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A PHASE III TRIAL EVALUATING BOTH ERLOTINIB AND CHEMORADIATION AS ADJUVANT TREATMENT FOR PATIENTS WITH RESECTED HEAD OF PANCREAS ADENOCARCINOMA


Phase 3
18 Years
N/A
Open (Enrolling)
Both
Adenocarcinoma of the Pancreas, Stage I Pancreatic Cancer, Stage II Pancreatic Cancer

Thank you

Trial Information

A PHASE III TRIAL EVALUATING BOTH ERLOTINIB AND CHEMORADIATION AS ADJUVANT TREATMENT FOR PATIENTS WITH RESECTED HEAD OF PANCREAS ADENOCARCINOMA


PRIMARY OBJECTIVES:

I. To determine whether the addition of erlotinib hydrochloride to adjuvant chemotherapy
comprising gemcitabine hydrochloride improves survival as compared to gemcitabine
hydrochloride alone following R0 or R1 resection in patients with pancreatic adenocarcinoma.

II. To determine whether the use of concurrent fluoropyrimidine and radiotherapy following
adjuvant gemcitabine hydrochloride-based chemotherapy further enhances survival of patients
who have no evidence of progressive disease after 5 courses of gemcitabine
hydrochloride-based chemotherapy.

SECONDARY OBJECTIVES:

I. To evaluate the disease-free survival of patients who are disease-free after 5 courses of
adjuvant gemcitabine hydrochloride-based chemotherapy followed by fluoropyrimidine-based
chemoradiotherapy.

II. To evaluate the disease-free survival of patients treated with adjuvant gemcitabine
hydrochloride-based chemotherapy with vs without erlotinib hydrochloride.

III. To evaluate the disease-free and overall survival of patients stratified by wild-type
and K-Ras status treated with adjuvant gemcitabine hydrochloride-based chemotherapy with vs
without erlotinib hydrochloride.

IV. To evaluate adverse events associated with adjuvant gemcitabine hydrochloride-based
chemotherapy with vs without erlotinib hydrochloride in these patients.

V. To evaluate adverse events associated with adjuvant gemcitabine hydrochloride-based
chemotherapy with vs without fluoropyrimidine-based chemoradiotherapy in patients who are
disease-free after adjuvant gemcitabine hydrochloride-based chemotherapy.

VI. To evaluate preoperative cross-sectional imaging of primary adenocarcinoma of the head
of the pancreas in order to determine the frequency with which objective criteria of
resectability are present.

VII. To determine the predictive roles of K-Ras mutations and epithelial to mesenchymal
transition phenotype in response to epidermal growth factor receptor (EGFR) tyrosine kinase
inhibition in early-stage pancreatic cancer.

VIII. To determine the frequency of EGFR-activated pathway and its influence on outcome.

IX. To determine the association between developmental molecular markers and outcome.

X. To determine the phenotype and genotype of tumors in patients with recurrence after
resection.

XI. To determine if low baseline fatigue, as measured by the FACIT-Fatigue, predicts
survival.

XII. To explore correlations between baseline fatigue, as measured by PROMIS, and survival.

OUTLINE: This is a multicenter study. Patients are stratified according to nodal status
(involved vs uninvolved), CA19-9 result (≤ 90 IU/L vs 91-180 IU/L), and surgical margins
(positive [R1] vs negative [R0]). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, and 15.
Treatment repeats every 28 days for 5 courses in the absence of disease progression or
unacceptable toxicity.

ARM II: Patients receive gemcitabine hydrochloride as in arm I and oral erlotinib
hydrochloride once daily on days 1-28. Treatment repeats every 28 days for 5 courses in the
absence of disease progression or unacceptable toxicity. Patients with no disease
progression after treatment in arm I or II are then stratified according to their first
randomization treatment arm (arm I vs arm II) and randomized to 1 of 2 additional treatment
arms (arm III or IV).

ARM III: Patients receive 1 course of the same treatment that they receive in arm I or II.

ARM IV: Patients receive 1 course of the same treatment that they receive in arm I or II.
Beginning within 7-21 days after completion of chemotherapy, patients undergo radiotherapy
(3-dimensional conformal radiotherapy or intensity-modulated radiotherapy) 5 days per week
for 5.5 weeks (28 fractions). During radiotherapy, patients receive either oral capecitabine
twice daily 5 days per week or fluorouracil IV continuously for 5.5 weeks or until
radiotherapy is completed.

After completion of study, patients are followed up periodically.


