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A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer


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

Thank you

Trial Information

A Phase III Prospective Randomized Trial of Dose-Escalated Radiotherapy With or Without Short-Term Androgen Deprivation Therapy for Patients With Intermediate-Risk Prostate Cancer


OBJECTIVES:

Primary

- Demonstrate an overall survival (OS) advantage in patients with intermediate-risk
prostate cancer treated with dose-escalated radiotherapy (RT) with versus without
short-term androgen-deprivation therapy (ADT).

Secondary

- Determine whether the addition of ADT to dose-escalated RT versus RT alone improves
clinical failures, biochemical failure by the "nadir +2", freedom from failure, rate of
salvage ADT, and prostate cancer-specific mortality in these patients.

- Estimate the magnitude of benefit of ADT with respect to OS in patients treated with
different RT modalities (i.e., external-beam radiation therapy alone vs low-dose rate
brachytherapy boost vs high-dose rate brachytherapy boost).

- Compare acute and late treatment adverse events of these regimens and correlate these
events with the presence or absence of pre-existing comorbidity as documented by the
Adult Comorbidity Evaluation 27 assessment.

OUTLINE: This is a multicenter, dose-escalation study of radiotherapy. Patients are
stratified according to number of risk factors (1 vs 2-3), comorbidity (ACE-27 grade ≥ 2 vs
< 2), and radiotherapy (RT) modality (dose-escalated external-beam RT [EBRT] vs EBRT and
low-dose rate brachytherapy boost vs EBRT and high-dose rate brachytherapy boost). Patients
are randomized to 1 of 2 treatment arms.

- Arm I: Patients undergo EBRT* once daily on days 1-5 for about 9 weeks (44 treatments).
Some patients instead receive EBRT with high-dose rate or low-dose rate brachytherapy
implant on days 1-5 for about 5 weeks (25 treatments). NOTE: *Type of RT is at
discretion of treating physician and may include either 3D-conformal RT or
intensity-modulated RT.

- Arm II: Patients receive androgen-deprivation therapy comprising luteinizing-hormone
releasing-hormone (LHRH) agonist (leuprolide, goserelin, buserelin, or triptorelin)
subcutaneously or as an injection every 1 to 3 months AND an oral antiandrogen therapy
(flutamide 3 times daily or bicalutamide once daily) for 6 months. Beginning 8 weeks
after the first LHRH injection, patients undergo radiotherapy as in arm I.

After completion of study therapy, patients are followed up periodically.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed adenocarcinoma of the prostate diagnosed within the past 180
days and at intermediate-risk for recurrence by meeting ≥ 1 of the following
criteria:

- Gleason score > 7

- PSA > 10 and ≤ 20 ng/mL

- Baseline serum PSA value performed within 60 days with an FDA-approved
assay (e.g., Abbott, Hybritech)

- Baseline PSA must not be obtained during any of the following time
frames:10-day period after prostate biopsy, after initiation of
androgen-deprivation therapy, or within the past 30 days after
discontinuation of finasteride (90 days for dutasteride)

- Clinical stage T2b or T2c disease

- Patients previously diagnosed with low-risk (Gleason score < 6, clinical stage <
T2a, and PSA < 10 ng/mL) prostate cancer undergoing active surveillance who are
re-biopsied and found to have intermediate-risk disease according to the
protocol criteria are eligible for enrollment within 6 months of the repeat
biopsy procedure

- Patients with Gleason Score ≥ 8, PSA > 20 ng/mL, OR clinical stage ≥ T3 are
ineligible for this trial

- If findings of extracapsular extension or seminal vesicle invasion are noted on
prostate MRI, this study, if used, will not render patients ineligible for
accrual to this protocol

- Primary tumor staging for eligibility purposes is to be based on palpable or
core biopsy evidence only with respect to extracapsular extension or seminal
vesicle involvement

- No patients with all 3 intermediate-risk factors who also have ≥ 50% of the number of
their biopsy cores positive for cancer

- The percentage of biopsy cores involved will only be considered with respect to
eligibility for those patients with all 3 of the above risk factors (i.e.,
patients with one or two of the above risk factors are eligible irrespective of
the percentage of biopsy cores involved)

