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A Phase III Trial of Accelerated Whole Breast Irradiation With Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Breast Cancer

Thank you

Trial Information

A Phase III Trial of Accelerated Whole Breast Irradiation With Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer


OBJECTIVES:

Primary

- To determine whether an accelerated course of hypofractionated whole-breast irradiation
(WBI) including a concomitant boost to the tumor bed in 15 fractions following
lumpectomy will prove to be non-inferior in local control to a regimen of standard WBI
with a sequential boost following lumpectomy for early-stage breast cancer patients.

Secondary

- To determine whether breast-related symptoms and cosmesis from accelerated WBI that is
hypofractionated (in only 3 weeks) with a concomitant boost is non-inferior to standard
WBI with sequential boost.

- To determine whether the risk of late cardiac toxicity in patients with left-sided
breast cancer treated with hypofractionation will be non-inferior to conventional
fractionated radiation therapy (RT) based upon analysis of radiation dosimetry from
CT-based treatment planning and NTCP calculations.

- To determine whether CT-based conformal methods intensity-modulated radiation therapy
(IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for WBI are feasible in a
multi-institutional setting following lumpectomy in early-stage breast cancer patients
and whether dose-volume analyses can be established to assess treatment adequacy and
likelihood of toxicity.

- To determine that cosmetic results and breast-related symptoms 3 years after
hypofractionated breast radiation with concomitant boost will not be inferior to that
obtained 3 years after WBI with sequential boost.

- To determine whether future correlative studies can identify individual gene
expressions and biological host factors associated with toxicity and/or local
recurrence from standard and hypofractionated WBI.

- If shown to be non-inferior, to then determine if accelerated course of
hypofractionated WBI including a concomitant boost to the tumor bed in 15 fractions
following lumpectomy will prove to be superior in local control to a regimen of
standard WBI with a sequential boost following lumpectomy for early-stage breast cancer
patients.

- To determine whether treatment costs for hypofractionated WBI with concomitant boost
are not higher than WBI with sequential boost.

OUTLINE: This is a multicenter study. Patients are stratified according to age (< 50 vs. ≥
50 years), prior chemotherapy (yes vs. no), estrogen-receptor status (+ vs. -), and
histology grade (1-2 vs. 3). Patients are randomized to 1 of 2 treatment arms. Treatment
begins within 9 weeks of last surgery or chemotherapy delivery.

- Arm I: Patients undergo standard whole-breast radiotherapy (WBI) comprising
intensity-modulated radiation therapy (IMRT) or three-dimensional conformal
radiotherapy (3D-CRT) 5 days a week for 3-5 weeks followed by a sequential radiotherapy
boost to the lumpectomy area 5 days a week for 1-1½ weeks. Treatment continues in the
absence of disease progression or unacceptable toxicity.

- Arm II: Patients undergo accelerated hypofractionated WBI comprising IMRT or 3D-CRT
with a concurrent boost to the lumpectomy area 5 days a week for 3 weeks. Treatment
continues in the absence of disease progression or unacceptable toxicity.

Patients' tissue samples may be collected for future research studies.

After completion of study therapy, patients are followed at 1 month, at 6 months, and then
yearly.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Pathologically proven diagnosis of breast cancer resected by lumpectomy and
whole-breast irradiation (WBI) with boost without regional nodal irradiation planned

- Must meet one of the following three criteria:

- pStage I or II breast cancer AND at least one of the following:

- Age < 50 years or

- Positive axillary nodes or

- Lymphovascular space invasion (LVI) or

- At least 2 close resection margins (> 0 mm to ≤ 2 mm) or

- One close resection margin and extensive in-situ component (EIC) or

- Focally positive resection margins or

- Non-hormone-sensitive breast cancer (estrogen and progesterone receptor
negative (ER- and PR-) or

- Grade III histology or

- Oncotype recurrence score > 25 or

- pStage 0 breast cancer with nuclear grade 3 ductal carcinoma in situ (DCIS) and
patient age < 50 years or

- If multifocal breast cancer, then it must have been resected through a single
lumpectomy incision with negative margins

- Breast-conserving surgery with margins defined as follows:

- Negative margins defined as no tumor at the resected specimen edge

- Close resection margins > 0 mm to ≤ 2 mm as follows:

- One close resection margin and EIC

- Two or more close resection margins

- A focally positive resection margin

- Allowable options for mandatory axillary staging include:

- Sentinel node biopsy alone (if sentinel node is negative, pN0, pN0[IHC-,+])

- Sentinel node biopsy alone, OR followed by axillary node dissection, for
clinically node-negative patients as described below:

- Microscopic sentinel node (SN) positive (pN1mic)

- One or two SNs positive (pN1) without extracapsular extension

- Negative SN biopsy after neoadjuvant chemotherapy

- Axillary node dissection is required following SN biopsy with a minimum total of
6 axillary nodes if any of the following exist:

- For > 2 positive SN

- Any positive SN biopsy after neoadjuvant chemotherapy

- For clinically (by either imaging or examination) T3 disease

- For extracapsular extension

- Axillary dissection alone (with a minimum of 6 axillary nodes)

- CT-imaging of the ipsilateral breast within 28 days of study entry for the radiation
treatment planning.