Inclusion Criteria:



- Histologically confirmed primary adenocarcinoma of the pancreatic head, neck, or
uncinate process

- Intraductal papillary mucinous neoplasm or invasive adenocarcinoma allowed

- No non-adenocarcinoma, adenosquamous carcinoma, islet cell (neuroendocrine)
tumor, cystadenoma, cystadenocarcinoma, carcinoid tumor, duodenal carcinoma,
distal bile duct tumor, or ampullary carcinoma

- Pathologic stage T1-3, N0-1, M0 disease according to American Joint Committee on
Cancer (AJCC) 6th edition

- Has undergone a potentially curative resection (i.e., removal of all gross tumor)
involving a classic (Whipple) or a pylorus preserving pancreaticoduodenectomy within
the past 21-56 days

- Operative report must contain a statement from the surgeon explicitly detailing
that a total gross excision of the primary tumor was achieved

- Pathology report must include documentation of margin status, size of the tumor,
and status of the 3 major surgical margins (bile duct, pancreatic parenchyma,
and retroperitoneal [uncinate])

- Post-resection serum CA19-9 =< 180 IU/L

- Tumor tissue block and peripheral blood samples must be submitted to the study's
central tumor bank for correlative studies

- No recurrent pancreatic cancer

- Zubrod performance status 0-1

- ANC >= 1,500/mm^3

- Platelet count >= 100,000/mm^3

- Hemoglobin >= 8.0 g/dL (transfusion or other intervention allowed)

- Serum total bilirubin =< 2 times upper limit of normal (ULN)

- Creatinine =< 2 times ULN

- SGOT =< 2.5 times ULN

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Suitable to receive study radiotherapy, as documented by a radiation oncologist

- Active HIV infection allowed provided the CD4 count is >= 499/mm^3 and the viral load
is =< 50 copies/mL

- Total oral caloric intake >= 1,500 calories/day

- No significant nausea and vomiting

- None of the following severe active comorbidities that would preclude study therapy:

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

- Transmural myocardial infarction within the past 3 months

- Acute bacterial or fungal infection requiring IV antibiotics

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- No other invasive malignancies within the past 2 years except for nonmelanomatous
skin cancer or carcinoma in situ

- See Disease Characteristics

- No prior systemic chemotherapy for pancreatic cancer

- Prior chemotherapy for a different cancer allowed

- No prior total pancreatectomy, distal pancreatectomy, or central pancreatectomy

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

- Concurrent highly active antiretroviral treatment (HAART) allowed

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival (first randomization)

Outcome Description:

Overall survival will be estimated by the Kaplan-Meier method. The distribution of overall survival estimates between the two arms for both primary endpoint questions will be compared using the log rank test. The Cox proportional hazard regression model will be used to analyze the effects of factors, in addition to treatment, that may be associated with overall survival.

Outcome Time Frame:

From the date of first randomization (gemcitabine vs. gemcitabine/erlotinib) to the date of death or last follow-up, assessed up to 11 years

Safety Issue:

No

Principal Investigator

Ross Abrams

Investigator Role:

Principal Investigator

Investigator Affiliation:

Radiation Therapy Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-01987

NCT ID:

NCT01013649

Start Date:

November 2009

Completion Date:

Related Keywords:

  • Adenocarcinoma of the Pancreas
  • Stage I Pancreatic Cancer
  • Stage II Pancreatic Cancer
  • Adenocarcinoma
  • Adenocarcinoma, Mucinous
  • Pancreatic Neoplasms