- Clinically negative lymph nodes as established by imaging (pelvic and/or abdominal CT
scan or MRI), nodal sampling, or dissection within the past 60 days (required for
patients with 2-3 risk factors)

- Abdominal imaging not required for a single intermediate-risk factor (these
studies may be obtained at the discretion of the treating physician)

- Lymph nodes that are equivocal or questionable by imaging allowed without biopsy
if nodes ≤ 1.5 cm

- Any node > 1.5 cm on imaging requires a negative biopsy

- No evidence of bone metastases on bone scan within the past 60 days

- Bone scan not required for patients with a single intermediate-risk factor (scan
may be obtained at the discretion of the treating physician)

- Equivocal bone scan findings allowed if plain film x-rays negative for
metastasis

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- ANC ≥ 1,800/mm^3*

- Platelet count ≥ 100,000/mm^3*

- Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve level allowed)*

- NOTE: *For patients undergoing brachytherapy only.

- Fertile patients must use effective contraception during and for the 3 months after
cessation of protocol treatment

- No invasive malignancy or hematological malignancy (e.g., leukemia, lymphoma,
myeloma) within the past 5 years except adequately treated non-melanomatous skin
cancer

- Prior diagnoses of carcinoma in situ allowed

- No severe or active co-morbidity with 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 intravenous antibiotics

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

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

- Laboratory tests for liver function and coagulation parameters not required
for entry into this protocol

- AIDS based upon current CDC definition

- HIV testing not required for entry into this protocol

- HIV-seropositive patients who do not meet criteria for diagnosis of AIDS
allowed

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior radical surgery (prostatectomy), high-intensity focused ultrasound, or
cryosurgery for prostate cancer

- No prior hormonal therapy, such as LHRH agonists (e.g., goserelin, leuprolide),
antiandrogens (e.g., flutamide, bicalutamide), estrogens (e.g., DES), or bilateral
orchiectomy

- No finasteride within past 30 days (90 days for dutasteride)

- No prior or concurrent cytotoxic chemotherapy for prostate cancer

- Prior chemotherapy for a different cancer allowed

- No prior radiotherapy (RT), including brachytherapy, to the region of the study
cancer that would result in overlap of RT fields

- Patients undergoing brachytherapy must have transrectal ultrasound confirmation
of prostate volume < 60 cc, AUA score ≤ 15 within the past 60 days of
registration, and no history of prior transurethral resection of the prostate
(TURP)

- TURP allowed for patients who receive external-beam radiation therapy only

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Overall survival (OS)

Safety Issue:

No

Principal Investigator

Alvaro A. Martinez, MD, FACR

Investigator Role:

Study Chair

Investigator Affiliation:

21st Century Oncology - Michigan Institute for Radiation Oncology

Authority:

Unspecified

Study ID:

CDR0000648194

NCT ID:

NCT00936390

Start Date:

September 2009

Completion Date:

Related Keywords:

