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A Phase III Trial of Short Term Androgen Deprivation With Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy


Phase 3
18 Years
N/A
Open (Enrolling)
Male
Prostate Cancer

Thank you

Trial Information

A Phase III Trial of Short Term Androgen Deprivation With Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy


OBJECTIVES:

Primary

- To determine whether the addition of short-term androgen deprivation (STAD) to prostate
bed radiotherapy (PBRT) improves freedom from progression (FFP) (i.e., maintenance of a
prostate-specific antigen [PSA] less than the nadir+2 ng/mL, absence of clinical
failure, and absence of death from any cause) for 5 years, over that of PBRT alone in
men treated with salvage radiotherapy after radical prostatectomy.

- To determine whether STAD, pelvic lymph node radiotherapy (PLNRT), and PBRT improves
FFP over that of STAD+PBRT and PBRT alone in men treated with salvage radiotherapy
after radical prostatectomy.

Secondary

- To compare the rates of a PSA ≥ 0.4 ng/mL and rising at 5 years after randomization
(secondary biochemical failure endpoint), the development of hormone-refractory disease
(3 rises in PSA during treatment with salvage androgen-deprivation therapy), distant
metastasis, cause-specific mortality, and overall mortality.

- To compare acute and late morbidity based on Common Toxicity Criteria for Adverse
Effects (CTCAE), v. 3.0.

- To measure the expression of cell kinetic, apoptotic pathway, and angiogenesis-related
genes in archival diagnostic tissue to better define the risk of FFP, distant failure,
cause-specific mortality, and overall mortality after salvage radiotherapy for prostate
cancer, independently of conventional clinical parameters now used.

- To quantify blood product-based proteomic and genomic (single nucleotide polymorphisms)
patterns and urine-based genomic patterns before and at different times after treatment
to better define the risk of FFP, distant failure, cause-specific mortality, and
overall mortality after salvage radiotherapy for prostate cancer, independently of
conventional clinical parameters now used.

- To assess the degree, duration, and significant differences of disease-specific
health-related quality of life (HRQOL) decrements among treatment arms.

- To assess whether mood is improved and depression is decreased with the more aggressive
therapy if it improves FFP.

- To collect paraffin-embedded tissue blocks, serum, plasma, urine, and buffy coat cells
for future translational research analyses.

Tertiary

- To assess whether an incremental gain in FFP and survival with more aggressive therapy
outweighs decrements in the primary generic domains of HRQOL (i.e., mobility, self
care, usual activities, pain/discomfort, and anxiety/depression).

- To evaluate the cost-utility of the treatment arm demonstrating the most significant
benefit (in terms of the primary outcome) in comparison with other widely accepted
cancer and non-cancer therapies.

- To assess associations between serum levels of beta-amyloid and measures of cognition
and mood and depression.

- An exploratory aim is to assess the relationship(s) between the American Urological
Association Symptom Index (AUA SI) and urinary morbidity using the CTCAE v. 3.0 grading
system.

OUTLINE: Patients are stratified according to seminal vesicle involvement (yes vs no),
prostatectomy Gleason score (≤ 7 vs 8-9), pre-radiotherapy PSA (≥ 0.1 and ≤ 1.0 ng/mL vs >
1.0 and < 2.0 ng/mL), and pathology stage (pT2 and margin negative vs all others). Patients
are randomized to 1 of 3 treatment arms.

- Arm I (prostate bed radiotherapy [PBRT] alone): Patients undergo PBRT once daily, 5
days a week, Monday through Friday, for approximately 7-8 weeks (36 to 39 fractions).

- Arm II (PBRT and short-term androgen-deprivation [STAD]): Beginning 2 months before the
start of PBRT, patients undergo STAD, using a combination of antiandrogen and
luteinizing hormone-releasing hormone (LHRH) agonist therapy, for a total of 4-6
months. Patients receive antiandrogen therapy comprising either oral flutamide 3 times
daily or oral bicalutamide once daily for at least 4 months (started within 1-14 days
prior to the LHRH agonist and ending the last day of radiotherapy ± 14 days). Patients
receive LHRH agonist injection beginning concurrently with or 2 weeks after the start
of antiandrogen therapy. LHRH agonist injection consists of analogs approved by the FDA
(or by Health Canada for Canadian institutions) (e.g., leuprolide, goserelin,
buserelin, or triptorelin) and may be given in any possible combination (may be given
as a single 4-month injection and one to two 1-month injection[s], two 3-month
injections, or a 6-month injection), such that the total LHRH agonist treatment time is
4-6 months. Approximately 2 months after beginning of STAD, patients undergo PBRT as in
arm I.