Name

Location

Louisiana State UniversityNew Orleans, Louisiana  70112-2282
Memorial Sloan Kettering Cancer CenterNew York, New York  10021
Mayo ClinicRochester, Minnesota  55905
University of Mississippi Medical CenterJackson, Mississippi  39216-4505
Abington Memorial HospitalAbington, Pennsylvania  19001
Medical University of South CarolinaCharleston, South Carolina  29425-0721
Rhode Island HospitalProvidence, Rhode Island  02903
Pennsylvania HospitalPhiladelphia, Pennsylvania  19107
Sinai Hospital of BaltimoreBaltimore, Maryland  21225
Boulder Community HospitalBoulder, Colorado  80301-9019
Porter Adventist HospitalDenver, Colorado  80210
Swedish Medical CenterEnglewood, Colorado  80110
Sky Ridge Medical CenterLone Tree, Colorado  80124
North Suburban Medical CenterThornton, Colorado  80229
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
United HospitalSt. Paul, Minnesota  55102
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Loyola University Medical CenterMaywood, Illinois  60153
Massachusetts General Hospital Cancer CenterBoston, Massachusetts  02114
Rapid City Regional HospitalRapid City, South Dakota  57709
Henry Ford HospitalDetroit, Michigan  48202
Northwest Community HospitalArlington Heights, Illinois  60005
Ingalls Memorial HospitalHarvey, Illinois  60426
Memorial Hospital of South BendSouth Bend, Indiana  46601
Newark Beth Israel Medical CenterNewark, New Jersey  07112
Akron General Medical CenterAkron, Ohio  44302
Delaware County Memorial HospitalDrexel Hill, Pennsylvania  19026
Reading Hospital and Medical CenterReading, Pennsylvania  19612-6052
York HospitalYork, Pennsylvania  17315
University of Texas Medical BranchGalveston, Texas  77555-1329
LDS HospitalSalt Lake City, Utah  84143
Rush University Medical CenterChicago, Illinois  60612-3824
Boston Medical CenterBoston, Massachusetts  02118
Hartford HospitalHartford, Connecticut  06102-5037
Illinois Masonic Medical CenterChicago, Illinois  60657
Bay Medical CenterPanama City, Florida  32401
Peninsula Regional Medical CenterSalisbury, Maryland  21801
Kaiser Permanente Medical Center - Santa ClaraSanta Clara, California  95051-5386
Via Christi Regional Medical CenterWichita, Kansas  67214
Carolinas Medical CenterCharlotte, North Carolina  28232-2861
University of Oklahoma Health Sciences CenterOklahoma City, Oklahoma  73104
Saint Anthony Medical CenterRockford, Illinois  61108
Iowa Methodist Medical CenterDes Moines, Iowa  50309
Iowa Lutheran HospitalDes Moines, Iowa  50316-2301
Maimonides Medical CenterBrooklyn, New York  11219
Bellin Memorial HospitalGreen Bay, Wisconsin  54301
Great Falls ClinicGreat Falls, Montana  59405
MetroHealth Medical CenterCleveland, Ohio  44109
Central Baptist HospitalLexington, Kentucky  40503
Valley HospitalRidgewood, New Jersey  07450
Long Island Jewish Medical CenterNew Hyde Park, New York  11040
North Colorado Medical CenterGreeley, Colorado  80631
McKee Medical CenterLoveland, Colorado  80539
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
Adena Regional Medical CenterChillicothe, Ohio  54601
Grady Memorial HospitalDelaware, Ohio  43015
McKay-Dee Hospital CenterOgden, Utah  84403
Welch Cancer CenterSheridan, Wyoming  82801
Rocky Mountain Cancer CenterDenver, Colorado  80218
Brigham and Women's HospitalBoston, Massachusetts  02115
Methodist Estabrook Cancer CenterOmaha, Nebraska  68114-4199
City of Hope Medical CenterDuarte, California  91010
Paoli Memorial HospitalPaoli, Pennsylvania  19301-1792
Elkhart General HospitalElkhart, Indiana  46515
Alta Bates Summit Medical Center - Summit CampusOakland, California  94609
Sutter Solano Medical CenterVallejo, California  94589
Saint Francis Medical CenterCape Girardeau, Missouri  63701
Grandview HospitalDayton, Ohio  45405
Legacy Mount Hood Medical CenterGresham, Oregon  97030
Bryn Mawr HospitalBryn Mawr, Pennsylvania  19010
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Medical Oncology and Hematology AssociatesDes Moines, Iowa  50309
Regions HospitalSaint Paul, Minnesota  55101
Northeast Georgia Medical CenterGainesville, Georgia  30501
Center for Cancer Care and ResearchSt. Louis, Missouri  63141
