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Randomized Phase II Study of ECF-C, IC-C, or FOLFOX-C in Metastatic Esophageal and GE Junction Cancer


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Esophageal Cancer

Thank you

Trial Information

Randomized Phase II Study of ECF-C, IC-C, or FOLFOX-C in Metastatic Esophageal and GE Junction Cancer


OBJECTIVES:

Primary

- Compare the tumor response rate in patients with metastatic esophageal or
gastroesophageal junction cancer treated with epirubicin hydrochloride, cisplatin,
fluorouracil, and cetuximab (ECF-C); irinotecan hydrochloride, cisplatin, and cetuximab
(IC-C); or fluorouracil, oxaliplatin, leucovorin calcium, and cetuximab (FOLFOX-C).

Secondary

- Compare overall survival of patients treated with these regimens.

- Compare progression-free survival of patients treated with these regimens.

- Compare treatment failure in patients treated with these regimens.

- Determine the type and severity of toxicities associated with these regimens in the
multi-institutional phase II setting.

- Correlate quantitative immunohistochemistry results with objective response rate,
overall survival, and time to progression in these patients.

- Evaluate the cellular damage (i.e., apoptosis) as a result of oxaliplatin in these
patients.

- Determine if germline epidermal growth factor receptor (EGFR) variants correlate with
skin rash in patients treated with cetuximab.

- Correlate germline EGFR variants with tumor EGFR expression as measured by
immunohistochemistry.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
histology (squamous cell carcinoma vs adenocarcinoma) and ECOG performance status (0 or 1 vs
2). Patients are randomized to 1 of 3 treatment arms.

- Arm I (ECF + cetuximab): Patients receive cetuximab IV over 1-2 hours on days 1, 8, and
15; epirubicin hydrochloride IV followed by cisplatin IV over 1 hour on day 1; and
fluorouracil IV continuously on days 1-21. Treatment repeats every 21 days in the
absence of disease progression and unacceptable toxicity.

- Arm II (IC + cetuximab): Patients receive cetuximab IV over 1-2 hours on days 1, 8, and
15 and cisplatin IV over 30 minutes followed by irinotecan hydrochloride IV over 90
minutes on days 1 and 8. Treatment repeats every 21 days in the absence of disease
progression or unacceptable toxicity.

- ARM III (FOLFOX + cetuximab): Patients receive cetuximab IV over 1-2 hours on days 1
and 8; oxaliplatin IV over 2 hours followed by leucovorin calcium IV over 2 hours on
day 1; and fluorouracil IV continuously over 46-48 hours on days 1 and 2. Treatment
repeats every 14 days in the absence of disease progression or unacceptable toxicity.

Patients undergo tumor sample collection at baseline to examine quantitative
immunofluorescence with subcellular localization for epidermal growth factor receptor
(EGFR), phospho EGFR, HER-2, phospho-HER-2, HER-3, HER-4, FEF, AKT, phospho AKT, PTEN,
gastrin-releasing peptide (GRP), and GRP receptor levels. Tumor samples are collected at
baseline from patients randomized to arm III to evaluate molecular mechanisms for
correlative studies. Cellular damage (i.e., apoptosis) by oxaliplatin is determined by DNA
fragmentation by TUNEL assay.

After completion of study treatment, patients are followed periodically for up to 2 years.

PROJECTED ACCRUAL: A total of 270 patients will be accrued for this study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically, cytologically, or radiologically confirmed esophageal cancer,
including any of the following types:

- Squamous cell carcinoma

- Adenocarcinoma* of the esophagus

- Adenocarcinoma* of the gastroesophageal (GE) junction according to Siewert
classification

- Type I or II disease

- No type III disease NOTE: Undifferentiated adenocarcinoma and
adenosquamous tumor will be considered as adenocarcinoma

- Metastatic disease or locally recurrent or residual (post-resection) disease

- Resected esophageal or GE junction disease that develops radiological or
clinical evidence of metastatic disease does not require histological or
cytological confirmation of metastatic disease unless 1 of the following is
true:

- More than 5 years since primary surgery and development of metastatic
disease

- Primary cancer was stage I

- Measurable disease, defined as at least 1 unidimensionally measurable lesion (longest
diameter) as ≥ 20 mm by conventional techniques or ≥ 10 mm by spiral CT scan

- Must have ≥ 1 paraffin block (or ≥ 15 unstained slides) available for analysis of
tumor epidermal growth factor receptor (EGFR) status

