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A Randomized Phase III Comparison of Standard-Dose (60 Gy) Versus High-Dose (74 Gy) Conformal Radiotherapy With Concurrent and Consolidation Carboplatin/Paclitaxel +/- Cetuximab (IND #103444) in Patients With Stage IIIA/IIIB Non-Small Cell Lung Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Lung Cancer, Radiation Toxicity

Thank you

Trial Information

A Randomized Phase III Comparison of Standard-Dose (60 Gy) Versus High-Dose (74 Gy) Conformal Radiotherapy With Concurrent and Consolidation Carboplatin/Paclitaxel +/- Cetuximab (IND #103444) in Patients With Stage IIIA/IIIB Non-Small Cell Lung Cancer


OBJECTIVES:

Primary

- To compare the overall survival of patients with newly diagnosed, unresectable stage
IIIA or IIIB non-small cell lung cancer treated with high- versus standard-dose
conformal radiotherapy with concurrent and consolidation chemotherapy comprising
carboplatin and paclitaxel.

- To compare the overall survival of patients treated with versus without cetuximab in
the setting of concurrent chemotherapy

Secondary

- To compare progression-free survival and local-regional tumor control in patients
treated with these regimens.

- To compare the toxicity of high- versus standard-dose conformal radiotherapy and
concurrent chemotherapy with versus without cetuximab in these patients.

- To investigate the prognostic and predictive effects of gross tumor volume on overall
survival of patients treated with these regimens.

- To compare the quality of life of patients treated with these regimens.

- To correlate outcomes (i.e., survival, toxicity, or QOL) in these patients with
biological parameters.

- To analyze the predictive value of pre-treatment standardized uptake value (SUV) of PET
scan in predicting survival, distant metastasis, and local-regional control in patients
treated with these regimens.

- To explore biological markers to predict clinical outcome including survival, distant
metastasis, local-regional control, and QOL (including toxicity) in patients treated
with these regimens.

- To prospectively collect and bank tissue, blood, and urine specimens for future
biomarker analyses in predicting clinical outcome in patients treated with these
regimens.

- To investigate associations between epidermal growth factor receptor (EGFR) expression
and toxicity, response, overall survival, and progression-free survival.

OUTLINE: This is a multicenter study. Patients are stratified according to PET staging (yes
vs no), radiotherapy technique (3-dimensional conformal radiotherapy vs intensity-modulated
radiotherapy), Zubrod performance status (0 vs 1), 4-dimensional CT planning utilization
(yes vs no), and histology (squamous vs non-squamous). Patients are randomized to 1 of 4
treatment arms. (Arms II and IV closed to accrual effective 6/17/11)

- Arm I: Patients undergo standard dose radiotherapy 5 days a week for 6 weeks for a
total of 60 Gy. Patients receive concurrent chemotherapy comprising paclitaxel IV over
1 hour and carboplatin IV over 30 minutes on days 1, 8, 15, 22, 29, and 36. Patients
also receive consolidation treatment of paclitaxel and carboplatin on days 64 and 85.
Treatment repeats in the absence of disease progression or unacceptable toxicity.

- Arm II: Patients undergo high-dose radiotherapy 5 days per week for 7.5 weeks. Patient
also receive concurrent paclitaxel and carboplatin as in Arm I on days 1, 8, 15, 22,
29, 36, and 43 . Patients also receive consolidation treatment comprising paclitaxel
and carboplatin on days 71 and 92. (closed to accrual effective 6/17/11)

- Arm III: Patients undergo standard-dose radiotherapy 5 days a week for 6 weeks for a
total of 60 Gy. Patients receive cetuximab in addition to concurrent chemotherapy as in
Arm I. Treatment continues with chemoradiation and cetuximab on days 8, 15, 22, 29, 36,
and 43. Patients receive consolidation treatment of cetuximab on days 50, 57, 64, 71,
78, 85, 92, 99, and 106 and paclitaxel and carboplatin on days 71 and 92.

