

Safety Issue:

No

Principal Investigator

K. Kian Ang, MD, PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

M.D. Anderson Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

RTOG 0522

NCT ID:

NCT00265941

Start Date:

November 2005

Completion Date:

Related Keywords:

  • Head and Neck Cancer
  • stage III squamous cell carcinoma of the hypopharynx
  • stage IV squamous cell carcinoma of the hypopharynx
  • stage III squamous cell carcinoma of the larynx
  • stage IV squamous cell carcinoma of the larynx
  • stage III squamous cell carcinoma of the oropharynx
  • stage IV squamous cell carcinoma of the oropharynx
  • Head and Neck Neoplasms

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
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
Hurley Medical CenterFlint, Michigan  48503
CCOP - Atlanta RegionalAtlanta, Georgia  30342-1701
CCOP - Kansas CityKansas City, Missouri  64131
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
Veterans Affairs Medical Center - Atlanta (Decatur)Decatur, Georgia  30033
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
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Swedish Medical CenterEnglewood, Colorado  80110
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical CenterGrand Junction, Colorado  81502
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
Joliet Oncology-Hematology Associates, Limited - WestJoliet, Illinois  60435
Carle Cancer Center at Carle Foundation HospitalUrbana, Illinois  61801
Methodist Cancer Center at Methodist HospitalIndianapolis, Indiana  46202
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
Tufts-NEMC Cancer CenterBoston, Massachusetts  02111
CCOP - Michigan Cancer Research ConsortiumAnn Arbor, Michigan  48106
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
Sparrow Regional Cancer CenterLansing, Michigan  48912-1811
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
Duluth Clinic Cancer Center - DuluthDuluth, Minnesota  55805-1983
CCOP - DuluthDuluth, Minnesota  55805
Miller - Dwan Medical CenterDuluth, Minnesota  55805
Fairview Southdale HospitalEdina, Minnesota  55435
Mercy and Unity Cancer Center at Unity HospitalFridley, Minnesota  55432
Minnesota Oncology Hematology, PA - MaplewoodMaplewood, Minnesota  55109
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
Hubert H. Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
St. Francis Cancer Center at St. Francis Medical CenterShakopee, Minnesota  55379
Park Nicollet Cancer CenterSt. Louis Park, Minnesota  55416
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
MeritCare BroadwayFargo, North Dakota  58122
CCOP - MeritCare HospitalFargo, North Dakota  58122
St. Rita's Medical CenterLima, Ohio  45801
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
University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadison, Wisconsin  53792-6164
Medical College of Wisconsin Cancer CenterMilwaukee, Wisconsin  53226
Rapid City Regional HospitalRapid City, South Dakota  57709
CCOP - Bay Area Tumor InstituteOakland, California  94609-3305
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
CCOP - Cancer Research for the OzarksSpringfield, Missouri  65807
CCOP - Montana Cancer ConsortiumBillings, Montana  59101
CCOP - ColumbusColumbus, Ohio  43206
Veterans Affairs Medical Center - DaytonDayton, Ohio  45428
CCOP - DaytonKettering, Ohio  45429
Albert Einstein Cancer CenterPhiladelphia, Pennsylvania  19141
CCOP - GreenvilleGreenville, South Carolina  29615
Harrington Cancer CenterAmarillo, Texas  79106
Joe Arrington Cancer Research and Treatment CenterLubbock, Texas  79410-1894
LDS HospitalSalt Lake City, Utah  84143
Rush University Medical CenterChicago, Illinois  60612-3824
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
CCOP - Grand RapidsGrand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
Charles M. Barrett Cancer Center at University HospitalCincinnati, Ohio  45267-0526
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
Veterans Affairs Medical Center - DenverDenver, Colorado  80220
MBCCOP - LSU Health Sciences CenterNew Orleans, Louisiana  70112
CCOP - St. Louis-Cape GirardeauSaint Louis, Missouri  63141
Brooke Army Medical CenterFort Sam Houston, Texas  78234-6200
Utah Valley Regional Medical Center - ProvoProvo, Utah  84604
Veterans Affairs Medical Center - RichmondRichmond, Virginia  23249
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
Medical Center of Central GeorgiaMacon, Georgia  31201
Arkansas Cancer Research Center at University of Arkansas for Medical SciencesLittle Rock, Arkansas  72205
Kansas Masonic Cancer Research Institute at the University of Kansas Medical CenterKansas City, Kansas  66160-7353
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