Miami Valley HospitalDayton, Ohio  45409
Cancer Treatment CenterWooster, Ohio  44691
Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Longmont United HospitalLongmont, Colorado  80501
Rocky Mountain Cancer CentersThornton, Colorado  80260
Singing River HospitalPascagoula, Mississippi  39581
Sharp Memorial HospitalSan Diego, California  92123
Greene Memorial HospitalXenia, Ohio  45385
Easton HospitalEaston, Pennsylvania  18042
Saint Agnes Medical CenterFresno, California  93720-3397
Rutherford HospitalRutherfordton, North Carolina  28139
Cancer Centers of the Carolinas - SenecaSeneca, South Carolina  29672
Presbyterian HospitalCharlotte, North Carolina  28233-3549
Mayo Clinic in ArizonaScottsdale, Arizona  85259-5404
Mayo Clinic in FloridaJacksonville, Florida  32224
Washington Hospital CenterWashington, District of Columbia  20010
Memorial Medical CenterSpringfield, Illinois  62781
Queen's Medical CenterHonolulu, Hawaii  96813
Solano Radiation Oncology CenterVacaville, California  95687
Tyler Cancer CenterTyler, Texas  75702
Providence HospitalMobile, Alabama  36608
Vanderbilt UniversityNashville, Tennessee  37232-6305
Northwestern UniversityChicago, Illinois  60611
Northwest Cancer SpecialistsVancouver, Washington  98664
Cancer Care Center, IncorporatedSalem, Ohio  44460
University of RochesterRochester, New York  14642
Holy Cross HospitalFort Lauderdale, Florida  33308
University of California at San DiegoLa Jolla, California  92093
Wayne State UniversityDetroit, Michigan  48202
Albert Einstein Medical CenterPhiladelphia, Pennsylvania  19141
Riverside Methodist HospitalColumbus, Ohio  43214
Licking Memorial HospitalNewark, Ohio  43055-2899
Providence Portland Medical CenterPortland, Oregon  97213-3635
California Pacific Medical CenterSan Francisco, California  94115
Columbus CCOPColumbus, Ohio  43206
Presbyterian - Saint Lukes Medical Center - Health OneDenver, Colorado  80218
University of KentuckyLexington, Kentucky  40536-0098
Montana Cancer Consortium CCOPBillings, Montana  59101
Flower HospitalSylvania, Ohio  43560-2197
Huntsman Cancer Institute/University of UtahSalt Lake City, Utah  84112
Radiation Oncology CenterAlliance, Ohio  44601
Thomas Jefferson University HospitalPhiladelphia, Pennsylvania  19131
Tulane University Health Sciences CenterNew Orleans, Louisiana  70112
Lankenau HospitalWynnewood, Pennsylvania  19096
Memorial Health University Medical CenterSavannah, Georgia  31404
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
M D Anderson Cancer CenterHouston, Texas  77030
University of Southern CaliforniaLos Angeles, California  90033
Northern Indiana Cancer Research ConsortiumSouth Bend, Indiana  
Rohnert Park Cancer CenterRohnert Park, California  94928
South Sacramento Cancer CenterSacramento, California  95823
Sands Cancer CenterCanandiaqua, New York  14424
University of CincinnatiCincinnati, Ohio  45267-0502
Hawaii Medical Center EastHonolulu, Hawaii  96817
Clackamas Radiation Oncology CenterClackamas, Oregon  97015
Froedtert and the Medical College of WisconsinMilwaukee, Wisconsin  53226
OSF Saint Francis Medical CenterPeoria, Illinois  61637
Saint Helena HospitalSaint Helena, California  94574
California Cancer Center - North FresnoFresno, California  93720
Bay Area Tumor Institution CCOPOakland, California  94609
The Medical Center of AuroraAurora, Colorado  80012
Penrose-Saint Francis HealthcareColorado Springs, Colorado  80907
Exempla Saint Joseph HospitalDenver, Colorado  80218
Saint Mary's Hospital and Regional Medical CenterGrand Junction, Colorado  81502
Saint Mary Corwin Medical CenterPueblo, Colorado  81004
The Hospital of Central ConnecticutNew Britain, Connecticut  06050
Lombardi Comprehensive Cancer Center at Georgetown UniversityWashington, District of Columbia  20057
M D Anderson Cancer Center- OrlandoOrlando, Florida  32806
Saint Joseph's-Candler Health SystemSavannah, Georgia  31405
University of HawaiiHonolulu, Hawaii  96813
Saint Luke's Mountain States Tumor InstituteBoise, Idaho  83712
Saint Anthony's HealthAlton, Illinois  62002
Provena Saint Mary's HospitalKankakee, Illinois  60901
Saint Francis Hospital and Health CentersBeech Grove, Indiana  46107