- Arm IV: Patients undergo high-dose radiotherapy 5 days a week for 7.5 weeks for a total
of 74 Gy. Patients receive cetuximab in addition to concurrent chemotherapy as in Arm
I. Treatment continues with chemoradiation and cetuximab on days 8, 15, 22, 29, 36, 43,
and 50. Patients receive consolidation treatment of cetuximab on days 57, 64, 71, 78,
85, 92, 99, 106, and 113 and paclitaxel and carboplatin on days 78 and 99. (closed to
accrual effective 6/17/11) Patients may undergo tumor tissue, blood, and urine
collection periodically during study for tissue banking or biomarker correlative
studies.

Patients may undergo quality-of-life assessment at baseline and periodically during study.

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

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed newly diagnosed non-small cell lung cancer
(NSCLC)

- Stage IIIA or IIIB disease

- N3 supraclavicular disease or contralateral hilar lymph node involvement
(i.e. greater than 1.5 cm on short axis or positive on PET scan) not
allowed

- N2 or N3 disease and an undetectable NSCLC primary tumor allowed

- Unresectable or inoperable disease

- No distant metastases

- Pleural effusion allowed provided effusion is minimal and none of the following
conditions are present:

- Cytologically positive pleural effusion detectable by CT scan and chest x-ray
(pleuracentesis required to confirm negative cytology of pleural fluid)

- Greater than minimal pleural effusions (minimal effusions not detectable by
chest x-ray and too small to tap safely are allowed)

- Exudative pleural effusions, regardless of cytology

- Malignant pleural effusion (T4 incurable disease)

- Measurable or evaluable disease

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- Absolute neutrophil (ANC) ≥ 1,800 cells/mm³

- Platelet count ≥ 100,000 cells/mm³

- Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)

- Creatinine normal OR creatinine clearance ≥ 60 mL/min

- Bilirubin normal

- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times upper
limit of normal

- Pulmonary Function Test (PFTs) including forced expiratory volume at 1 sec. (FEV1) ≥
1.2 L/sec or ≥ 50% predicted (best value obtained prior to or after use of
bronchodilator)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective protection

- No uncontrolled neuropathy ≥ grade 2

- Patients with post-obstructive pneumonia allowed

- No prior invasive malignancy, except nonmelanoma skin cancer, carcinoma in situ of
the breast, oral cavity, or cervix, unless the patient has been disease-free for the
past 3 years

- No prior severe infusion reaction to a monoclonal antibody

- No weight loss of ≥ 10% within the past 4 weeks

- No history of allergic reaction to paclitaxel or other taxanes, or to carboplatin

- No severe, active comorbidity, including any of the following:

- Unstable angina and/or congestive heart failure requiring hospitalization within
the past 6 months

- Transmural myocardial infarction within the past 6 months

- Acute bacterial or fungal infection requiring IV antibiotics at the time of
study entry

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or within past 30 days precluding study therapy

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- AIDS

- No significant history of uncontrolled cardiac disease, including any of the
following:

- Uncontrolled hypertension

- unstable angina

- Myocardial infarction within the past 6 months

- Uncontrolled congestive heart failure

- Cardiomyopathy with decreased ejection fraction

PRIOR CONCURRENT THERAPY:

- At least 3 weeks since prior exploratory thoracotomy (if performed)

- Prior systemic chemotherapy allowed, provided it was not given for NSCLC

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

- No prior radiotherapy to the region of NSCLC that would result in overlap of
radiotherapy fields

- No concurrent white blood cell (WBC) growth factors (i.e., filgrastim [G-CSF] or
sargramostim [GM-CSF]) given during radiotherapy or prophylactically during
consolidation chemotherapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Overall (Failure: death from any cause) survival

Outcome Time Frame:

From randomization to date of death or last follow-up. Analysis occurs after 339 deaths have been reported.

Safety Issue:

No

Principal Investigator

Jeffrey Bradley, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Mallinckrodt Institute of Radiology at Washington University Medical Center

Authority:

United States: Food and Drug Administration

Study ID:

RTOG 0617

NCT ID:

NCT00533949

Start Date:

November 2007

Completion Date:

Related Keywords:

  • Lung Cancer
  • Radiation Toxicity
  • radiation toxicity
  • stage IIIA non-small cell lung cancer
  • stage IIIB non-small cell lung cancer
  • Carcinoma, Non-Small-Cell Lung
  • Lung Neoplasms
  • Radiation Injuries