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

Name

Location

Roswell Park Cancer InstituteBuffalo, New York  14263
University of Michigan Comprehensive Cancer CenterAnn Arbor, Michigan  48109-0752
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
University of Chicago Cancer Research CenterChicago, Illinois  60637
Barbara Ann Karmanos Cancer InstituteDetroit, Michigan  48201
CCOP - Upstate CarolinaSpartanburg, South Carolina  29303
CCOP - Christiana Care Health ServicesWilmington, Delaware  19899
CCOP - North Shore University HospitalManhasset, New York  11030
Veterans Affairs Medical Center - Atlanta (Decatur)Decatur, Georgia  30033
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical CenterGrand Junction, Colorado  81502
Baystate Regional Cancer Program at D'Amour Center for Cancer CareSpringfield, Massachusetts  01199
Saint Joseph Mercy Cancer CenterAnn Arbor, Michigan  48106-0995
Genesys Hurley Cancer InstituteFlint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical CenterGrosse Pointe Woods, Michigan  48236
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
St. John Macomb HospitalWarren, Michigan  48093
MeritCare BemidjiBemidji, Minnesota  56601
Fairview Southdale HospitalEdina, Minnesota  55435
CCOP - MeritCare HospitalFargo, North Dakota  58122
Case Comprehensive Cancer CenterCleveland, Ohio  44106-5065
Medical College of Wisconsin Cancer CenterMilwaukee, Wisconsin  53226
CCOP - OchsnerNew Orleans, Louisiana  70121
Rapid City Regional HospitalRapid City, South Dakota  57709
Veterans Affairs Medical Center - Long BeachLong Beach, California  90822
Cape Cod HospitalHyannis, Massachusetts  02601
Albert Einstein Cancer CenterPhiladelphia, Pennsylvania  19141
CCOP - GreenvilleGreenville, South Carolina  29615
University of Texas Medical BranchGalveston, Texas  77555-1329
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
Charles M. Barrett Cancer Center at University HospitalCincinnati, Ohio  45267-0526
CCOP - Columbia River Oncology ProgramPortland, Oregon  97225
Cancer Research Center of HawaiiHonolulu, Hawaii  96813
USC/Norris Comprehensive Cancer Center and HospitalLos Angeles, California  90033-0804
Brooke Army Medical CenterFort Sam Houston, Texas  78234-6200
CCOP - Virginia Mason Research CenterSeattle, Washington  98101
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical CenterMilwaukee, Wisconsin  53201-2901
University of California Davis Cancer CenterSacramento, California  95817
John Stoddard Cancer Center at Iowa Methodist Medical CenterDes Moines, Iowa  50309
Bellin Memorial HospitalGreen Bay, Wisconsin  54301
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
Thompson Cancer Survival CenterKnoxville, Tennessee  37916
Maine Center for Cancer Medicine and Blood Disorders - ScarboroughScarborough, Maine  04074
Hulston Cancer Center at Cox Medical Center SouthSpringfield, Missouri  65807
St. John's Regional Health CenterSpringfield, Missouri  65804
UMDNJ University HospitalNewark, New Jersey  07103
SUNY Downstate Medical CenterBrooklyn, New York  11203
McDowell Cancer Center at Akron General Medical CenterAkron, Ohio  44307
Lake/University Ireland Cancer CenterMentor, Ohio  44060
Central Baptist HospitalLexington, Kentucky  40503
Mercy Fitzgerald HospitalDarby, Pennsylvania  19023
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
Broward General Medical Center Cancer CenterFt. Lauderdale, Florida  33316
Florida Hospital Cancer Institute at Florida Hospital OrlandoOrlando, Florida  32803-1273
Winship Cancer Institute of Emory UniversityAtlanta, Georgia  30322
SUNY Upstate Medical University HospitalSyracuse, New York  13210
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
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
Lourdes Regional Cancer CenterBinghamton, New York  13905
Battle Creek Health System Cancer Care CenterBattle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak CampusRoyal Oak, Michigan  48073
Adena Regional Medical CenterChillicothe, Ohio  54601
Riverside Methodist Hospital Cancer CareColumbus, Ohio  43214
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Veterans Affairs Medical Center - HinesHines, Illinois  60141
Greenebaum Cancer Center at University of Maryland Medical CenterBaltimore, Maryland  21201
Zimmer Cancer Center at New Hanover Regional Medical CenterWilmington, North Carolina  28402-9025
UCSF Helen Diller Family Comprehensive Cancer CenterSan Francisco, California  94115
M.D. Anderson Cancer Center at OrlandoOrlando, Florida  32806