James Graham Brown Cancer Center at University of LouisvilleLouisville, Kentucky  40202
Northside Hospital Cancer CenterAtlanta, Georgia  30342-1611
Washington Cancer Institute at Washington Hospital CenterWashington, District of Columbia  20010
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
McDowell Cancer Center at Akron General Medical CenterAkron, Ohio  44307
Mercy Fitzgerald HospitalDarby, Pennsylvania  19023
Wilford Hall Medical CenterLackland Air Force Base, Texas  78236-5300
Winship Cancer Institute of Emory UniversityAtlanta, Georgia  30322
Mission Hospitals - Memorial CampusAsheville, North Carolina  28801
Presbyterian Cancer Center at Presbyterian HospitalCharlotte, North Carolina  28233-3549
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
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
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Dickinson County Healthcare SystemIron Mountain, Michigan  49801
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
St. Vincent's Comprehensive Cancer Center - ManhattanNew York, New York  10011
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's HospitalGreen Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical CenterMarinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto FallsOconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon BaySturgeon Bay, Wisconsin  54235
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Baptist Cancer Institute - JacksonvilleJacksonville, Florida  32207
Saint Anthony's Hospital at Saint Anthony's Health CenterAlton, Illinois  62002
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Munson Medical CenterTraverse City, Michigan  49684
Southeast Missouri Regional Cancer Center at Southeast Missouri HospitalGape Girardeau, Missouri  63701
David C. Pratt Cancer Center at St. John's MercySt. Louis, Missouri  63141
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
Adena Regional Medical CenterChillicothe, Ohio  54601
Doctors Hospital at Ohio HealthColumbus, Ohio  43228
Riverside Methodist Hospital Cancer CareColumbus, Ohio  43214
Grady Memorial HospitalDelaware, Ohio  43015
Strecker Cancer Center at Marietta Memorial HospitalMarietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial HospitalNewark, Ohio  43055
Utah Cancer Specialists at UCS Cancer CenterSalt Lake City, Utah  84106
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
UCSF Helen Diller Family Comprehensive Cancer CenterSan Francisco, California  94115
Lombardi Comprehensive Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
M.D. Anderson Cancer Center at OrlandoOrlando, Florida  32806
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical CenterSavannah, Georgia  31403-3089
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
University of Illinois Cancer CenterChicago, Illinois  60612-7243
Advocate Lutheran General Cancer Care CenterPark Ridge, Illinois  60068-1174
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
Lucille P. Markey Cancer Center at University of KentuckyLexington, Kentucky  40536-0093
Tulane Cancer Center Office of Clinical ResearchAlexandria, Louisiana  71315-3198
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey  08903
Maimonides Cancer Center at Maimonides Medical CenterBrooklyn, New York  11219
Oklahoma University Cancer InstituteOklahoma City, Oklahoma  73104
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
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
General Robert Huyser Cancer Center at David Grant Medical CenterTravis Air Force Base, California  94535
Huntsman Cancer Institute at University of UtahSalt Lake City, Utah  84112
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. JosephSt. Joseph, Michigan  49085
Mount Carmel Health - West HospitalColumbus, Ohio  43222
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
Peninsula Medical CenterBurlingame, California  94010
Sutter Health - Western Division Cancer Research GroupGreenbrae, California  94904
Marin Cancer Institute at Marin General HospitalGreenbrae, California  94904
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
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
Saint Joseph's Hospital of AtlantaAtlanta, Georgia  30342-1701
Piedmont HospitalAtlanta, Georgia  30309
Charles B. Eberhart Cancer Center at DeKalb Medical CenterDecatur, Georgia  30033
Kennestone Cancer Center at Wellstar Kennestone HospitalMarietta, Georgia  30060
Southern Regional Medical CenterRiverdale, Georgia  30274-2600
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
St. Joseph Medical CenterBloomington, Illinois  61701
InterCommunity Cancer Center of Western IllinoisGalesburg, Illinois  61401
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
BroMenn Regional Medical CenterNormal, Illinois  61761
