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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 Institute Buffalo, New York  14263
University of Michigan Comprehensive Cancer Center Ann Arbor, Michigan  48109-0752
Mayo Clinic Scottsdale Scottsdale, Arizona  85259
Mayo Clinic - Jacksonville Jacksonville, Florida  32224
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
University of Chicago Cancer Research Center Chicago, Illinois  60637
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - North Shore University Hospital Manhasset, 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 Center Grand Junction, Colorado  81502
Baystate Regional Cancer Program at D'Amour Center for Cancer Care Springfield, Massachusetts  01199
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
St. John Macomb Hospital Warren, Michigan  48093
MeritCare Bemidji Bemidji, Minnesota  56601
Fairview Southdale Hospital Edina, Minnesota  55435
CCOP - MeritCare Hospital Fargo, North Dakota  58122
Case Comprehensive Cancer Center Cleveland, Ohio  44106-5065
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
CCOP - Ochsner New Orleans, Louisiana  70121
Rapid City Regional Hospital Rapid City, South Dakota  57709
Veterans Affairs Medical Center - Long Beach Long Beach, California  90822
Cape Cod Hospital Hyannis, Massachusetts  02601
Albert Einstein Cancer Center Philadelphia, Pennsylvania  19141
CCOP - Greenville Greenville, South Carolina  29615
University of Texas Medical Branch Galveston, Texas  77555-1329
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill Chapel Hill, North Carolina  27599-7570
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
CCOP - Columbia River Oncology Program Portland, Oregon  97225
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
CCOP - Virginia Mason Research Center Seattle, Washington  98101
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical Center Milwaukee, Wisconsin  53201-2901
University of California Davis Cancer Center Sacramento, California  95817
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
Bellin Memorial Hospital Green Bay, Wisconsin  54301
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center Kansas City, Kansas  66160-7353
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Maine Center for Cancer Medicine and Blood Disorders - Scarborough Scarborough, Maine  04074
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
UMDNJ University Hospital Newark, New Jersey  07103
SUNY Downstate Medical Center Brooklyn, New York  11203
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
Lake/University Ireland Cancer Center Mentor, Ohio  44060
Central Baptist Hospital Lexington, Kentucky  40503
Mercy Fitzgerald Hospital Darby, Pennsylvania  19023
Long Island Jewish Medical Center New Hyde Park, New York  11040
Broward General Medical Center Cancer Center Ft. Lauderdale, Florida  33316
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas Dallas, Texas  75390
Naval Medical Center - Portsmouth Portsmouth, Virginia  23708-2197
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Lourdes Regional Cancer Center Binghamton, New York  13905
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Adena Regional Medical Center Chillicothe, Ohio  54601
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Veterans Affairs Medical Center - Hines Hines, Illinois  60141
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
Zimmer Cancer Center at New Hanover Regional Medical Center Wilmington, North Carolina  28402-9025
UCSF Helen Diller Family Comprehensive Cancer Center San Francisco, California  94115
M.D. Anderson Cancer Center at Orlando Orlando, Florida  32806
Indiana University Melvin and Bren Simon Cancer Center Indianapolis, Indiana  46202-5289
Lucille P. Markey Cancer Center at University of Kentucky Lexington, Kentucky  40536-0093
Tulane Cancer Center Office of Clinical Research Alexandria, Louisiana  71315-3198
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Rosenfeld Cancer Center at Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
All Saints Cancer Center at Wheaton Franciscan Healthcare Racine, Wisconsin  53405
California Pacific Medical Center - California Campus San Francisco, California  94118
Sutter Solano Medical Center Vallejo, California  94589
Piedmont Hospital Atlanta, Georgia  30309
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
OSF St. Francis Medical Center Peoria, Illinois  61637