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
McFarland ClinicAmes, Iowa  50010
Medical Oncology and Hematology Associates-West Des MoinesClive, Iowa  50325
Iowa Oncology Research Association CCOPDes Moines, Iowa  50309
Mercy Medical Center - Des MoinesDes Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des MoinesDes Moines, Iowa  50309
Stormont-Vail Regional Health CenterTopeka, Kansas  66604
Ochsner Clinic CCOPNew Orleans, Louisiana  70121
Unity HospitalFridley, Minnesota  55432
Minnesota Oncology Hematology PA-MaplewoodMaplewood, Minnesota  55109
Saint Louis-Cape Girardeau CCOPSaint Louis, Missouri  63141
Missouri Baptist Medical CenterSaint Louis, Missouri  63131
Saint John's Mercy Medical CenterSaint Louis, Missouri  63141
Ozark Health Ventures LLC dba Cancer Research for The Ozarks SpringfieldSpringfield, Missouri  65802
Saint John's HospitalSpringfield, Missouri  65804
Cox Medical CenterSpringfield, Missouri  65807
Billings ClinicBillings, Montana  59107-7000
Berdeaux, Donald MD (UIA Investigator)Great Falls, Montana  59405
Good Samaritan HospitalKearney, Nebraska  68847
Nevada Cancer Research Foundation CCOPLas Vegas, Nevada  89106
Elliot HospitalManchester, New Hampshire  03103
Cooper Hospital University Medical CenterCamden, New Jersey  08103
Saint Barnabas Medical CenterLivingston, New Jersey  07039
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington CountyMount Holly, New Jersey  08060
Sparta Cancer Treatment CenterSparta, New Jersey  07871
Virtua West Jersey Hospital VoorheesVoorhees, New Jersey  08043
Orange Regional Medical CenterMiddletown, New York  10940
New York University Langone Medical CenterNew York, New York  10016
Highland HospitalRochester, New York  14620
Kinston Medical Specialists PAKinston, North Carolina  28501
Summa Barberton HospitalBarberton, Ohio  44203
Doctors HospitalColumbus, Ohio  43228
Grant Medical CenterColumbus, Ohio  43215
Mount Carmel Health Center WestColumbus, Ohio  43222
Good Samaritan Hospital - DaytonDayton, Ohio  45406
Dayton CCOPDayton, Ohio  45429
Samaritan North Health CenterDayton, Ohio  45415
Blanchard Valley HospitalFindlay, Ohio  45840
Atrium Medical Center-Middletown Regional HospitalFranklin, Ohio  45005-1066
Kettering Medical CenterKettering, Ohio  45429
Marietta Memorial HospitalMarietta, Ohio  45750
North Coast Cancer CareSandusky, Ohio  44870
Upper Valley Medical CenterTroy, Ohio  45373
Saint Ann's HospitalWesterville, Ohio  43081
Natalie W Bryant Cancer CenterTulsa, Oklahoma  74136
Legacy Good Samaritan Hospital and Medical CenterPortland, Oregon  97210
Providence Saint Vincent Medical CenterPortland, Oregon  97225
Columbia River Oncology ProgramPortland, Oregon  97225
Riddle HospitalMedia, Pennsylvania  19063
Aria Health-Torresdale CampusPhiladelphia, Pennsylvania  19114
Mainline Health CCOPWynnewood, Pennsylvania  19096
Greenville CCOPGreenville, South Carolina  29615
Upstate Carolina CCOPSpartanburg, South Carolina  29303
The Don and Sybil Harrington Cancer CenterAmarillo, Texas  79106
Saint Francis HospitalFederal Way, Washington  98003
Good Samaritan Community HospitalPuyallup, Washington  98372
Northwest CCOPTacoma, Washington  98405
Multicare Health SystemTacoma, Washington  98415
Saint Joseph Medical CenterTacoma, Washington  98405
Wheeling HospitalWheeling, West Virginia  26003
Langlade Hospital and Cancer CenterAntigo, Wisconsin  54409
Saint Vincent HospitalGreen Bay, Wisconsin  54301
Saint Mary's HospitalGreen Bay, Wisconsin  54303
Aspirus Regional Cancer CenterWausau, Wisconsin  54401
University of California Medical Center At Irvine-Orange CampusOrange, California  92868
University of Maryland Greenebaum Cancer CenterBaltimore, Maryland  21201
Northeast Radiation Oncology CenterDunmore, Pennsylvania  18512
Radiological Associates of SacramentoSacramento, California  95816
University of IllinoisChicago, Illinois  60612
Alle-Kiski Medical CenterNatrona Heights, Pennsylvania  15065
Marin General HospitalGreenbrae, California  94904
Mount Sinai Medical Center CCOPMiami Beach, Florida  33140
Saint Agnes HospitalBaltimore, Maryland  21229