Name

Location

Mayo Clinic ScottsdaleScottsdale, Arizona  85259
Mayo Clinic - JacksonvilleJacksonville, Florida  32224
Mayo Clinic Cancer CenterRochester, Minnesota  55905
University of Chicago Cancer Research CenterChicago, Illinois  60637
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
Cleveland Clinic Cancer CenterCleveland, Ohio  44195
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Mount Sinai Medical CenterMiami Beach, Florida  33140
Penrose Cancer Center at Penrose HospitalColorado Springs, Colorado  80933
Swedish Medical CenterEnglewood, Colorado  80110
North Suburban Medical CenterThornton, Colorado  80229
Siouxland Hematology-Oncology Associates, LLPSioux City, Iowa  51101
Baystate Regional Cancer Program at D'Amour Center for Cancer CareSpringfield, Massachusetts  01199
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Fairview Ridges HospitalBurnsville, Minnesota  55337
Minnesota Oncology Hematology, PA - MaplewoodMaplewood, Minnesota  55109
Virginia Piper Cancer Institute at Abbott - Northwestern HospitalMinneapolis, Minnesota  55407
Regions Hospital Cancer Care CenterSt. Paul, Minnesota  55101
CCOP - MeritCare HospitalFargo, North Dakota  58122
Aultman Cancer Center at Aultman HospitalCanton, Ohio  44710-1799
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
Natalie Warren Bryant Cancer Center at St. Francis HospitalTulsa, Oklahoma  74136
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 College of Wisconsin Cancer CenterMilwaukee, Wisconsin  53226
CCOP - OchsnerNew Orleans, Louisiana  70121
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Veterans Affairs Medical Center - AlbanyAlbany, New York  12208
Albert Einstein Cancer CenterPhiladelphia, Pennsylvania  19141
CCOP - GreenvilleGreenville, South Carolina  29615
Harrington Cancer CenterAmarillo, Texas  79106
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel HillChapel Hill, North Carolina  27599-7570
Charles M. Barrett Cancer Center at University HospitalCincinnati, Ohio  45267-0526
Kimmel Cancer Center at Thomas Jefferson University - PhiladelphiaPhiladelphia, Pennsylvania  19107
Cleveland Clinic Taussig Cancer CenterCleveland, Ohio  44195
MBCCOP - LSU Health Sciences CenterNew Orleans, Louisiana  70112
CCOP - Virginia Mason Research CenterSeattle, Washington  98101
Utah Valley Regional Medical Center - ProvoProvo, Utah  84604
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Rebecca and John Moores UCSD Cancer CenterLa Jolla, California  92093-0658
University of California Davis Cancer CenterSacramento, California  95817
Fletcher Allen Health Care - University Health Center CampusBurlington, Vermont  05401
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
Bellin Memorial HospitalGreen Bay, Wisconsin  54301
Josephine Ford Cancer Center at Henry Ford HospitalDetroit, Michigan  48202
Blumenthal Cancer Center at Carolinas Medical CenterCharlotte, North Carolina  28232-2861
Washington Cancer Institute at Washington Hospital CenterWashington, District of Columbia  20010
UMDNJ University HospitalNewark, New Jersey  07103
McDowell Cancer Center at Akron General Medical CenterAkron, Ohio  44307
Central Baptist HospitalLexington, Kentucky  40503
Waukesha Memorial Hospital Regional Cancer CenterWaukesha, Wisconsin  53188
Broward General Medical Center Cancer CenterFt. Lauderdale, Florida  33316
University of Florida Shands Cancer CenterGainesville, Florida  32610-0232
Baptist-South Miami Regional Cancer ProgramMiami, Florida  33176
Sacred Heart Cancer Center at Sacred Heart HospitalPensacola, Florida  32504
Winship Cancer Institute of Emory UniversityAtlanta, Georgia  30322
SUNY Upstate Medical University HospitalSyracuse, New York  13210
Presbyterian Cancer Center at Presbyterian HospitalCharlotte, North Carolina  28233-3549
Hollings Cancer Center at Medical University of South CarolinaCharleston, South Carolina  29425
St. Vincent Hospital Regional Cancer CenterGreen Bay, Wisconsin  54307-3508
James P. Wilmot Cancer Center at University of Rochester Medical CenterRochester, New York  14642
St. Mary's Hospital Medical Center - Green BayGreen Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical CenterMarinette, Wisconsin  54143
Baptist Cancer Institute - JacksonvilleJacksonville, Florida  32207