- No known CNS metastases or carcinomatous meningitis

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Platelet count ≥ 100,000/mm^3

- Granulocyte count ≥ 1,500/mm^3

- Creatinine ≤ 1.5 mg/dL

- AST ≤ 5.0 times upper limit of normal

- Bilirubin ≤ 1.5 mg/dL

- Albumin ≥ 2.5 g/dL

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Must have a stable weight loss of (i.e., < 1 pound weight loss during the past week)

- No diarrhea ≥ grade 2 within the past 7 days

- No myocardial infarction within the past 6 months

- No New York Heart Association class III or IV congestive heart failure

- No interstitial pneumonia or symptomatic interstitial fibrosis of the lung

- No seizure disorder or active neurological disease requiring anti-epileptic
medication

- No peripheral neuropathy ≥ grade 2

- No evidence of Gilbert's syndrome

- No prior allergic reaction to chimerized or murine monoclonal antibody therapy or
documented presence of human anti-mouse antibodies (HAMA)

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior chemotherapy or radiotherapy

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

- At least 4 weeks since prior major surgery* and recovered

- At least 2 weeks since prior minor surgery* and recovered

- No concurrent palliative radiotherapy

- No other concurrent investigational agent

- No other concurrent chemotherapy

- No concurrent hormonal therapy except for the following:

- Steroids given temporarily for adrenal failure

- Hormones for nondisease-related conditions (e.g., insulin for diabetes)

- Intermittent steroids (e.g., dexamethasone) as an antiemetic NOTE: *Insertion of
a vascular device is not considered major or minor surgery

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Tumor response rate (complete and partial) in patients with measurable esophageal or GE junction adenocarcinoma

Safety Issue:

No

Principal Investigator

Peter C. Enzinger, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Dana-Farber Cancer Institute

Authority:

Unspecified

Study ID:

CDR0000505535

NCT ID:

NCT00381706

Start Date:

September 2006

Completion Date:

Related Keywords:

  • Esophageal Cancer
  • squamous cell carcinoma of the esophagus
  • adenocarcinoma of the esophagus
  • stage IV esophageal cancer
  • recurrent esophageal cancer
  • Esophageal Diseases
  • Esophageal Neoplasms