- Arm III (Pelvic lymph node radiotherapy [PLNRT], PBRT, and STAD): Beginning 2 months
before the start of radiotherapy, patients receive STAD therapy as in arm II.
Approximately 2 months after beginning of STAD, patients undergo PBRT and PLNRT once
daily, 5 days a week, Monday through Friday, for approximately 5 weeks (25 fractions)
followed by PBRT only once daily, 5 days a week for approximately 2-3 weeks (11-14
fractions).

Patients complete the American Urological Association Symptom Index (AUA SI) questionnaire
prior to protocol treatment, at week 6 of radiotherapy, and then periodically after
completion of study therapy.

After completion of study therapy, patients are followed up every 3 months for 1 year, every
6 months for 4 years, and then annually thereafter.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Adenocarcinoma of the prostate treated primarily with radical prostatectomy

- Pathologically proven to be lymph node-negative by pelvic lymphadenectomy (N0)
or lymph node status pathologically unknown (Nx [undissected pelvic lymph nodes
because lymph node dissection is not required])

- Any type of radical prostatectomy allowed, including retropubic, perineal,
laparoscopic, or robotically assisted

- Meets 1 of the following pathologic classifications:

- T3 N0/Nx disease with or without positive prostatectomy margins

- T2 N0/Nx disease with or without positive prostatectomy margins

- N1 patients are ineligible, as are those with pelvic lymph node enlargement ≥
1.5 cm in greatest dimension by CT scan or MRI of the pelvis, unless the
enlarged lymph node is negative

- Prostatectomy Gleason score of 9 or less

- A post-radical prostatectomy entry PSA of ≥ 0.1 and ≤ 1.0 ng/mL at least 6 weeks
after prostatectomy and within 30 days of registration

- Serum total testosterone ≥ 40% of the lower limit of normal (patients who have had a
unilateral orchiectomy are eligible as long as this requirement is met)

- No distant metastases based on history/physical examination, CT scan or MRI of the
abdomen and pelvis, and bone scan

- No palpable prostatic fossa abnormality/mass suggestive of recurrence, unless shown
by biopsy under ultrasound guidance not to contain cancer

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- Platelets ≥ 100,000/mm^3

- Hemoglobin ≥ 10.0 g/dL (the use of transfusion or other intervention to achieve this
is allowed)

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2 x upper limit
of normal

- No prior invasive malignancy (except nonmelanoma skin cancer) or superficial bladder
cancer unless disease free for a minimum of 5 years (e.g., carcinoma in situ of the
oral cavity is permissible)

- No severe, active co-morbidity, including any of the following:

- History of inflammatory bowel disease

- History of hepatitis B or C

- 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 intravenous antibiotics at the
time of registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy at the time of
registration

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

- Acquired immune deficiency syndrome (AIDS) based upon current Centers for
Disease Control (CDC) definition

- HIV testing is not required for entry

- No prior allergic reaction to the study drug(s) involved in this protocol

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- More than 5 years since prior chemotherapy for any other disease site

- No androgen-deprivation therapy started prior to prostatectomy for > 6 months
duration

- The use of finasteride or dutasteride (± tamsulosin) for longer periods prior to
prostatectomy is acceptable

- No androgen-deprivation therapy started after prostatectomy and prior to registration

- The use of finasteride or dutasteride (± tamsulosin) after prostatectomy is not
acceptable, it must be stopped within 3 months after prostatectomy

- No neoadjuvant chemotherapy before or after prostatectomy

- No prior cryosurgery or brachytherapy of the prostate (prostatectomy should be the
primary treatment and not a salvage procedure)

- No prior pelvic radiotherapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Freedom from progression (FFP)

Outcome Time Frame:

From date of randomization to the first occurrence of biochemical failure by the Phoenix definition (PSA >= 2 ng/ml over the nadir PSA), clinical failure (local, regional or distant) or death from any cause.