- Must be able to delineate on CT scan the extent of the target lumpectomy cavity
for boost (placement of surgical clips to assist in treatment planning of the
boost is strongly recommended)

- No clinical evidence for distant metastases, based upon the following minimum
diagnostic workup:

- History/physical examination, including breast exam (inspection and palpation of
the breasts) and documentation of weight and Zubrod Performance Status of 0-2
within 28 days prior to study entry

- Bilateral or right and left mammography within 90 days prior to neoadjuvant
chemotherapy, or diagnostic biopsy establishing diagnosis, or last surgery
(breast or axilla)

- No prior invasive or in-situ carcinoma of the breast (prior LCIS is eligible)

- No American Joint Committee on Cancer (AJCC) pathologic T4, N2 or N3, or M1 breast
cancer

- Must not have two or more breast cancers that are not resectable through a single
lumpectomy incision

- Must not be DCIS and ≥ 50 years old

- Must not be DCIS < 50 years old, and nuclear, grade 1-2

- No suspicious unresected microcalcification, densities, or palpable abnormalities (in
the ipsilateral or contralateral breast) unless biopsied and found to be benign

- No non-epithelial breast malignancies such as sarcoma or lymphoma

- No Paget disease of the nipple

- No male breast cancer

- Breast implants allowed

PATIENT CHARACTERISTICS:

- ANC ≥ 1,800/mm³

- Platelet count ≥ 75,000/mm³

- Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve Hgb ≥ 8.0 g/dL is
acceptable)

- Negative serum pregnancy test within 14 days of study entry

- Women of childbearing potential must not be pregnant or nursing and willing to use
medically acceptable form of contraception during radiotherapy

- No prior invasive non-breast malignancy (except non-melanomatous skin cancer or
carcinoma in situ of the cervix) unless disease free for a minimum of 5 years prior
to study entry

- No severely active co-morbidity, defined as follows:

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

- Transmural myocardial infarction within the past 6 months

- Acute bacterial or fungal infection requiring intravenous antibiotics at the
time of registration

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy within 30 days before
registration

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
note, however, that laboratory tests for liver function and coagulation
parameters are not required for entry into this protocol

- Acquired Immune-Deficiency Syndrome (AIDS) based upon current CDC definition

- HIV testing is not required for entry into this protocol

- No active systemic lupus, erythematosus, or any history of scleroderma or
dermatomyositis with active rash

- Medical, psychiatric, or other condition that would prevent the patient from
receiving the protocol therapy or providing informed consent

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Study entry must be within 50 days of last breast/axillary surgery and/or last
chemotherapy

- No treatment plan that includes regional-node radiotherapy

- No prior radiotherapy to the breast or prior radiation to the region of the
ipsilateral breast that would result in overlap of radiation therapy fields

- No intention to administer concurrent chemotherapy for current breast cancer

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Local control

Outcome Time Frame:

From randomization to the date of first local failure or last follow-up. Analysis occurs after 245 local failures have been reported.

Safety Issue:

No

Principal Investigator

Frank Vicini, MD, FACR

Investigator Role:

Principal Investigator

Investigator Affiliation:

William Beaumont Hospital - Royal Oak Campus

Authority:

United States: Federal Government

Study ID:

RTOG 1005

NCT ID:

NCT01349322

Start Date:

May 2011

Completion Date:

Related Keywords:

  • Breast Cancer
  • stage IA breast cancer
  • stage IB breast cancer
  • stage II breast cancer
  • estrogen receptor-negative breast cancer
  • estrogen receptor-positive breast cancer
  • progesterone receptor-negative breast cancer
  • progesterone receptor-positive breast cancer
  • ductal breast carcinoma in situ
  • Breast Neoplasms