Adena Regional Medical CenterChillicothe, Ohio  54601
Riverside Methodist Hospital Cancer CareColumbus, Ohio  43214
Utah Cancer Specialists at UCS Cancer CenterSalt Lake City, Utah  84106
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
Memorial Cancer Institute at Memorial Regional HospitalHollywood, Florida  33021
UCSF Helen Diller Family Comprehensive Cancer CenterSan Francisco, California  94115
M.D. Anderson Cancer Center at OrlandoOrlando, Florida  32806
Mountain States Tumor Institute at St. Luke's Regional Medical CenterBoise, Idaho  83712-6297
Tulane Cancer Center Office of Clinical ResearchAlexandria, Louisiana  71315-3198
University of Mississippi Cancer ClinicJackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
CCOP - Nevada Cancer Research FoundationLas Vegas, Nevada  89109-2306
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
St. Luke's - Roosevelt Hospital Center - St.Luke's DivisionNew York, New York  10027
Oklahoma University Cancer InstituteOklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger HealthDanville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of TexasHouston, Texas  77030-4009
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
University of Virginia Cancer CenterCharlottesville, Virginia  22908
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital MarltonMarlton, New Jersey  08053
Cleveland Clinic Cancer Center at Fairview HospitalCleveland, Ohio  44111
Hillcrest Cancer Center at Hillcrest HospitalMayfield Heights, Ohio  44124
Morgan Cancer Center at Lehigh Valley Hospital - Cedar CrestAllentown, Pennsylvania  18105
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
All Saints Cancer Center at Wheaton Franciscan HealthcareRacine, Wisconsin  53405
Ella Milbank Foshay Cancer Center at Jupiter Medical CenterJupiter, Florida  33458
Piedmont HospitalAtlanta, Georgia  30309
Charles B. Eberhart Cancer Center at DeKalb Medical CenterDecatur, Georgia  30033
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
Community Cancer CenterNormal, Illinois  61761
Cancer Treatment Center at Pekin HospitalPekin, Illinois  61554
OSF St. Francis Medical CenterPeoria, Illinois  61637
Mercy Regional Cancer Center at Mercy Medical CenterCedar Rapids, Iowa  52403
Mercy Cancer Center at Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
CentraCare Clinic - River CampusSt. Cloud, Minnesota  56303
Cancer Institute of New Jersey at Cooper - VoorheesVoorhees, New Jersey  08043
Highland Hospital of RochesterRochester, New York  14620
St. Charles Mercy HospitalOregon, Ohio  43616
North Coast Cancer Care, IncorporatedSandusky, Ohio  44870
Cleveland Clinic - WoosterWooster, Ohio  44691
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
Lankenau Cancer Center at Lankenau HospitalWynnewood, Pennsylvania  19096
Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical CenterKingsport, Tennessee  37662
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Poudre Valley Radiation OncologyFort Collins, Colorado  80528
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Cancer Center at Ball Memorial HospitalMuncie, Indiana  47303
Mercy Cancer Center at Mercy Medical Center - North IowaMason City, Iowa  50401
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Altru Cancer Center at Altru HospitalGrand Forks, North Dakota  58201
Midelfort Clinic - LutherEau Claire, Wisconsin  54702
UAB Comprehensive Cancer CenterBirmingham, Alabama  35294
Stanford Cancer CenterStanford, California  94305-5824
St. Mary Mercy HospitalLivonia, Michigan  48154
Mercy Regional Cancer Center at Mercy HospitalPort Huron, Michigan  48060
Billings Clinic - DowntownBillings, Montana  59107-7000
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Barberton Citizens HospitalBarberton, Ohio  44203
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Penn State Hershey Cancer Institute at Milton S. Hershey Medical CenterHershey, Pennsylvania  17033-0850
McGlinn Family Regional Cancer Center at Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
Jon and Karen Huntsman Cancer Center at Intermountain Medical CenterMurray, Utah  84157
FirstHealth Moore Regional Community Hospital Comprehensive Cancer CenterPinehurst, North Carolina  28374