Community Cancer CenterNormal, Illinois  61761
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
Valley Cancer CenterSpring Valley, Illinois  61362
St. Francis Hospital and Health Centers - Beech Grove CampusBeech Grove, Indiana  46107
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
Pennington Cancer Center at Baton Rouge GeneralBaton Rouge, Louisiana  70806
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
Medical Center of Louisiana - New OrleansNew Orleans, Louisiana  70112
Feist-Weiller Cancer Center at Louisiana State University Health SciencesShreveport, Louisiana  71130-3932
Providence Cancer Institute at Providence Hospital - Southfield CampusSouthfield, Michigan  48075
Saint Francis Medical CenterCape Girardeau, Missouri  63701
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Kingsbury Center for Cancer Care at Cheshire Medical CenterKeene, New Hampshire  03431
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Charles R. Wood Cancer Center at Glens Falls HospitalGlens Falls, New York  12801
Highland Hospital of RochesterRochester, New York  14620
Wayne Radiation OncologyGoldsboro, North Carolina  27534
Forsyth Regional Cancer Center at Forsyth Medical CenterWinston-Salem, North Carolina  27103
Samaritan North Cancer Care CenterDayton, Ohio  45415
Grandview HospitalDayton, Ohio  45405
David L. Rike Cancer Center at Miami Valley HospitalDayton, Ohio  45409
Good Samaritan HospitalDayton, Ohio  45406
Blanchard Valley Medical AssociatesFindlay, Ohio  45840
Charles F. Kettering Memorial HospitalKettering, Ohio  45429
Middletown Regional HospitalMiddletown, Ohio  45044
Mercy Medical CenterSpringfield, Ohio  45504
UVMC Cancer Care Center at Upper Valley Medical CenterTroy, Ohio  45373-1300
Ruth G. McMillan Cancer Center at Greene Memorial HospitalXenia, Ohio  45385
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
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Danville Regional Medical CenterDanville, Virginia  24541
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
San Francisco General Hospital Medical CenterSan Francisco, California  94110
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
St. Francis HospitalFederal Way, Washington  98003
Poudre Valley Radiation OncologyFort Collins, Colorado  80528
H. Lee Moffitt Cancer Center and Research Institute at University of South FloridaTampa, Florida  33612
Northeast Georgia Medical CenterGainesville, Georgia  30501
Good Shepherd HospitalBarrington, Illinois  60010
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Great Lakes Cancer Institute at McLaren Regional Medical CenterFlint, Michigan  48532
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Cancer Treatment CenterWooster, Ohio  44691
St. Joseph Medical CenterReading, Pennsylvania  19604
Alta Bates Summit Comprehensive Cancer CenterBerkeley, California  94704
Stanford Cancer CenterStanford, California  94305-5824
Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross HospitalFort Lauderdale, Florida  33308
University of Miami Sylvester Comprehensive Cancer Center - MiamiMiami, Florida  33136
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/CandlerSavannah, Georgia  31405
Reid Hospital & Health Care ServicesRichmond, Indiana  47374
McFarland Clinic, PCAmes, Iowa  50010
Menorah Medical CenterOverland Park, Kansas  66209
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
Cotton-O'Neil Cancer CenterTopeka, Kansas  66606
Foote Memorial HospitalJackson, Michigan  49201
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
St. Luke's Hospital Cancer Care CenterDuluth, Minnesota  55805
Truman Medical Center - Hospital HillKansas City, Missouri  64108
St. Joseph Medical CenterKansas City, Missouri  64114
North Kansas City HospitalKansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's HospitalKansas City, Missouri  64111
Research Medical CenterKansas City, Missouri  64132
Liberty HospitalLiberty, Missouri  64068
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Billings Clinic - DowntownBillings, Montana  59107-7000
Great Falls Clinic - Main FacilityGreat 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
Leo W. Jenkins Cancer Center at ECU Medical SchoolGreenville, North Carolina  27834
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Grant Medical Center Cancer CareColumbus, Ohio  43215
Mount Carmel St. Ann's Cancer CenterWesterville, Ohio  43081
Adventist Medical CenterPortland, Oregon  97216
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
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
Jon and Karen Huntsman Cancer Center at Intermountain Medical CenterMurray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital CenterOgden, Utah  84403