Safety Issue:

No

Principal Investigator

Alan Pollack, MD, PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Fox Chase Cancer Center

Authority:

United States: Federal Government

Study ID:

RTOG 0534

NCT ID:

NCT00567580

Start Date:

February 2008

Completion Date:

Related Keywords:

  • Prostate Cancer
  • stage IIB prostate cancer
  • stage IIA prostate cancer
  • stage III prostate cancer
  • adenocarcinoma of the prostate
  • Prostatic Neoplasms

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
Memorial Sloan-Kettering Cancer CenterNew York, New York  10021
University of Michigan Comprehensive Cancer CenterAnn Arbor, Michigan  48109-0752
Mayo Clinic Cancer CenterRochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical CenterMaywood, Illinois  60153-5500
University of Chicago Cancer Research CenterChicago, Illinois  60637
Cleveland Clinic Cancer CenterCleveland, Ohio  44195
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - WichitaWichita, Kansas  67214-3882
Hurley Medical CenterFlint, Michigan  48503
CCOP - Missouri Valley Cancer ConsortiumOmaha, Nebraska  68131
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - Iowa Oncology Research AssociationDes Moines, Iowa  50309-1016
Beth Israel Deaconess Medical CenterBoston, Massachusetts  02215
CCOP - Metro-MinnesotaSaint Louis Park, Minnesota  55416
Aurora Presbyterian HospitalAurora, Colorado  80012
Boulder Community HospitalBoulder, Colorado  80301-9019
Porter Adventist HospitalDenver, Colorado  80210
Presbyterian - St. Luke's Medical CenterDenver, Colorado  80218
St. Joseph HospitalDenver, Colorado  80218
Swedish Medical CenterEnglewood, Colorado  80110
Hope Cancer Care Center at Longmont United HospitalLongmont, Colorado  80502
St. Mary - Corwin Regional Medical CenterPueblo, Colorado  81004
North Suburban Medical CenterThornton, Colorado  80229
George Bray Cancer Center at the Hospital of Central Connecticut - New Britain CampusNew Britain, Connecticut  06050
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
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
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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
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
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
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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
University of Wisconsin Paul P. Carbone Comprehensive Cancer CenterMadison, Wisconsin  53792-6164
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Memorial Hospital of South BendSouth Bend, Indiana  46601
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Albert Einstein Cancer CenterPhiladelphia, Pennsylvania  19141
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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
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UPMC Cancer Center at Magee-Womens HospitalPittsburgh, Pennsylvania  15213-3180
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Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
Zimmer Cancer Center at New Hanover Regional Medical CenterWilmington, North Carolina  28402-9025
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical CenterLos Angeles, California  90048-1865
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Tulane Cancer Center Office of Clinical ResearchAlexandria, Louisiana  71315-3198
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Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical SchoolNew Brunswick, New Jersey  08903
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
West Virginia University Health Sciences Center - CharlestonCharleston, West Virginia  25302
Gundersen Lutheran Center for Cancer and BloodLa Crosse, Wisconsin  54601
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
Huntsman Cancer Institute at University of UtahSalt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern UniversityChicago, Illinois  60611
Decatur Memorial Hospital Cancer Care InstituteDecatur, Illinois  62526
Leonard C. Ferguson Cancer CenterFreeport, Illinois  61032
Elkhart General HospitalElkhart, Indiana  46515
Howard Community HospitalKokomo, Indiana  46904
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
Cleveland Clinic Cancer Center at Fairview HospitalCleveland, Ohio  44111
Mount Carmel Health - West HospitalColumbus, Ohio  43222
Hillcrest Cancer Center at Hillcrest HospitalMayfield Heights, Ohio  44124
Rosenfeld Cancer Center at Abington Memorial HospitalAbington, Pennsylvania  19001
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
Fox Valley Hematology and Oncology - East Grant StreetAppleton, Wisconsin  54911-3496
All Saints Cancer Center at Wheaton Franciscan HealthcareRacine, Wisconsin  53405
