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A Randomized Phase III Trial of the Value of Early Local Therapy for the Intact Primary Tumor in Patients With Metastatic Breast Cancer

Phase 3
18 Years
Open (Enrolling)
Breast Cancer

Thank you

Trial Information

A Randomized Phase III Trial of the Value of Early Local Therapy for the Intact Primary Tumor in Patients With Metastatic Breast Cancer



- To evaluate whether early local therapy comprising surgery of intact primary disease
compared to local palliative therapy only in patients with stage IV breast cancer,
whose disease does not progress during initial optimal systemic therapy, will result in
prolonged survival.


- To compare the time to uncontrolled chest wall disease between patients treated with
these regimens.

- To determine whether there is a difference in health-related quality-of-life (HRQOL)
between patients treated with these regimens.

- To determine whether the absolute value of circulating tumor cells (CTC) burden at 6
months following randomization (time +6) will be lower in the palliative therapy arm
than in early local therapy arm, and whether this value is inversely related to
survival (lower CTC, longer survival).

- To collect tumor and blood specimens for future exploration of the biological
interactions between the primary tumor and metastatic lesions and the effect of primary
tumor resection.

OUTLINE: This is a multicenter study. Patients are stratified according to hormone receptor
and treatment plan (ER+ or PR+, HER2-, endocrine therapy alone vs ER+ or PR+, and HER2-,
chemotherapy and/or endocrine therapy vs ER- or PR-, and HER2- vs HER2+), and number of
involved organ systems with distant disease (regional nodes in the axillary,
supraclavicular, and internal mammary locations are not considered distant sites) (1 vs >
1). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive standard palliative therapy, if needed, to address symptoms
such as tumor ulceration, pain, bulky adenopathy causing arm symptoms, and other
similar situations. Therapy may consist of radiotherapy alone, surgery alone, or a
combination of both.

- Arm II: Patients undergo surgery comprising breast-conserving therapy (BCT) or total
mastectomy according to patient and treating physician preference. Surgery is to occur
no later than 10 weeks after completion of 32 weeks of systemic therapy. Free surgical
margins must be achieved with re-excision or mastectomy for patients undergoing BCT.
After completion of BCT, patients undergo radiotherapy once a day, 5 days per week.
Patients who had mastectomy undergo radiotherapy at the discretion of treating

Patients may undergo blood and tumor tissue sample collection for circulating tumor cells
(CTC) burden and future studies.

Patients complete the Functional Assessment of Cancer Therapy - Breast Trial Outcome Index
(FACT- TOI) and FACT - General (22) and the Breast Cancer Subscale (FACT-B) quality-of-life
questionnaires at baseline and periodically during study.

After completion of study therapy, patients are followed up periodically for 5 years.

Inclusion Criteria


- Diagnosis of intact primary (not recurrent) invasive carcinoma of the breast

- Stage IV disease

- Confirmation of the primary tumor should be by needle biopsy (preferred)

- Incisional surgical biopsy allowed as long as there is residual palpable or
tumor image in the breast

- Patients must be judged to be candidates for complete resection with free margins
followed by radiation therapy (if radiation therapy is indicated)

- For women not undergoing axillary dissection, sentinel node biopsy should document an
axillary nodal burden of 1-2 involved lymph nodes (i.e., ACOSOG Z-11 criteria may be

- Prior non-invasive (DCIS) cancer allowed provided there has been no recurrence

- Prior ipsilateral invasive cancer allowed if more than 5 years previous

- No synchronous contralateral breast cancer

- Patients should have at least one organ system involved with distant metastatic

- If patient has only one metastatic lesion/focus, this must be proven by biopsy
and the pathology report confirming the diagnosis of primary breast cancer, as
well as the metastatic site, must be available

- Must have available radiologic reports documenting disease status within the past 6
weeks prior to initiating systemic therapy

- CNS metastases allowed provided projected survival > 6 months

- Patients must have completed at least 16 weeks of optimal systemic therapy
(appropriate to the tumor biological profile and the patient's age and menopausal

- If systemic therapy is discontinued for toxicity, but there is no distant
progression and at least 12 weeks of therapy have been delivered, then the
patient remains eligible

- Radiation therapy (if indicated) must begin within 12 weeks of final therapeutic
surgical procedure (including re-excision for free margins and completion of
axillary dissection)