St. Joseph Hospital Regional Cancer Center - OrangeOrange, California  92868-3849
Enloe Cancer Center at Enloe Medical CenterChico, California  95926
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
Elliot Regional Cancer Center at Elliot HospitalManchester, New Hampshire  03103
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Theda Care Cancer InstituteAppleton, Wisconsin  54911
Kinston Medical SpecialistsKinston, North Carolina  28501
Cancer Centers of the Carolinas - Faris RoadGreenville, South Carolina  29605
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Regional Cancer Center - ErieErie, Pennsylvania  16505
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
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
Tyler Cancer CenterTyler, Texas  75702
Memorial Medical CenterModesto, California  95355
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
Trinity CancerCare CenterMinot, North Dakota  58701
Cancer Center of Paoli Memorial HospitalPaoli, Pennsylvania  19301-1792
Dale and Frances Hughes Cancer Center at Pocono Medical CenterEast Stroudsburg, Pennsylvania  18301
Center for Cancer Care at Goshen General HospitalGoshen, Indiana  46526
J. Phillip Citta Regional Cancer Center at Community Medical CenterToms River, New Jersey  08755
Veterans Affairs Medical Center - MilwaukeeMilwaukee, Wisconsin  53295
Saint Mary's Regional Medical CenterReno, Nevada  89503
Cancer Centers of North Carolina - RaleighRaleigh, North Carolina  27607
Integrated Community Oncology Network - Orange ParkOrange Park, Florida  32073
Alamance Cancer Center at Alamance Regional Medical CenterBurlington, North Carolina  27216
Luther Midlelfort HospitalEau Claire, Wisconsin  54702
Frankford Hospital Cancer Center - Torresdale CampusPhiladelphia, Pennsylvania  19114
Cancer Care Center at John Muir Health - Concord CampusConcord, California  94524-4110
Georgia Cancer Center for Excellence at Grady Memorial HospitalAtlanta, Georgia  30303
Shore Regional Cancer Center at Memorial Hospital - EastonEaston, Maryland  21601
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
West Texas Cancer CenterOdessa, Texas  79761
Emory Crawford Long HospitalAtlanta, Georgia  30308
New York Oncology Hematology, PC at Albany Regional Cancer CareAlbany, New York  12208
Radiation Oncology Center - RosevilleRoseville, California  95661
Mercy Cancer Center at Mercy San Juan Medical CenterCarmichael, California  95608
St. Agnes Hospital Cancer CenterBaltimore, Maryland  21229
Barnes-Jewish West County HospitalSaint Louis, Missouri  63141
Siteman Cancer Center at Barnes-Jewish St. Peters Hospital - St. PetersSaint Peters, Missouri  63376
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
Community Regional Cancer Care at Community Hospital NorthIndianapolis, Indiana  46256
Community Regional Cancer Care at Community Hospital EastIndianapolis, Indiana  46219
Integrated Community Oncology Network at Southside Cancer CenterJacksonville, Florida  32207
Southwest General Health CenterMiddleburgh Heights, Ohio  44130
UHHS Chagrin Highlands Medical CenterOrange Villager, Ohio  44122
UHHS Westlake Medical CenterWestlaker, Ohio  44145
Longview Cancer CenterLongview, Texas  75601
Riverview UW Cancer Center at Riverview HospitalWisconsin Rapids, Wisconsin  54494
Saint Helena HospitalSaint Helena, California  94574
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
Feather River Hospital Cancer CenterParadise, California  95969
Radiation Oncology Associates SouthwestFort Wayne, Indiana  46804
Central Indiana Cancer Centers - EastIndianapolis, Indiana  46219
Payson Center for Cancer Care at Concord HospitalConcord, New Hampshire  03301
Willamette Valley Cancer Center - EugeneEugene, Oregon  97401
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
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
Arizona Oncology - TucsonTucson, Arizona  85704
Door County Cancer Center at Door County Memorial HospitalSturgeon Bay, Wisconsin  54235-1495
Saint Agnes Cancer Center at Saint Agnes Medical CenterFresno, California  93720
Saint Elizabeth Cancer Institute at Saint Elizabeth Regional Medical CenterLincoln, Nebraska  68510
Texas Oncology, PA at Texas Cancer Center - Arlington SouthArlington, Texas  76014
D.N. Greenwald CenterMukwonago, Wisconsin  53149