Peninsula Medical CenterBurlingame, California  94010
Sutter Health - Western Division Cancer Research GroupGreenbrae, 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
Piedmont HospitalAtlanta, Georgia  30309
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical CenterBoise, Idaho  83706
Ingalls Cancer Care Center at Ingalls Memorial HospitalHarvey, Illinois  60426
Center for Cancer Therapy at LaPorte Hospital and Health ServicesLa Porte, Indiana  46350
John Stoddard Cancer Center at Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
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
Cancer Center of Kansas, PA - Dodge CityDodge City, Kansas  67801
Mary Bird Perkins Cancer Center - Baton RougeBaton Rouge, Louisiana  70809
Medical Center of Louisiana - New OrleansNew Orleans, Louisiana  70112
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
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
Highland Hospital of RochesterRochester, New York  14620
Lima Memorial HospitalLima, Ohio  45804
Northwest Ohio Oncology CenterMaumee, Ohio  43537
St. Charles Mercy HospitalOregon, Ohio  43616
North Coast Cancer Care, IncorporatedSandusky, Ohio  44870
Mercy Hospital of TiffinTiffin, Ohio  44883
Toledo Clinic, Incorporated - Main ClinicToledo, Ohio  43623
Cleveland Clinic - WoosterWooster, Ohio  44691
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Legacy Meridian Park HospitalTualatin, Oregon  97062
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
St. Mary Regional Cancer CenterLanghorne, Pennsylvania  19047
Lankenau Cancer Center at Lankenau HospitalWynnewood, Pennsylvania  19096
Dixie Regional Medical Center - East CampusSaint George, Utah  84770
Danville Regional Medical CenterDanville, Virginia  24541
North Star Lodge Cancer Center at Yakima Valley Memorial HospitalYakima, Washington  98902
Massachusetts General HospitalBoston, Massachusetts  02114-2617
Fairbanks Cancer Treatment Center at Fairbanks Memorial HospitalFairbanks, Alaska  99701
St. Anthony Central HospitalDenver, Colorado  80204-1335
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
St. Francis HospitalFederal Way, Washington  98003
Good Samaritan Cancer CenterPuyallup, Washington  98371
William W. Backus HospitalNorwich, Connecticut  06360
Lancaster General HospitalLancaster, Pennsylvania  17604-3555
California Cancer Center - Woodward Park OfficeFresno, California  93720
Providence Holy Cross Cancer CenterMission Hills, California  91346-9600
Middlesex Hospital Cancer CenterMiddletown, Connecticut  06457
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Regional Cancer Center at Singing River HospitalPascagoula, Mississippi  39581
Cancer Resource Center - LincolnLincoln, Nebraska  68510
Randolph HospitalAsheboro, North Carolina  27203
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John B. Amos Cancer CenterColumbus, Georgia  31904
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/CandlerSavannah, Georgia  31405
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Billings Clinic - DowntownBillings, Montana  59107-7000
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Sletten Cancer Institute at Benefis HealthcareGreat Falls, Montana  59405
Alegant Health Cancer Center at Bergan Mercy Medical CenterOmaha, Nebraska  68124
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Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer CenterColumbus, Ohio  43210-1240
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Hematology Oncology CenterElyria, Ohio  44035
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Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Mount Carmel St. Ann's Cancer CenterWesterville, Ohio  43081
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St. Luke's Cancer Network at St. Luke's HospitalBethlehem, Pennsylvania  18015
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McGlinn Family Regional Cancer Center at Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
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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
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Franciscan Cancer Center at St. Joseph Medical CenterTacoma, Washington  98405-3004
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FirstHealth Moore Regional Community Hospital Comprehensive Cancer CenterPinehurst, North Carolina  28374
Regional Cancer Center at Memorial Medical CenterSpringfield, Illinois  62781-0001
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
Washington Township HospitalFremont, California  94538
Radiological Associates of Sacramento Medical Group, IncorporatedSacramento, California  95815
Queen's Cancer Institute at Queen's Medical CenterHonolulu, Hawaii  96813