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Kingsbury Center for Cancer Care at Cheshire Medical Center Keene, New Hampshire  03431
Highland Hospital of Rochester Rochester, New York  14620
Northwest Ohio Oncology Center Maumee, Ohio  43537
St. Charles Mercy Hospital Oregon, Ohio  43616
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Providence Cancer Center at Providence Portland Medical Center Portland, Oregon  97213-2967
Providence St. Vincent Medical Center Portland, Oregon  97225
Delaware County Regional Cancer Center at Delaware County Memorial Hospital Drexel Hill, Pennsylvania  19026
Danville Regional Medical Center Danville, Virginia  24541
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Massachusetts General Hospital Boston, Massachusetts  02114-2617
Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital Fairbanks, Alaska  99701
DeCesaris Cancer Institute at Anne Arundel Medical Center Annapolis, Maryland  21401
Poudre Valley Radiation Oncology Fort Collins, Colorado  80528
Creticos Cancer Center at Advocate Illinois Masonic Medical Center Chicago, Illinois  60657
Randolph Hospital Asheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Cancer Treatment Center Wooster, Ohio  44691
West Allis Memorial Hospital West Allis, Wisconsin  53227
John B. Amos Cancer Center Columbus, Georgia  31904
McFarland Clinic, PC Ames, Iowa  50010
Greater Baltimore Medical Center Cancer Center Baltimore, Maryland  21204
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
Billings Clinic - Downtown Billings, Montana  59107-7000
Frederick R. and Betty M. Smith Cancer Treatment Center Sparta, New Jersey  07871
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Barberton Citizens Hospital Barberton, Ohio  44203
Community Cancer Center Elyria, Ohio  44035
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
St. Joseph Cancer Center Bellingham, Washington  98225
John H. Stroger, Jr. Hospital of Cook County Chicago, Illinois  60612-9985
Arizona Oncology Services Foundation Phoenix, Arizona  85013
Enloe Cancer Center at Enloe Medical Center Chico, California  95926
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
St. Vincent's Medical Center Bridgeport, Connecticut  06606
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Parkview Regional Cancer Center at Parkview Health Fort Wayne, Indiana  46805
Lowell General Hospital Lowell, Massachusetts  01854
Rex Cancer Center at Rex Hospital Raleigh, North Carolina  27607
Three Rivers Community Hospital Grants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical Center Medford, Oregon  97504
Easton Regional Cancer Center at Easton Hospital Easton, Pennsylvania  18042
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Community Cancer Center at Rutland Regional Medical Center Rutland, Vermont  05701
Theda Care Cancer Institute Appleton, Wisconsin  54911
Community Memorial Hospital Cancer Care Center Menomonee Falls, Wisconsin  53051
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Regional Cancer Center - Erie Erie, Pennsylvania  16505
Cancer Institute at St. John's Hospital Springfield, Illinois  62701
St. John's Regional Medical Center Joplin, Missouri  64804
Sentara Cancer Institute at Sentara Norfolk General Hospital Norfolk, Virginia  23507
Lacks Cancer Center at Saint Mary's Health Care Grand Rapids, Michigan  49503
Solano Radiation Oncology Center Vacaville, California  95687
Boston University Cancer Research Center Boston, Massachusetts  02118
Center for Cancer Care and Research at Watson Clinic, LLP Lakeland, Florida  33805
Mercy General Hospital Sacramento, California  95819
Memorial Medical Center Modesto, California  95355
Hawaii Medical Center - East Honolulu, Hawaii  96817
Mitchell Memorial Cancer Center at Owensboro Medical Health System Owensboro, Kentucky  42303
Center for Cancer Care at Exeter Hospital Exeter, New Hampshire  03833
Trinity CancerCare Center Minot, North Dakota  58701
United States Air Force Medical Center - Wright-Patterson Wright-Patterson AFB, Ohio  45433-5529
Franciscan Skemp Healthcare - La Crosse Campus La Crosse, Wisconsin  54601
Cancer Care Center, Incorporated Salem, Ohio  44460
University of Colorado Cancer Center at UC Health Sciences Center Aurora, Colorado  80045
Center for Cancer Care at Goshen General Hospital Goshen, Indiana  46526
J. Phillip Citta Regional Cancer Center at Community Medical Center Toms River, New Jersey  08755
Providence Cancer Center at PMCC Medford, Oregon  97504
Veterans Affairs Medical Center - Milwaukee Milwaukee, Wisconsin  53295