- Patients may register at any time from the time of diagnosis of stage IV breast
cancer (if eligibility criteria met) to the time when a maximum of 30 weeks of
induction systemic therapy has been completed

- Patients must be randomized within 16-32 weeks after the start of systemic

- Patients must not have experienced disease progression since the start of systemic
therapy, as evidenced by radiographic documentation of disease status before
treatment and within 4 weeks +/- 2 weeks prior to randomization, including:

- No new sites of disease

- No enlargement of existing sites by 20% or more in longest diameter

- No symptomatic deterioration

- Patients who require radiotherapy to bone metastases during induction systemic
therapy are eligible

- Local disease at the primary site must be asymptomatic

- Hormone receptor status known


- See Disease Characteristics

- Menopausal status not specified

- Patients must have adequate organ function to undergo local therapy 4 weeks +/- 2
weeks prior to randomization per investigator discretion and institutional guidelines

- More than 5 years since other primary cancers that were curatively treated

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use an accepted and effective contraception method


- See Disease Characteristics

Type of Study:


Study Design:

Allocation: Randomized, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall survival

Safety Issue:


Principal Investigator

Seema A. Khan, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Robert H. Lurie Cancer Center



Study ID:




Start Date:

February 2011

Completion Date:

Related Keywords:

  • Breast Cancer
  • male breast cancer
  • stage IV breast cancer
  • Breast Neoplasms