Indiana University Melvin and Bren Simon Cancer CenterIndianapolis, Indiana  46202-5289
Lucille P. Markey Cancer Center at University of KentuckyLexington, Kentucky  40536-0093
Tulane Cancer Center Office of Clinical ResearchAlexandria, Louisiana  71315-3198
Butterworth Hospital at Spectrum HealthGrand Rapids, Michigan  49503-2560
Siteman Cancer Center at Barnes-Jewish Hospital - Saint LouisSt. Louis, Missouri  63110
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
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
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
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical CenterHartford, Connecticut  06105
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital MarltonMarlton, New Jersey  08053
Rosenfeld Cancer Center at Abington Memorial HospitalAbington, Pennsylvania  19001
Fox Chase Cancer Center - PhiladelphiaPhiladelphia, Pennsylvania  19111-2497
All Saints Cancer Center at Wheaton Franciscan HealthcareRacine, Wisconsin  53405
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
OSF St. Francis Medical CenterPeoria, Illinois  61637
Hickman Cancer Center at Bixby Medical CenterAdrian, Michigan  49221
Kingsbury Center for Cancer Care at Cheshire Medical CenterKeene, New Hampshire  03431
Highland Hospital of RochesterRochester, New York  14620
Northwest Ohio Oncology CenterMaumee, Ohio  43537
St. Charles Mercy HospitalOregon, Ohio  43616
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Providence Cancer Center at Providence Portland Medical CenterPortland, Oregon  97213-2967
Providence St. Vincent Medical CenterPortland, Oregon  97225
Delaware County Regional Cancer Center at Delaware County Memorial HospitalDrexel Hill, Pennsylvania  19026
Danville Regional Medical CenterDanville, Virginia  24541
Southwest Washington Medical Center Cancer CenterVancouver, Washington  98668
Massachusetts General HospitalBoston, Massachusetts  02114-2617
Fairbanks Cancer Treatment Center at Fairbanks Memorial HospitalFairbanks, Alaska  99701
DeCesaris Cancer Institute at Anne Arundel Medical CenterAnnapolis, Maryland  21401
Poudre Valley Radiation OncologyFort Collins, Colorado  80528
Creticos Cancer Center at Advocate Illinois Masonic Medical CenterChicago, Illinois  60657
Randolph HospitalAsheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community HospitalGreensboro, North Carolina  27401
Cancer Treatment CenterWooster, Ohio  44691
West Allis Memorial HospitalWest Allis, Wisconsin  53227
John B. Amos Cancer CenterColumbus, Georgia  31904
McFarland Clinic, PCAmes, Iowa  50010
Greater Baltimore Medical Center Cancer CenterBaltimore, Maryland  21204
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
Billings Clinic - DowntownBillings, Montana  59107-7000
Frederick R. and Betty M. Smith Cancer Treatment CenterSparta, New Jersey  07871
Summa Center for Cancer Care at Akron City HospitalAkron, Ohio  44309-2090
Barberton Citizens HospitalBarberton, Ohio  44203
Community Cancer CenterElyria, Ohio  44035
Flower Hospital Cancer CenterSylvania, Ohio  43560
St. Anne Mercy HospitalToledo, Ohio  43623
Legacy Good Samaritan Hospital & Comprehensive Cancer CenterPortland, Oregon  97210
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
York Cancer Center at Apple Hill Medical CenterYork, Pennsylvania  17405
St. Joseph Cancer CenterBellingham, Washington  98225
John H. Stroger, Jr. Hospital of Cook CountyChicago, Illinois  60612-9985
Arizona Oncology Services FoundationPhoenix, Arizona  85013
Enloe Cancer Center at Enloe Medical CenterChico, California  95926
Radiological Associates of Sacramento Medical Group, IncorporatedSacramento, California  95815
St. Vincent's Medical CenterBridgeport, Connecticut  06606
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
Easton Regional Cancer Center at Easton HospitalEaston, Pennsylvania  18042
Gibbs Regional Cancer Center at Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Community Cancer Center at Rutland Regional Medical CenterRutland, Vermont  05701
Theda Care Cancer InstituteAppleton, Wisconsin  54911
Community Memorial Hospital Cancer Care CenterMenomonee Falls, Wisconsin  53051
Cancer Centers of the Carolinas - SpartanburgSpartanburg, South Carolina  29307
Regional Cancer Center - ErieErie, Pennsylvania  16505
Cancer Institute at St. John's HospitalSpringfield, Illinois  62701
St. John's Regional Medical CenterJoplin, Missouri  64804
Sentara Cancer Institute at Sentara Norfolk General HospitalNorfolk, Virginia  23507
Lacks Cancer Center at Saint Mary's Health CareGrand Rapids, Michigan  49503