Parkview Regional Cancer Center at Parkview HealthFort Wayne, Indiana  46805
Lowell General HospitalLowell, Massachusetts  01854
Rex Cancer Center at Rex HospitalRaleigh, North Carolina  27607
Three Rivers Community HospitalGrants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical CenterMedford, Oregon  97504
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Martha Jefferson Hospital Cancer Care CenterCharlottesville, Virginia  22901
Theda Care Cancer InstituteAppleton, Wisconsin  54911
Community Memorial Hospital Cancer Care CenterMenomonee Falls, Wisconsin  53051
Regional Cancer Center at Oconomowoc Memorial HospitalOconomowoc, Wisconsin  53066
Dana-Farber/Brigham and Women's Cancer CenterBoston, Massachusetts  02115
Cancer Centers of the Carolinas - Grove CommonsGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris RoadGreenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical OncologyGreer, South Carolina  29650
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
Cancer Institute at St. John's HospitalSpringfield, Illinois  62701
Cancer Centers of the Carolinas - EastsideGreenville, South Carolina  29601
West Tennessee Cancer Center at Jackson-Madison County General HospitalJackson, Tennessee  38301
Sentara Cancer Institute at Sentara Norfolk General HospitalNorfolk, Virginia  23507
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
Franklin & Edith Scarpa Regional Cancer Center at South Jersey HealthcareVineland, New Jersey  08360
Lipson Cancer and Blood Center at Rochester General HospitalRochester, New York  14621
Tyler Cancer CenterTyler, Texas  75702
Doctors Medical Center - San Pablo CampusSan Pablo, California  94806
Boston University Cancer Research CenterBoston, Massachusetts  02118
Mercy General HospitalSacramento, California  95819
East Bay Radiation Oncology CenterCastro Valley, California  94546
Contra Costa Regional Medical CenterMartinez, California  94553-3156
Memorial Medical CenterModesto, California  95355
El Camino Hospital Cancer CenterMountain View, California  94040
Larry G Strieff MD Medical CorporationOakland, California  94609
Tom K Lee, IncorporatedOakland, California  94609
Bay Area Breast Surgeons, IncorporatedOakland, California  94609
Kapiolani Medical Center at Pali MomiAiea, Hawaii  96701
Straub Clinic and Hospital, IncorporatedHonolulu, Hawaii  96813
Hawaii Medical Center - EastHonolulu, Hawaii  96817
Pacific Cancer Institute - MauiWailuku, Hawaii  96793
Trinity Cancer Center at Trinity Medical Center - 7th Street CampusMoline, Illinois  61265
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
Valley Hospital - RidgewoodRidgewood, New Jersey  07450
Cancer Center of Paoli Memorial HospitalPaoli, Pennsylvania  19301-1792
CCOP - Main Line HealthWynnewood, Pennsylvania  19096
AnMed Cancer CenterAnderson, South Carolina  29621
Franciscan Skemp Healthcare - La Crosse CampusLa Crosse, Wisconsin  54601
Cancer Care Center, IncorporatedSalem, Ohio  44460
University of Colorado Cancer Center at UC Health Sciences CenterAurora, Colorado  80045
Center for Cancer Care at Goshen General HospitalGoshen, Indiana  46526
UPMC Cancer Center at UPMC PresbyterianPittsburgh, Pennsylvania  15213
Cancer Institute of Cape Girardeau, LLCCape Girardeau, Missouri  63703
Providence Cancer Center at PMCCMedford, Oregon  97504
Veterans Affairs Medical Center - MilwaukeeMilwaukee, Wisconsin  53295
Central Maryland Oncology CenterColumbia, Maryland  21044
Valley Medical Oncology Consultants - Castro ValleyCastro Valley, California  94546
Valley Medical OncologyFremont, California  94538
Cancer Care AssociatesFresno, California  93720
Integrated Community Oncology Network - Orange ParkOrange Park, Florida  32073
Mount Sinai Hospital Medical CenterChicago, Illinois  60608
Hudner Oncology Center at Saint Anne's Hospital - Fall RiverFall River, Massachusetts  02721
Immanuel St. Joseph'sMankato, Minnesota  56002
Columbia Saint Mary's Hospital - OzaukeeMequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care CenterMilwaukee, Wisconsin  53211
Cancer Centers of the Carolinas - Greer Radiation OncologyGreer, South Carolina  29650
Minnesota Oncology - MaplewoodMaplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient CenterRobbinsdale, Minnesota  55422-2900
Minnesota Oncology - WoodburyWoodbury, Minnesota  55125
UPMC Cancer Center at Beaver Medical CenterBeaver, Pennsylvania  15009
UPMC Cancer Center at Jefferson Regional Medical CenterClairton, Pennsylvania  15025
UPMC Cancer Center - Arnold Palmer PavilionGreensburg, Pennsylvania  15601
UPMC Cancer Center at the John P. Murtha PavilionJohnstown, Pennsylvania  15901
UPMC - MoonMoon Township, Pennsylvania  15108
UPMC Cancer Center - Natrona HeightsNatrona Heights, Pennsylvania  15065