University of Michigan University HospitalAnn Arbor, Michigan  48109
University of Missouri - Ellis FischelColumbia, Missouri  65203
Renown Regional Medical CenterReno, Nevada  89502
East Carolina UniversityGreenville, North Carolina  27858
Rex Cancer CenterRaleigh, North Carolina  27607
Community Health Partners Regional Medical CenterElyria, Ohio  44035
Cancer Centers of the Carolinas - FarisGreenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Radiation OncologyGreer, South Carolina  29650
Sandra L Maxwell Cancer CenterCedar City, Utah  84720
Intermountain Medical CenterMurray, Utah  84157
Utah Valley Regional Medical CenterProvo, Utah  84603
Dixie Medical Center Regional Cancer CenterSaint George, Utah  84770
Utah Cancer Specialists-Salt Lake CitySalt Lake City, Utah  84106
West Virginia University CharlestonCharleston, West Virginia  25304
Texas Cancer Center-ShermanSherman, Texas  75090
University of Miami Miller School of Medicine-Sylvester Cancer CenterMiami, Florida  33136
Grady Health SystemAtlanta, Georgia  30303
Adams Cancer CenterGettysburg, Pennsylvania  17325
Cherry Tree Cancer CenterHanover, Pennsylvania  17331
Kaiser Permanente Oakland-BroadwayOakland, California  94611
Kaiser Permanente-Rancho Cordova Cancer CenterRancho Cardova, California  95670
The Permanente Medical Group-Roseville Radiation OncologyRoseville, California  95678
Kaiser Permanente Radiation Oncology Cancer Treatment CenterSanta Clara, California  95051
Kaiser Permanente Cancer Treatment CenterSouth San Francisco, California  94080
Saint Vincent's Medical CenterBridgeport, Connecticut  06606
OSF Saint Francis Medical Center Radiation Oncology Service at the Central Illinois Comprehensive CCPeoria, Illinois  61615-7827
The Mark H Zangmeister CenterColumbus, Ohio  43219
Mid-Columbia Medical CenterThe Dalles, Oregon  97058
Legacy Salmon Creek HospitalVancouver, Washington  98686
Gundersen LutheranLa Crosse, Wisconsin  54601
New York Oncology Hematology PC - AlbanyAlbany, New York  12206
Robinson Radiation OncologyRavenna, Ohio  44266
Los Angeles County-USC Medical CenterLos Angeles, California  90033
Siouxland Hematology Oncology AssociatesSioux City, Iowa  51101
University PointeWest Chester, Ohio  45069
Texas Oncology-Longview Cancer CenterLongview, Texas  75601
Carle Foundation - Carle Cancer CenterUrbana, Illinois  61801
Summa Akron City HospitalAkron, Ohio  44304
Radiation Oncology Associates IncorporatedProvidence, Rhode Island  02904
Indiana University Health Goshen Center For Cancer CareGoshen, Indiana  46526
Texas Oncology-Arlington SouthArlington, Texas  76014
North Shore-LIJ Health System CCOPManhasset, New York  11030
Christiana Care Health System-Christiana HospitalNewark, Delaware  19718
Sentara HospitalsNorfolk, Virginia  23507
Memorial Sloan-Kettering Cancer Center at SuffolkCommack, New York  11725
Edward Hospital/Cancer CenterNaperville, Illinois  60540
Toledo Clinic Cancer Centers-MaumeeMaumee, Ohio  43537-1839
PeaceHealth Southwest Medical CenterVancouver, Washington  98664
Auburn Radiation Oncology CenterAuburn, California  95603
Marshall Radiation Oncology CenterCameron Park, California  95682
Mercy San Juan Medical CenterCarmichael, California  95608
Roseville Radiation Oncology CenterRoseville, California  95661
Mercy General Hospital Radiation Oncology CenterSacramento, California  95819
Saint Luke's Mountain States Tumor Institute-Twin FallsTwin Falls, Idaho  83301
Memorial Sloan Kettering Cancer Center at Basking RidgeBasking Ridge, New Jersey  07920
Memorial Sloan-Kettering Cancer Center Rockville CentreRockville Centre, New York  11570
Memorial Sloan-Kettering Cancer Center at PhelpsSleepy Hollow, New York  10591
University Radiation OncologyRochester, New York  14626
Texas Oncology PA - BedfordBedford, Texas  76022
The Klabzuba Cancer CenterFort Worth, Texas  76104
Texas Oncology Cancer Center Sugar LandSugar Land, Texas  77479
Saint John's HospitalSpringfield, Illinois  62702
Huron Valley-Sinai HospitalCommerce, Michigan  48382
Cancer Care Centers of South Texas- NortheastSan Antonio, Texas  78217
Sentara Virginia Beach General HospitalVirginia Beach, Virginia  23454