Central Maryland Oncology Center Columbia, Maryland  21044
Cancer Centers of North Carolina - Raleigh Raleigh, North Carolina  27607
Precision Radiotherapy at University Pointe West Chester, Ohio  45069
Hudner Oncology Center at Saint Anne's Hospital - Fall River Fall River, Massachusetts  02721
NSMC Cancer Center - Peabody Peabody, Massachusetts  01960
Immanuel St. Joseph's Mankato, Minnesota  56002
Columbia Saint Mary's Hospital - Ozaukee Mequon, Wisconsin  53097
Columbia-Saint Mary's Cancer Care Center Milwaukee, Wisconsin  53211
Georgia Cancer Center for Excellence at Grady Memorial Hospital Atlanta, Georgia  30303
Central Maine Comprehensive Cancer Center at Central Maine Medical Center Lewiston, Maine  04240
University Medical Center at Princeton Princeton, New Jersey  08540
Emory Crawford Long Hospital Atlanta, Georgia  30308
New York Oncology Hematology, PC at Albany Regional Cancer Care Albany, New York  12208
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Center - Roseville Roseville, California  95661
Saint John's Cancer Center at Saint John's Medical Center Anderson, Indiana  46016
Hudson Valley Oncology Associates Poughkeepsie, New York  12601
Northwest Cancer Specialists at Vancouver Cancer Center Vancouver, Washington  98684
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Barnes-Jewish West County Hospital Saint Louis, Missouri  63141
Siteman Cancer Center at Barnes-Jewish St. Peters Hospital - St. Peters Saint Peters, Missouri  63376
University Radiation Oncology at Parkridge Hospital Rochester, New York  14626
Coleman Radiation Oncology Center at Carter General Hospital Morehead City, North Carolina  28557
CarolinaEast Cancer Care New Bern, North Carolina  28560
South Atlantic Radiation Oncology, LLC Supply, North Carolina  28462
Coastal Carolina Radiation Oncology Center Wilmington, North Carolina  28401
Norris Cotton Cancer Center - North Saint Johnsbury, Vermont  05819
Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center Burbank, California  91505
Southwest General Health Center Middleburgh Heights, Ohio  44130
UHHS Chagrin Highlands Medical Center Orange Villager, Ohio  44122
UHHS Westlake Medical Center Westlaker, Ohio  44145
Kansas City Cancer Centers - Southwest Overland Park, Kansas  66210
Longview Cancer Center Longview, Texas  75601
Piedmont Fayette Hospital Fayetteville, Georgia  30214
Clemens Regional Medical Center Mount Clemens, Michigan  48043
Lakeside Hospital Omaha, Nebraska  68130
University of New Mexico Cancer Center - South Las Cruces, New Mexico  88011
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Saint Helena Hospital Saint Helena, California  94574
Northeast Radiation Oncology Center Dunmore, Pennsylvania  18512
Arizona Center for Cancer Care - Peoria Peoria, Arizona  85381
Feather River Hospital Cancer Center Paradise, California  95969
Radiation Oncology Associates Southwest Fort Wayne, Indiana  46804
McLaren Cancer Institute Flint, Michigan  48532
Kansas City Cancer Centers - North Kansas City, Missouri  64154
Willamette Valley Cancer Center - Eugene Eugene, Oregon  97401
Texas Oncology, PA at Harris Center HEB Bedford, Texas  76022
Texas Oncology, PA at Texas Cancer Center - Denton South Denton, Texas  76210
Klabzuba Cancer Center at Harris Methodist Fort Worth Hospital Fort Worth, Texas  76104
Texas Oncology, PA at Texas Cancer Center - Sherman Sherman, Texas  75090
Texas Oncology, PA at Texas Oncology Cancer Center Sugar Land Sugar Land, Texas  77479
Bloomington Hospital Regional Cancer Institute Bloomington, Indiana  47403
Nebraska Medical Center Omaha, Nebraska  68198
Arizona Oncology - Tucson Tucson, Arizona  85704
Kansas City Cancer Centers - South Kansas City, Missouri  64131
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331
Tate Cancer Center at Baltimore Washington Medical Center Glen Burnie, Maryland  21061
Robinson Radiation Oncology Ravenna, Ohio  44266
Saint Agnes Cancer Center at Saint Agnes Medical Center Fresno, California  93720
Coastal Cancer Center at Sentara Virginia Beach General Hospital Virginia Beach, Virginia  23454
Veterans Affairs Medical Center - Tampa Tampa, Florida  33612
Memorial Hermann Hospital - Memorial City Houston, Texas  77024
Texas Oncology, PA - Wichita Falls Wichita Falls, Texas  76310
Zangmeister Center Columbus, Ohio  43219
Great Lakes Cancer Institute - Lapeer Campus Lapeer, Michigan  48446
St. Peter's Hospital Albany, New York  12208
RMH Regional Cancer Center at Rockingham Memorial Hospital Harrisonburg, Virginia  22801