Name

Location

Memorial Sloan-Kettering Cancer CenterNew York, New York  10021
University of Chicago Cancer Research CenterChicago, Illinois  60637
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Kansas CityKansas City, Missouri  64131
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Illinois Oncology Research AssociationPeoria, Illinois  61602
CCOP - Carle Cancer CenterUrbana, Illinois  61801
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Rush-Copley Cancer Care CenterAurora, Illinois  60507
Joliet Oncology-Hematology Associates, Limited - WestJoliet, Illinois  60435
Carle Cancer Center at Carle Foundation HospitalUrbana, Illinois  61801
Saint Anthony Memorial Health CentersMichigan City, Indiana  46360
Cedar Rapids Oncology AssociatesCedar Rapids, Iowa  52403
Mercy Medical Center - Sioux CitySioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
St. Luke's Regional Medical CenterSioux City, Iowa  51104
Baystate Regional Cancer Program at D'Amour Center for Cancer CareSpringfield, Massachusetts  01199
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
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
Hutchinson Area Health CareHutchinson, Minnesota  55350
Meeker County Memorial HospitalLichfield, Minnesota  55355
Minnesota Oncology Hematology, PA - MaplewoodMaplewood, Minnesota  55109
HealthEast Cancer Care at St. John's HospitalMaplewood, Minnesota  55109
Hennepin County Medical Center - MinneapolisMinneapolis, Minnesota  55415
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
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Minnesota Oncology Hematology, PA - WoodburyWoodbury, Minnesota  55125
Aultman Cancer Center at Aultman HospitalCanton, Ohio  44710-1799
MetroHealth Cancer Care Center at MetroHealth Medical CenterCleveland, Ohio  44109
St. Rita's Medical CenterLima, Ohio  45801
Abramson Cancer Center of the University of PennsylvaniaPhiladelphia, Pennsylvania  19104-4283
Geisinger Medical Group - Scenery ParkState College, Pennsylvania  16801
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
Medical X-Ray Center, PCSioux Falls, South Dakota  57105
Avera Cancer InstituteSioux Falls, South Dakota  57105
Marshfield Clinic - Indianhead CenterRice Lake, Wisconsin  54868
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Memorial Hospital of South BendSouth Bend, Indiana  46601
Newark Beth Israel Medical CenterNewark, New Jersey  07112
CCOP - Northern Indiana CR ConsortiumSouth Bend, Indiana  46601
Saint Joseph Regional Medical CenterSouth Bend, Indiana  46617
Holden Comprehensive Cancer Center at University of IowaIowa City, Iowa  52242-1002
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical CenterLebanon, New Hampshire  03756-0002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel HillChapel Hill, North Carolina  27599-7570
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
CCOP - Scott and White HospitalTemple, Texas  76508
Veterans Affairs Medical Center - MinneapolisMinneapolis, Minnesota  55417
Veterans Affairs Medical Center - BuffaloBuffalo, New York  14215
Fletcher Allen Health Care - University Health Center CampusBurlington, Vermont  05401
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
Blumenthal Cancer Center at Carolinas Medical CenterCharlotte, North Carolina  28232-2861
Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital CenterBaltimore, Maryland  21237
Via Christi Cancer Center at Via Christi Regional Medical CenterWichita, Kansas  67214
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
Lahey Clinic Medical Center - BurlingtonBurlington, Massachusetts  01805
McCreery Cancer Center at Ottumwa RegionalOttumwa, Iowa  52501
Green Bay Oncology, Limited - EscanabaEscanaba, Michigan  49431
Dickinson County Healthcare SystemIron Mountain, Michigan  49801
Our Lady of Mercy Medical Center Comprehensive Cancer CenterBronx, New York  10466
CCOP - Hematology-Oncology Associates of Central New YorkEast Syracuse, New York  13057
Lewistown HospitalLewistown, Pennsylvania  17044
Mount Nittany Medical CenterState College, Pennsylvania  16803
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
Hematology Oncology Associates of the Quad CitiesBettendorf, Iowa  52722
Southwest Medical CenterLiberal, Kansas  67901
Wayne Memorial Hospital, IncorporatedGoldsboro, North Carolina  27534
Lombardi Comprehensive Cancer Center at Georgetown University Medical CenterWashington, District of Columbia  20007
Swedish-American Regional Cancer CenterRockford, Illinois  61104-2315
Indiana University Melvin and Bren Simon Cancer CenterIndianapolis, Indiana  46202-5289
CancerCare of Maine at Eastern Maine Medical CenterBangor, Maine  04401
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer InstituteBoston, Massachusetts  02115
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
Geisinger Cancer Institute at Geisinger HealthDanville, Pennsylvania  17822-0001
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
South Bend ClinicSouth Bend, Indiana  46617
Lakeland Regional Cancer Care Center - St. JosephSt. Joseph, Michigan  49085
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital MarltonMarlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West JerseyVoorhees, New Jersey  08043
Morgan Cancer Center at Lehigh Valley Hospital - Cedar CrestAllentown, Pennsylvania  18105
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
University Medical Center of Southern NevadaLas Vegas, Nevada  89102
Joan Karnell Cancer Center at Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
St. Joseph Medical CenterBloomington, Illinois  61701
Graham HospitalCanton, Illinois  61520
Memorial HospitalCarthage, Illinois  62321
Eureka Community HospitalEureka, Illinois  61530