Roswell Park Cancer Institute Buffalo, New York  14263
Memorial Sloan-Kettering Cancer Center New York, New York  10021
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 - Wichita Wichita, Kansas  67214-3882
Hurley Medical Center Flint, Michigan  48503
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Penrose Cancer Center at Penrose Hospital Colorado Springs, Colorado  80933
CCOP - Colorado Cancer Research Program Denver, Colorado  80224-2522
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
Hope Cancer Care Center at Longmont United Hospital Longmont, Colorado  80502
St. Mary - Corwin Regional Medical Center Pueblo, Colorado  81004
North Suburban Medical Center Thornton, Colorado  80229
Hinsdale Hematology Oncology Associates Hinsdale, Illinois  60521
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
Fairview Ridges Hospital Burnsville, Minnesota  55337
Mercy and Unity Cancer Center at Mercy Hospital Coon Rapids, Minnesota  55433
Fairview Southdale Hospital Edina, Minnesota  55435
Mercy and Unity Cancer Center at Unity Hospital Fridley, Minnesota  55432
Hutchinson Area Health Care Hutchinson, Minnesota  55350
HealthEast Cancer Care at St. John's Hospital Maplewood, Minnesota  55109
Hennepin County Medical Center - Minneapolis Minneapolis, Minnesota  55415
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
St. Francis Cancer Center at St. Francis Medical Center Shakopee, Minnesota  55379
Park Nicollet Cancer Center St. Louis Park, Minnesota  55416
Regions Hospital Cancer Care Center St. Paul, Minnesota  55101
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
CCOP - MeritCare Hospital Fargo, North Dakota  58122
Aultman Cancer Center at Aultman Hospital Canton, Ohio  44710-1799
Case Comprehensive Cancer Center Cleveland, Ohio  44106-5065
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Sanford Cancer Center at Sanford USD Medical Center Sioux Falls, South Dakota  57117-5039
Avera Cancer Institute Sioux Falls, South Dakota  57105
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Madison, Wisconsin  53792-6164
Marshfield Clinic - Marshfield Center Marshfield, Wisconsin  54449
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Marshfield Clinic - Indianhead Center Rice Lake, Wisconsin  54868
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Methodist Medical Center of Illinois Peoria, Illinois  61636
Memorial Hospital of South Bend South Bend, Indiana  46601
CCOP - Montana Cancer Consortium Billings, Montana  59101
Newark Beth Israel Medical Center Newark, New Jersey  07112
CCOP - Columbus Columbus, Ohio  43206
University of Texas Medical Branch Galveston, Texas  77555-1329
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Saint Joseph Regional Medical Center South Bend, Indiana  46617
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
CCOP - Scott and White Hospital Temple, Texas  76508
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
MidMichigan Medical Center - Midland Midland, Michigan  48670
Louis A. Weiss Memorial Hospital Chicago, Illinois  60640
West Suburban Center for Cancer Care River Forest, Illinois  60305
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
Blumenthal Cancer Center at Carolinas Medical Center Charlotte, North Carolina  28232-2861
Northside Hospital Cancer Center Atlanta, Georgia  30342-1611
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
Winthrop University Hospital Mineola, New York  11501
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
Advocate Christ Medical Center Oak Lawn, Illinois  60453
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital Baltimore, Maryland  21215
Albert Einstein Cancer Center at Albert Einstein College of Medicine Bronx, New York  10461
Mount Sinai Medical Center New York, New York  10029
Wake Forest University Comprehensive Cancer Center Winston-Salem, North Carolina  27157-1096
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
Hollings Cancer Center at Medical University of South Carolina Charleston, South Carolina  29425
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas Dallas, Texas  75390
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
McCreery Cancer Center at Ottumwa Regional Ottumwa, Iowa  52501
Green Bay Oncology, Limited - Escanaba Escanaba, Michigan  49431
Dickinson County Healthcare System Iron Mountain, Michigan  49801
Hunterdon Regional Cancer Center at Hunterdon Medical Center Flemington, New Jersey  08822
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
St. Mary's Hospital Medical Center - Green Bay Green Bay, Wisconsin  54303
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54301-3526
Green Bay Oncology, Limited at St. Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Green Bay Oncology, Limited - Oconto Falls Oconto Falls, Wisconsin  54154
Green Bay Oncology, Limited - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
St. Elizabeth Medical Center Edgewood, Kentucky  41017
Batte Cancer Center at Northeast Medical Center Concord, North Carolina  28025
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Munson Medical Center Traverse City, Michigan  49684
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
Big Sky Oncology Great Falls, Montana  59405
Adena Regional Medical Center Chillicothe, Ohio  54601