Jameson Memorial Hospital - North CampusNew Castle, Pennsylvania  16105
UPMC - ShadysidePittsburgh, Pennsylvania  15213-2582
UPMC Cancer Center at UPMC St. MargaretPittsburgh, Pennsylvania  15215
UPMC Cancer Center at UPMC PassavantPittsburgh, Pennsylvania  15237
Washington Hospital Cancer CenterWashington, Pennsylvania  15301
Emory Crawford Long HospitalAtlanta, Georgia  30308
Holy Cross HospitalSilver Spring, Maryland  20910
New York Oncology Hematology, PC at Albany Regional Cancer CareAlbany, New York  12208
Central Wisconsin Cancer Program at Agnesian HealthCareFond du Lac, Wisconsin  54935
Auburn Radiation OncologyAuburn, California  95603
Radiation Oncology Centers - Cameron ParkCameron Park, California  95682
Radiation Oncology Center - RosevilleRoseville, California  95661
Hudson Valley Oncology AssociatesPoughkeepsie, New York  12601
Inova Alexandria HospitalAlexandria, Virginia  22304
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
Sands Cancer CenterCanandiaqua, New York  14424
University Radiation Oncology at Parkridge HospitalRochester, New York  14626
Coleman Radiation Oncology Center at Carter General HospitalMorehead City, North Carolina  28557
CarolinaEast Cancer CareNew Bern, North Carolina  28560
South Atlantic Radiation Oncology, LLCSupply, North Carolina  28462
Coastal Carolina Radiation Oncology CenterWilmington, North Carolina  28401
Norris Cotton Cancer Center - NorthSaint Johnsbury, Vermont  05819
Langlade Memorial HospitalAntigo, Wisconsin  54409
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
Piedmont Fayette HospitalFayetteville, Georgia  30214
Lakeside HospitalOmaha, Nebraska  68130
University of New Mexico Cancer Center - SouthLas Cruces, New Mexico  88011
Cleveland Clinic Foundation - StrongsvilleStrongsville, Ohio  44136
Riverview UW Cancer Center at Riverview HospitalWisconsin Rapids, Wisconsin  54494
Roger Maris Cancer Center at MeritCare HospitalFargo, North Dakota  58122
Capital Health Regional Cancer CenterTrenton, New Jersey  08618
Dyson Center for Cancer Care at Vassar Brothers Medical CenterPoughkeepsie, New York  12601-3990
AtlantiCare Cancer Care Institute at AtlantiCare Regional Medical Center - Mainland CampusPomona, New Jersey  08240
Saint Helena HospitalSaint Helena, California  94574
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
New Mexico Cancer CenterAlbuquerque, New Mexico  87109
Southern Ohio Medical Center Cancer CenterPortsmouth, Ohio  45662
Arizona Center for Cancer Care - PeoriaPeoria, Arizona  85381
Feather River Hospital Cancer CenterParadise, California  95969
Radiation Oncology Associates SouthwestFort Wayne, Indiana  46804
Henry Ford Macomb HospitalClinton Township, Michigan  48038
McLaren Cancer InstituteFlint, Michigan  48532
Willamette Valley Cancer Center - EugeneEugene, Oregon  97401
Intercommunity Cancer CenterMonroeville, Pennsylvania  15146
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
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
Alle-Kiski Medical CenterNatrona Heights, Pennsylvania  15065
Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital CenterSleepy Hollow, New York  10591
Nebraska Medical CenterOmaha, Nebraska  68198
Upper Delaware Valley Cancer CenterMilford, Pennsylvania  18337
Arizona Oncology - TucsonTucson, Arizona  85704
Rocky Mountain Cancer Centers - AuroraAurora, Colorado  80012
Norton Suburban HospitalLouisville, Kentucky  40207
UPMC Cancer Center at UPMC McKeesportMcKeesport, Pennsylvania  15132
UPMC Cancer Center - Upper St. ClairPittsburgh, Pennsylvania  15243
Door County Cancer Center at Door County Memorial HospitalSturgeon Bay, Wisconsin  54235-1495
Adams Cancer CenterGettysburg, Pennsylvania  17325
Tate Cancer Center at Baltimore Washington Medical CenterGlen Burnie, Maryland  21061
Saint Elizabeth Cancer Institute at Saint Elizabeth Regional Medical CenterLincoln, Nebraska  68510
D.N. Greenwald CenterMukwonago, Wisconsin  53149
Coastal Cancer Center at Sentara Virginia Beach General HospitalVirginia Beach, Virginia  23454
Veterans Affairs Medical Center - TampaTampa, Florida  33612
Northside Hospital-ForsythCumming, Georgia  30041
Memorial Sloan-Kettering Cancer Center - Basking RidgeBasking Ridge, New Jersey  07920
Stich Radiation Center at NewYork-Presbyterian Hospital/Weill Cornell Medical CenterNew York, New York  10021
Memorial Sloan-Kettering Cancer Center - Rockville CentreRockville Centre, New York  11570
Tony Teramana Cancer CenterSteubenville, Ohio  43952
Hilton Head Radiation Oncology CenterHilton Head Island, South Carolina  29926
Memorial Hermann Hospital - Memorial CityHouston, Texas  77024
Texas Oncology, PA - Wichita FallsWichita Falls, Texas  76310
Beloit Memorial HospitalBeloit, Wisconsin  53511