Name

Location

Memorial Sloan Kettering Cancer Center New York, New York  10021
Cleveland Clinic Foundation Cleveland, Ohio  44195
Roswell Park Cancer Institute Buffalo, New York  14263
Mayo Clinic Rochester, Minnesota  55905
H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida  33612
Washington University School of Medicine Saint Louis, Missouri  63110
Abington Memorial Hospital Abington, Pennsylvania  19001
Medical University of South Carolina Charleston, South Carolina  29425-0721
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Avera Cancer Institute Sioux Falls, South Dakota  57105
Loyola University Medical Center Maywood, Illinois  60153
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
CentraCare Clinic Saint Cloud, Minnesota  56303
Rapid City Regional Hospital Rapid City, South Dakota  57709
Morristown Memorial Hospital Morristown, New Jersey  07962-1956
Henry Ford Hospital Detroit, Michigan  48202
University of Florida Health Science Center Gainesville, Florida  32610-0296
Community Medical Center Toms River, New Jersey  08755
Akron General Medical Center Akron, Ohio  44302
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
York Hospital York, Pennsylvania  17315
Community Memorial Hospital Menomonee Falls, Wisconsin  53051
Waukesha Memorial Hospital Waukesha, Wisconsin  53188
Cedars-Sinai Medical Center Los Angeles, California  90048
University of Kansas Medical Center Kansas City, Kansas  66160-7353
Boston Medical Center Boston, Massachusetts  02118
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
Illinois Masonic Medical Center Chicago, Illinois  60657
Staten Island University Hospital Staten Island, New York  10305
Peninsula Regional Medical Center Salisbury, Maryland  21801
William Beaumont Hospital Royal Oak, Michigan  48073
Monmouth Medical Center Long Branch, New Jersey  07740-6395
Kaiser Permanente Medical Center - Santa Clara Santa Clara, California  95051-5386
University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma  73104
Inova Fairfax Hospital Falls Church, Virginia  22042-3300
Iowa Methodist Medical Center Des Moines, Iowa  50309
New Hanover Regional Medical Center Wilmington, North Carolina  28402-9025
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
Long Island Jewish Medical Center New Hyde Park, New York  11040
Saint Peter's University Hospital New Brunswick, New Jersey  08901-1780
Parma Community General Hospital Parma, Ohio  44129
Adena Regional Medical Center Chillicothe, Ohio  54601
Logan Regional Hospital Logan, Utah  84321
McKay-Dee Hospital Center Ogden, Utah  84403
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
Piedmont Hospital Atlanta, Georgia  30309
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Mary Imogene Bassett Hospital Cooperstown, New York  13326
Altru Cancer Center Grand Forks, North Dakota  58206
Lancaster General Hospital Lancaster, Pennsylvania  17604-3555
Saint Luke's Hospital Chesterfield, Missouri  63017
Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
UW Cancer Center Johnson Creek Johnson Creek, Wisconsin  53038
Singing River Hospital Pascagoula, Mississippi  39581
Lowell General Hospital Lowell, Massachusetts  01854
Providence Medford Medical Center Medford, Oregon  97504
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Mayo Clinic in Arizona Scottsdale, Arizona  85259-5404
Mayo Clinic in Florida Jacksonville, Florida  32224
Washington Hospital Center Washington, District of Columbia  20010
City of Hope Duarte, California  91010
Queen's Medical Center Honolulu, Hawaii  96813
Solano Radiation Oncology Center Vacaville, California  95687
University of Alabama at Birmingham Birmingham, Alabama  35294-3300
Cancer Care Northwest Spokane, Washington  99202
Duke University Medical Center Durham, North Carolina  27710
Willamette Valley Cancer Center Eugene, Oregon  97401-8122
University of Florida Gainesville, Florida  32610-0277
University of Rochester Rochester, New York  14642
Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Hospital of the University of Pennsylvania Philadelphia, Pennsylvania  19104
Case Western Reserve University Cleveland, Ohio  44106
Emory University Atlanta, Georgia  30322
Wayne State University Detroit, Michigan  48202
Ohio State University Medical Center Columbus, Ohio  43210
University of Arizona Health Sciences Center Tucson, Arizona  85724
Saint Mary's Regional Medical Center Reno, Nevada  89503
Providence Portland Medical Center Portland, Oregon  97213-3635
Dartmouth Hitchcock Medical Center Lebanon, New Hampshire  03756
Indiana University Medical Center Indianapolis, Indiana  46202
University of Texas Southwestern Medical Center Dallas, Texas  
University of Kentucky Lexington, Kentucky  40536-0098
Virginia Mason CCOP Seattle, Washington  98101
Huntsman Cancer Institute/University of Utah Salt Lake City, Utah  84112