Doctors Hospital at Ohio Health Columbus, Ohio  43228
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Grady Memorial Hospital Delaware, Ohio  43015
Fairfield Medical Center Lancaster, Ohio  43130
Strecker Cancer Center at Marietta Memorial Hospital Marietta, Ohio  45750
Licking Memorial Cancer Care Program at Licking Memorial Hospital Newark, Ohio  43055
Community Hospital of Springfield and Clark County Springfield, Ohio  45505
Genesis - Good Samaritan Hospital Zanesville, Ohio  43701
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Veterans Affairs Medical Center - Hines Hines, Illinois  60141
Zimmer Cancer Center at New Hanover Regional Medical Center Wilmington, North Carolina  28402-9025
University of South Alabama Mitchell Cancer Institute Mobile, Alabama  36604
M.D. Anderson Cancer Center at Orlando Orlando, Florida  32806
Mountain States Tumor Institute at St. Luke's Regional Medical Center Boise, Idaho  83712-6297
University of Illinois Cancer Center Chicago, Illinois  60612-7243
Swedish-American Regional Cancer Center Rockford, Illinois  61104-2315
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
University of Mississippi Cancer Clinic Jackson, Mississippi  39216-4505
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Beth Israel Medical Center - Petrie Division New York, New York  10003-3803
St. Luke's - Roosevelt Hospital Center - St.Luke's Division New York, New York  10027
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Virginia Commonwealth University Massey Cancer Center Richmond, Virginia  23298-0037
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Chao Family Comprehensive Cancer Center at University of California Irvine Medical Center Orange, California  92868
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
Todd Cancer Institute at Long Beach Memorial Medical Center Long Beach, California  90801
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
Elkhart General Hospital Elkhart, Indiana  46515
Howard Community Hospital Kokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. Joseph St. Joseph, Michigan  49085
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
Hematology Oncology Associates - Skokie Skokie, Illinois  60076
UPMC Cancer Centers Pittsburgh, Pennsylvania  15232
Fox Valley Hematology and Oncology - East Grant Street Appleton, Wisconsin  54911-3496
North Bay Cancer Center Fairfield, California  94533
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
Saint Joseph's Hospital of Atlanta Atlanta, Georgia  30342-1701
Piedmont Hospital Atlanta, Georgia  30309
Charles B. Eberhart Cancer Center at DeKalb Medical Center Decatur, Georgia  30033
Kennestone Cancer Center at Wellstar Kennestone Hospital Marietta, Georgia  30060
Southern Regional Medical Center Riverdale, Georgia  30274-2600
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
St. Joseph Medical Center Bloomington, Illinois  61701
Graham Hospital Canton, Illinois  61520
Memorial Hospital Carthage, Illinois  62321
Hematology and Oncology Associates Chicago, Illinois  60611
Eureka Community Hospital Eureka, Illinois  61530
Ingalls Cancer Care Center at Ingalls Memorial Hospital Harvey, Illinois  60426
North Shore Oncology and Hematology Associates, Limited - Libertyville Libertyville, Illinois  60048
McDonough District Hospital Macomb, Illinois  61455
BroMenn Regional Medical Center Normal, Illinois  61761
Community Cancer Center Normal, Illinois  61761
Community Hospital of Ottawa Ottawa, Illinois  61350
Oncology Hematology Associates of Central Illinois, PC - Ottawa Ottawa, Illinois  61350
Cancer Treatment Center at Pekin Hospital Pekin, Illinois  61554
Oncology Hematology Associates of Central Illinois, PC - Peoria Peoria, Illinois  61615
OSF St. Francis Medical Center Peoria, Illinois  61637
Proctor Hospital Peoria, Illinois  61614
Illinois Valley Community Hospital Peru, Illinois  61354
St. Francis Hospital and Health Centers - Beech Grove Campus Beech Grove, Indiana  46107
Center for Cancer Therapy at LaPorte Hospital and Health Services La Porte, Indiana  46350
John Stoddard Cancer Center at Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Medical Oncology and Hematology Associates at John Stoddard Cancer Center Des Moines, Iowa  50309
Medical Oncology and Hematology Associates at Mercy Cancer Center Des Moines, Iowa  50314
Mercy Cancer Center at Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates - West Des Moines West Des Moines, Iowa  50266
Cancer Center of Kansas, PA - Dodge City Dodge City, Kansas  67801
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Community Cancer Center of Monroe Monroe, Michigan  48162
Providence Cancer Institute at Providence Hospital - Southfield Campus Southfield, Michigan  48075
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Immanuel Medical Center Omaha, Nebraska  68122
Creighton University Medical Center Omaha, Nebraska  68131-2197
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Highland Hospital of Rochester Rochester, New York  14620
Iredell Memorial Hospital Statesville, North Carolina  28677
Wood County Oncology Center Bowling Green, Ohio  43402
Samaritan North Cancer Care Center Dayton, Ohio  45415
David L. Rike Cancer Center at Miami Valley Hospital Dayton, Ohio  45409