Lurleen Wallace Comprehensive Cancer at University of Alabama - BirminghamBirmingham, Alabama  35294
Saint Louis University Cancer CenterSaint Louis, Missouri  63110
John H. Stroger, Jr. Hospital of Cook CountyChicago, Illinois  60612-9985
Radiological Associates of Sacramento Medical Group, IncorporatedSacramento, California  95815
Parkview Regional Cancer Center at Parkview HealthFort Wayne, Indiana  46805
Good Samaritan Cancer Center at Good Samaritan HospitalKearney, Nebraska  68848-1990
Dartmouth - Hitchcock ConcordConcord, New Hampshire  03301
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Pardee Memorial HospitalHendersonville, North Carolina  28791
Rex Cancer Center at Rex HospitalRaleigh, North Carolina  27607
Wilmed Radiation Oncology ServicesWilson, North Carolina  27893
Three Rivers Community HospitalGrants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical CenterMedford, Oregon  97504
Theda Care Cancer InstituteAppleton, Wisconsin  54911
Miriam HospitalProvidence, Rhode Island  02906
Cancer Institute at St. John's HospitalSpringfield, Illinois  62701
Sentara Cancer Institute at Sentara Norfolk General HospitalNorfolk, Virginia  23507
Providence Cancer CenterAnchorage, Alaska  99508
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
Great Falls, Montana  59405
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
Center for Cancer Care at OSF Saint Anthony Medical CenterRockford, Illinois  61108
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
Boston University Cancer Research CenterBoston, Massachusetts  02118
Independence Regional Health CenterIndependence, Missouri  64050
Parvin Radiation OncologyKansas City, Missouri  64116
Lynchburg Hematology-Oncology ClinicLynchburg, Virginia  24501
Mercy General HospitalSacramento, California  95819
East Bay Radiation Oncology CenterCastro Valley, California  94546
Memorial Medical CenterModesto, California  95355
Larry G Strieff MD Medical CorporationOakland, California  94609
Tom K Lee, IncorporatedOakland, California  94609
Bay Area Breast Surgeons, IncorporatedOakland, California  94609
Valley Medical Oncology Consultants - PleasantonPleasanton, California  94588
Bay Area HospitalCoos Bay, Oregon  97420
Dale and Frances Hughes Cancer Center at Pocono Medical CenterEast Stroudsburg, Pennsylvania  18301
Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia FieldsOlympia Fields, Illinois  60461
University of Colorado Cancer Center at UC Health Sciences CenterAurora, Colorado  80045
Center for Cancer Care at Goshen General HospitalGoshen, Indiana  46526
Bay MedicalPanama City, Florida  32401
Cancer Institute of Cape Girardeau, LLCCape Girardeau, Missouri  63703
Ocean Medical Center at Meridian HealthBrick, New Jersey  08724
J. Phillip Citta Regional Cancer Center at Community Medical CenterToms River, New Jersey  08755
Providence Cancer Center at PMCCMedford, Oregon  97504
Veterans Affairs Medical Center - MilwaukeeMilwaukee, Wisconsin  53295
Cancer Centers of North Carolina - RaleighRaleigh, North Carolina  27607
Precision Radiotherapy at University PointeWest Chester, Ohio  45069
Valley Medical Oncology Consultants - Castro ValleyCastro Valley, California  94546
Valley Medical OncologyFremont, California  94538
Integrated Community Oncology Network - Orange ParkOrange Park, Florida  32073
NSMC Cancer Center - PeabodyPeabody, Massachusetts  01960
Columbia Saint Mary's Hospital - OzaukeeMequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care CenterMilwaukee, Wisconsin  53211
Cancer Care Center at John Muir Health - Concord CampusConcord, California  94524-4110
Georgia Cancer Center for Excellence at Grady Memorial HospitalAtlanta, Georgia  30303
Oregon Health and Science University Cancer InstitutePortland, Oregon  97239-3098
University Medical Center at PrincetonPrinceton, New Jersey  08540
Virginia K. Crosson Cancer Center at St. Jude Medical CenterFullerton, California  92835
Emory Crawford Long HospitalAtlanta, Georgia  30308
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
Inova Alexandria HospitalAlexandria, Virginia  22304
Mercy Cancer Center at Mercy San Juan Medical CenterCarmichael, California  95608
St. Agnes Hospital Cancer CenterBaltimore, Maryland  21229
Norris Cotton Cancer Center - NorthSaint Johnsbury, Vermont  05819
Integrated Community Oncology Network at Southside Cancer CenterJacksonville, Florida  32207
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
New Mexico Cancer CenterAlbuquerque, New Mexico  87109
Good Samaritan Cancer Care Center at Advocate Good Samaritan HospitalDowners Grove, Illinois  60515-1500
Radiation Oncology Associates SouthwestFort Wayne, Indiana  46804
Princeton Radiation Oncology CenterJamesburg, New Jersey  08831
Upper Delaware Valley Cancer CenterMilford, Pennsylvania  18337