Galesburg Cottage HospitalGalesburg, Illinois  61401
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
Mason District HospitalHavana, Illinois  62644
Hopedale Medical ComplexHopedale, Illinois  61747
McDonough District HospitalMacomb, Illinois  61455
BroMenn Regional Medical CenterNormal, Illinois  61761
Community Cancer CenterNormal, Illinois  61761
Community Hospital of OttawaOttawa, Illinois  61350
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
Proctor HospitalPeoria, Illinois  61614
Illinois Valley Community HospitalPeru, Illinois  61354
Perry Memorial HospitalPrinceton, Illinois  61356
St. Margaret's HospitalSpring Valley, Illinois  61362
Fort Wayne Medical Oncology and HematologyFort Wayne, Indiana  46815
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
Mercy Regional Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Mercy Capitol HospitalDes Moines, Iowa  50307
Medical Oncology and Hematology Associates at John Stoddard Cancer CenterDes Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer CenterDes Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des MoinesWest Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Immanuel Medical CenterOmaha, Nebraska  68122
Creighton University Medical CenterOmaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Charles R. Wood Cancer Center at Glens Falls HospitalGlens Falls, New York  12801
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical CenterKingsport, Tennessee  37662
Mountainview MedicalBerlin, Vermont  05602
Danville Regional Medical CenterDanville, Virginia  24541
Massachusetts General HospitalBoston, Massachusetts  02114-2617
Mercy Cancer Center at Mercy Medical Center - North IowaMason City, Iowa  50401
Missouri Baptist Cancer CenterSt. Louis, Missouri  63131
Tunnell Cancer Center at Beebe Medical CenterLewes, Delaware  19958
Evanston HospitalEvanston, Illinois  60201-1781
William N. Wishard Memorial HospitalIndianapolis, Indiana  46202
McFarland Clinic, PCAmes, Iowa  50010
Hospital District Sixth of Harper CountyAnthony, Kansas  67003
Cancer Center of Kansas, PA - ChanuteChanute, Kansas  66720
Cancer Center of Kansas, PA - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas - Fort ScottFort Scott, Kansas  66701
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Cancer Center of Kansas, PA - KingmanKingman, Kansas  67068
Lawrence Memorial HospitalLawrence, Kansas  66044
Cancer Center of Kansas, PA - NewtonNewton, Kansas  67114
Menorah Medical CenterOverland Park, Kansas  66209
Cancer Center of Kansas, PA - ParsonsParsons, Kansas  67357
Cancer Center of Kansas, PA - PrattPratt, Kansas  67124
Cancer Center of Kansas, PA - SalinaSalina, Kansas  67401
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
Cancer Center of Kansas, PA - WellingtonWellington, Kansas  67152
Cancer Center of Kansas, PA - WichitaWichita, Kansas  67214
Associates in Womens Health, PA - North ReviewWichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas, PA - WinfieldWinfield, Kansas  67156
Foote Memorial HospitalJackson, Michigan  49201
St. Mary Mercy HospitalLivonia, Michigan  48154
St. Joseph Mercy OaklandPontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - SaginawSaginaw, Michigan  48601
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
Arch Medical Services, Incorporated at Center for Cancer Care and ResearchSaint Louis, Missouri  63141
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
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer CenterColumbus, Ohio  43210-1240
St. Luke's Cancer Network at St. Luke's HospitalBethlehem, Pennsylvania  18015
Geisinger Hazleton Cancer CenterHazleton, Pennsylvania  18201
Penn State Hershey Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
Hematology and Oncology Associates of Northeastern PennsylvaniaScranton, Pennsylvania  18510
Susquehanna Cancer Center at Divine Providence HospitalWilliamsport, Pennsylvania  17701
Southwest Virginia Regional Cancer Center at Wellmonth HealthNorton, Virginia  24273
Center for Cancer Treatment & Prevention at Sacred Heart HospitalEau Claire, Wisconsin  54701
Marshfield Clinic Cancer Care at Regional Cancer CenterEau Claire, Wisconsin  54701
Saint Joseph's HospitalMarshfield, Wisconsin  54449
Medical Consultants, LimitedMilwaukee, Wisconsin  53215
Marshfield Clinic - Lakeland CenterMinocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's HospitalRhinelander, Wisconsin  54501
Saint Michael's Hospital Cancer CenterStevens Point, Wisconsin  54481
Marshfield Clinic - Wausau CenterWausau, Wisconsin  54401
Marshfield Clinic - Weston CenterWeston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
Pardee Memorial HospitalHendersonville, North Carolina  28791
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Dana-Farber/Brigham and Women's Cancer CenterBoston, Massachusetts  02115
Kinston Medical SpecialistsKinston, North Carolina  28501
McLeod Regional Medical CenterFlorence, South Carolina  29501
University of Wisconcin Cancer Center at Aspirus Wausau HospitalWausau, Wisconsin  54401
Galesburg Clinic, PCGalesburg, Illinois  61401
Oncology Care Associates, PLLCSaint Joseph, Michigan  49085
Independence Regional Health CenterIndependence, Missouri  64050
Parvin Radiation OncologyKansas City, Missouri  64116
Dale and Frances Hughes Cancer Center at Pocono Medical CenterEast Stroudsburg, Pennsylvania  18301
South Shore HospitalSouth Weymouth, Massachusetts  02190
Frankford Hospital Cancer Center - Torresdale CampusPhiladelphia, Pennsylvania  19114
Shore Regional Cancer Center at Memorial Hospital - EastonEaston, Maryland  21601
Ralph Lauren Center for Cancer Care and PreventionNew York, New York  10035
Norwalk HospitalNorwalk, Connecticut  06856
Mercy Hospital at Wilkes-BarreWilkes-Barre, Pennsylvania  18765