Good Samaritan Hospital Dayton, Ohio  45406
Blanchard Valley Medical Associates Findlay, Ohio  45840
Charles F. Kettering Memorial Hospital Kettering, Ohio  45429
Lima Memorial Hospital Lima, Ohio  45804
Northwest Ohio Oncology Center Maumee, Ohio  43537
Middletown Regional Hospital Middletown, Ohio  45044
Toledo Clinic - Oregon Oregon, Ohio  43616
St. Charles Mercy Hospital Oregon, Ohio  43616
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Fulton County Health Center Wauseon, Ohio  43567
St. Mary Regional Cancer Center Langhorne, Pennsylvania  19047
Doctor's Hospital of Laredo Laredo, Texas  78041
Holy Family Memorial Medical Center Cancer Care Center Manitowoc, Wisconsin  54221-1450
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
DeCesaris Cancer Institute at Anne Arundel Medical Center Annapolis, Maryland  21401
Lancaster General Hospital Lancaster, Pennsylvania  17604-3555
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida Tampa, Florida  33612
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Cancer Resource Center - Lincoln Lincoln, Nebraska  68510
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Stanford Cancer Center Stanford, California  94305-5824
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
Herbert D. Kerman Regional Oncology Center - Daytona Beach Daytona Beach, Florida  32114
John B. Amos Cancer Center Columbus, Georgia  31904
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Kellogg Cancer Care Center Highland Park, Illinois  60035
Cancer Care and Hematology Specialists of Chicagoland - Niles Niles, Illinois  60714
William N. Wishard Memorial Hospital Indianapolis, Indiana  46202
Michiana Hematology-Oncology, PC - South Bend Mishawaka, Indiana  46545-1470
Reid Hospital & Health Care Services Richmond, Indiana  47374
McFarland Clinic, PC Ames, Iowa  50010
Cancer Center of Kansas, PA - Chanute Chanute, Kansas  66720
Cancer Center of Kansas, PA - El Dorado El Dorado, Kansas  67042
Cancer Center of Kansas - Fort Scott Fort Scott, Kansas  66701
Cancer Center of Kansas-Independence Independence, Kansas  67301
Cancer Center of Kansas, PA - Kingman Kingman, Kansas  67068
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Liberal Liberal, Kansas  67905
Cancer Center of Kansas, PA - Newton Newton, Kansas  67114
Cancer Center of Kansas, PA - Parsons Parsons, Kansas  67357
Cancer Center of Kansas, PA - Pratt Pratt, Kansas  67124
Cancer Center of Kansas, PA - Salina Salina, Kansas  67401
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Greater Baltimore Medical Center Cancer Center Baltimore, Maryland  21204
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital - Monroe Monroe, Michigan  48162
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
Lakeside Cancer Specialists, PLLC Saint Joseph, Michigan  49085
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Saint Luke's Cancer Institute at Saint Luke's Hospital Kansas City, Missouri  64111
Research Medical Center Kansas City, Missouri  64132
Heartland Regional Medical Center Saint Joseph, Missouri  64506
Saint Joseph Oncology, Incorporated Saint Joseph, Missouri  64507
Billings Clinic - Downtown Billings, Montana  59107-7000
Great Falls Clinic - Main Facility Great Falls, Montana  59405
Sletten Cancer Institute at Benefis Healthcare Great Falls, Montana  59405
Alegant Health Cancer Center at Bergan Mercy Medical Center Omaha, Nebraska  68124
Norris Cotton Cancer Center at Catholic Medical Center Manchester, New Hampshire  03102
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center Columbus, Ohio  43210-1240
Grant Medical Center Cancer Care Columbus, Ohio  43215
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Knox Community Hospital Mount Vernon, Ohio  43050
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
St. Luke's Cancer Network at St. Luke's Hospital Bethlehem, Pennsylvania  18015
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
Susquehanna Cancer Center at Divine Providence Hospital Williamsport, Pennsylvania  17701
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Fredericksburg Oncology, Incorporated Fredericksburg, Virginia  22401
St. Joseph Cancer Center Bellingham, Washington  98225
Marshfield Clinic - Chippewa Center Chippewa Falls, Wisconsin  54729
Center for Cancer Treatment & Prevention at Sacred Heart Hospital Eau Claire, Wisconsin  54701
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center Green Bay, Wisconsin  54311
UW Cancer Center Johnson Creek Johnson Creek, Wisconsin  53038
Vince Lombardi Cancer Clinic - Marinette Marinette, Wisconsin  54143
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Marshfield Clinic - Lakeland Center Minocqua, Wisconsin  54548
Ministry Medical Group at Saint Mary's Hospital Rhinelander, Wisconsin  54501
Vince Lombardi Cancer Clinic - Sheboygan Sheboygan, Wisconsin  53081
Marshfield Clinic at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Saint Michael's Hospital Cancer Center Stevens Point, Wisconsin  54481
Aurora Medical Center Summit, Wisconsin  53066
Vince Lombardi Cancer Clinic - Two Rivers Two Rivers, Wisconsin  54241
Marshfield Clinic - Wausau Center Wausau, Wisconsin  54401
Oncology Alliance, SC - Milwaukee - West Wauwatosa, Wisconsin  53226