Solano Radiation Oncology CenterVacaville, California  95687
Boston University Cancer Research CenterBoston, Massachusetts  02118
Center for Cancer Care and Research at Watson Clinic, LLPLakeland, Florida  33805
Mercy General HospitalSacramento, California  95819
Memorial Medical CenterModesto, California  95355
Hawaii Medical Center - EastHonolulu, Hawaii  96817
Mitchell Memorial Cancer Center at Owensboro Medical Health SystemOwensboro, Kentucky  42303
Center for Cancer Care at Exeter HospitalExeter, New Hampshire  03833
Trinity CancerCare CenterMinot, North Dakota  58701
United States Air Force Medical Center - Wright-PattersonWright-Patterson AFB, Ohio  45433-5529
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
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
Central Maryland Oncology CenterColumbia, Maryland  21044
Cancer Centers of North Carolina - RaleighRaleigh, North Carolina  27607
Precision Radiotherapy at University PointeWest Chester, Ohio  45069
Hudner Oncology Center at Saint Anne's Hospital - Fall RiverFall River, Massachusetts  02721
NSMC Cancer Center - PeabodyPeabody, Massachusetts  01960
Immanuel St. Joseph'sMankato, Minnesota  56002
Columbia Saint Mary's Hospital - OzaukeeMequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care CenterMilwaukee, Wisconsin  53211
Georgia Cancer Center for Excellence at Grady Memorial HospitalAtlanta, Georgia  30303
Central Maine Comprehensive Cancer Center at Central Maine Medical CenterLewiston, Maine  04240
University Medical Center at PrincetonPrinceton, New Jersey  08540
Emory Crawford Long HospitalAtlanta, Georgia  30308
New York Oncology Hematology, PC at Albany Regional Cancer CareAlbany, New York  12208
Auburn Radiation OncologyAuburn, California  95603
Radiation Oncology Center - RosevilleRoseville, California  95661
Saint John's Cancer Center at Saint John's Medical CenterAnderson, Indiana  46016
Hudson Valley Oncology AssociatesPoughkeepsie, New York  12601
Northwest Cancer Specialists at Vancouver Cancer CenterVancouver, Washington  98684
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
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
Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical CenterBurbank, California  91505
Southwest General Health CenterMiddleburgh Heights, Ohio  44130
UHHS Chagrin Highlands Medical CenterOrange Villager, Ohio  44122
UHHS Westlake Medical CenterWestlaker, Ohio  44145
Kansas City Cancer Centers - SouthwestOverland Park, Kansas  66210
Longview Cancer CenterLongview, Texas  75601
Piedmont Fayette HospitalFayetteville, Georgia  30214
Clemens Regional Medical CenterMount Clemens, Michigan  48043
Lakeside HospitalOmaha, Nebraska  68130
University of New Mexico Cancer Center - SouthLas Cruces, New Mexico  88011
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Saint Helena HospitalSaint Helena, California  94574
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
Arizona Center for Cancer Care - PeoriaPeoria, Arizona  85381
Feather River Hospital Cancer CenterParadise, California  95969
Radiation Oncology Associates SouthwestFort Wayne, Indiana  46804
McLaren Cancer InstituteFlint, Michigan  48532
Kansas City Cancer Centers - NorthKansas City, Missouri  64154
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
Texas Oncology, PA at Texas Cancer Center - ShermanSherman, Texas  75090
Texas Oncology, PA at Texas Oncology Cancer Center Sugar LandSugar Land, Texas  77479
Bloomington Hospital Regional Cancer InstituteBloomington, Indiana  47403
Nebraska Medical CenterOmaha, Nebraska  68198
Arizona Oncology - TucsonTucson, Arizona  85704
Kansas City Cancer Centers - SouthKansas City, Missouri  64131
Adams Cancer CenterGettysburg, Pennsylvania  17325
Cherry Tree Cancer CenterHanover, Pennsylvania  17331
Tate Cancer Center at Baltimore Washington Medical CenterGlen Burnie, Maryland  21061
Robinson Radiation OncologyRavenna, Ohio  44266
Saint Agnes Cancer Center at Saint Agnes Medical CenterFresno, California  93720
Coastal Cancer Center at Sentara Virginia Beach General HospitalVirginia Beach, Virginia  23454
Veterans Affairs Medical Center - TampaTampa, Florida  33612
Memorial Hermann Hospital - Memorial CityHouston, Texas  77024
Texas Oncology, PA - Wichita FallsWichita Falls, Texas  76310
Zangmeister CenterColumbus, Ohio  43219
Great Lakes Cancer Institute - Lapeer CampusLapeer, Michigan  48446
St. Peter's HospitalAlbany, New York  12208
RMH Regional Cancer Center at Rockingham Memorial HospitalHarrisonburg, Virginia  22801