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Diagnostic and Treatment Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Mid Dakota Clinic, PC Bismarck, North Dakota  58501
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
John H. Stroger, Jr. Hospital of Cook County Chicago, Illinois  60612-9985
Methodist Hospital Houston, Texas  77030
St. Joseph Hospital Regional Cancer Center - Orange Orange, California  92868-3849
Enloe Cancer Center at Enloe Medical Center Chico, California  95926
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Easton Regional Cancer Center at Easton Hospital Easton, Pennsylvania  18042
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Theda Care Cancer Institute Appleton, Wisconsin  54911
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Union Hospital of Cecil County Elkton MD, Maryland  21921
Resurrection Medical Center Chicago, Illinois  60631
West Tennessee Cancer Center at Jackson-Madison County General Hospital Jackson, Tennessee  38301
Nalitt Cancer Institute at Staten Island University Hospital Staten Island, New York  10305
Providence Cancer Center Anchorage, Alaska  99508
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
University of Wisconcin Cancer Center at Aspirus Wausau Hospital Wausau, Wisconsin  54401
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Galesburg Clinic, PC Galesburg, Illinois  61401
East Bay Radiation Oncology Center Castro Valley, California  94546
Contra Costa Regional Medical Center Martinez, California  94553-3156
El Camino Hospital Cancer Center Mountain View, California  94040
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
Hawaii Medical Center - East Honolulu, Hawaii  96817
Elmhurst Memorial Hospital Elmhurst, Illinois  60126
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus Moline, Illinois  61265
Mercy General Health Partners Muskegon, Michigan  49443
Trinity CancerCare Center Minot, North Dakota  58701
St. Anthony's Cancer Center St. Louis, Missouri  63128
Medcenter One Hospital Cancer Care Center Bismarck, North Dakota  58501
St. Alexius Medical Center Cancer Center Bismarck, North Dakota  58502
Center for Cancer Care at Goshen General Hospital Goshen, Indiana  46526
St. Mary's Regional Cancer Center at St. Mary's Medical Center Huntington, West Virginia  25702
J. Phillip Citta Regional Cancer Center at Community Medical Center Toms River, New Jersey  08755
Lovelace Medical Center - Downtown Albuquerque, New Mexico  87102
Provena St. Mary's Regional Cancer Center - Kankakee Kankakee, Illinois  60901
Immanuel St. Joseph's Mankato, Minnesota  56002
Fox Valley Surgical Associates at Appleton Medical Center Appleton, Wisconsin  54911-3454
Georgia Cancer Center for Excellence at Grady Memorial Hospital Atlanta, Georgia  30303
Shore Regional Cancer Center at Memorial Hospital - Easton Easton, Maryland  21601
Minnesota Oncology - Maplewood Maplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Lakeview Hospital Stillwater, Minnesota  55082
Minnesota Oncology - Woodbury Woodbury, Minnesota  55125
Community Hospital of the Monterey Peninsula Comprehensive Cancer Center Monterey, California  93940
Emory Crawford Long Hospital Atlanta, Georgia  30308
St. Mary Regional Cancer Center at St. Mary Medical Center Walla Walla, Washington  99362
Harrison Medical Center Bremerton, Washington  98310
Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett Hospital Cooperstown, New York  13326
CCOP - Kansas City Prairie Village, Kansas  66208
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
California Cancer Care, Incorporated - Greenbrae Greenbrae, California  94904
Norwalk Hospital Norwalk, Connecticut  06856
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Langlade Memorial Hospital Antigo, Wisconsin  54409
Lakeside Hospital Omaha, Nebraska  68130
University of New Mexico Cancer Center - South Las Cruces, New Mexico  88011
Riverview UW Cancer Center at Riverview Hospital Wisconsin Rapids, Wisconsin  54494
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
New Ulm Medical Center New Ulm, Minnesota  56073
St. Nicholas Hospital Sheboygan, Wisconsin  53081
Dyson Center for Cancer Care at Vassar Brothers Medical Center Poughkeepsie, New York  12601-3990
Saint Luke's Mountain States Tumor Institute Boise, Idaho  83712
Southern Ohio Medical Center Cancer Center Portsmouth, Ohio  45662
Baylor Medical Center at Irving Irving, Texas  75061
Kuakini Medical Center Honolulu, Hawaii  96817
Saint Luke's Mountain States Tumor Institute - Fruitland Fruitland, Idaho  83619
Mountain States Tumor Institute - Meridian Meridian, Idaho  83642
Mountain States Tumor Institute at St. Luke's Twin Falls, Idaho  83301
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331
Charles A. & Betty Bott Cancer Center at Holy Redeemer Hospital Meadowbrook, Pennsylvania  19046
Spectrum Health Reed City Hospital Reed City, Michigan  49677
Cancer Center of Kansas, PA - McPherson McPherson, Kansas  67460
Dickstein Cancer Treatment Center at White Plains Hospital Center White Plains, New York  10601
Mercy Clinic Cancer and Hematology - Rolla Rolla, Missouri  65401
Leeward Radiation Oncology Ewa Beach, Hawaii  96706
Radiation Oncology Center at Kennedy Health System - Sewell Sewell, New Jersey  08080