University of New Mexico Albuquerque, New Mexico  87131
UC Davis Comprehensive Cancer Center Sacramento, California  95817
Appleton Medical Center Appleton, Wisconsin  54911
Thomas Jefferson University Hospital Philadelphia, Pennsylvania  19131
Jersey Shore Medical Center Neptune, New Jersey  07754
Decatur Memorial Hospital Decatur, Illinois  62526
Tulane University Health Sciences Center New Orleans, Louisiana  70112
West Texas Cancer Center Odessa, Texas  79761
Virginia Commonwealth University Richmond, Virginia  
Lankenau Hospital Wynnewood, Pennsylvania  19096
Santa Clara Valley Medical Center San Jose, California  95128
Memorial Health University Medical Center Savannah, Georgia  31404
Hillcrest Hospital Cancer Center Mayfield Heights, Ohio  44124
Hudson Valley Oncology Associates Poughkeepsie, New York  12601
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
University of Southern California Los Angeles, California  90033
Inova Alexandria Hospital Alexandria, Virginia  22304
Rohnert Park Cancer Center Rohnert Park, California  94928
University of Cincinnati Cincinnati, Ohio  45267-0502
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Northside Hospital Atlanta, Georgia  30342
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Edna Williams Cancer Center at the Baptist Cancer Institute Jacksonville, Florida  32207
M D Anderson Cancer Center- Orlando Orlando, Florida  32806
Saint Joseph's-Candler Health System Savannah, Georgia  31405
Community Cancer Center Foundation Normal, Illinois  61761
Finley Hospital Dubuque, Iowa  52001
Stormont-Vail Regional Health Center Topeka, Kansas  66604
North Shore Medical Center Cancer Center Peabody, Massachusetts  01960
Saint Mary's Health Care Grand Rapids, Michigan  49503
Northern Michigan Regional Hospital Petoskey, Michigan  49770
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Miller-Dwan Hospital Duluth, Minnesota  55805
Billings Clinic Billings, Montana  59107-7000
Ocean Medical Center Brick, New Jersey  08724
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County Mount Holly, New Jersey  08060
Sparta Cancer Treatment Center Sparta, New Jersey  07871
Virtua West Jersey Hospital Voorhees Voorhees, New Jersey  08043
Memorial Medical Center - Las Cruces Las Cruces, New Mexico  88011
Columbia University Medical Center New York, New York  10032
Highland Hospital Rochester, New York  14620
Summa Barberton Hospital Barberton, Ohio  44203
Cleveland Clinic Cancer Center Independence Independence, Ohio  44131
North Coast Cancer Care Sandusky, Ohio  44870
Natalie W Bryant Cancer Center Tulsa, Oklahoma  74136
Pocono Medical Center East Stroudsburg, Pennsylvania  18301
Saint Joseph Medical Center Reading, Pennsylvania  19605
Greenville CCOP Greenville, South Carolina  29615
Saint Francis Hospital Federal Way, Washington  98003
Edwards Comprehensive Cancer Center Huntington, West Virginia  25701
West Virginia University Morgantown, West Virginia  26506
Wheeling Hospital Wheeling, West Virginia  26003
Central Wisconsin Cancer Program Fond Du Lac, Wisconsin  54935
Saint Vincent Hospital Green Bay, Wisconsin  54301
Saint Mary's Hospital Green Bay, Wisconsin  54303
Bay Area Medical Center Marinette, Wisconsin  54143
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Radiological Associates of Sacramento Sacramento, California  95816
Lake University Ireland Cancer Center Mentor, Ohio  44060
The Nebraska Medical Center Omaha, Nebraska  68198
Henry Ford Macomb Hospital Clinton Township, Michigan  48038
Kansas City Cancer Centers - North Kansas City, Missouri  64154
Baylor Medical Center at Irving Irving, Texas  75061
Stony Brook University Medical Center Stony Brook, New York  11794
Moores University of California San Diego Cancer Center LA Jolla, California  92093
University of Colorado Cancer Center - Anschutz Cancer Pavilion Aurora, Colorado  80045
Saint Agnes Hospital Baltimore, Maryland  21229
Renown Regional Medical Center Reno, Nevada  89502
The Regional Cancer Center Erie, Pennsylvania  16505
Saint Mary Medical and Regional Cancer Center Langhorne, Pennsylvania  19047
Cancer Centers of the Carolinas - Faris Greenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Radiation Oncology Greer, South Carolina  29650
Texas Oncology - Round Rock Cancer Center Round Rock, Texas  78681
Intermountain Medical Center Murray, Utah  84157
Dixie Medical Center Regional Cancer Center Saint George, Utah  84770
Skagit Valley Hospital Mt. Vernon, Washington  98273
Wheaton Franciscan Cancer Care - All Saints Racine, Wisconsin  53405
Vince Lombardi Cancer Clinic-Sheboygan Sheboygan, Wisconsin  53081
Aurora Medical Center in Summit Summit, Wisconsin  53066
Texas Cancer Center-Sherman Sherman, Texas  75090
Kansas City Cancer Centers-Southwest Overland Park, Kansas  66210
University of Miami Miller School of Medicine-Sylvester Cancer Center Miami, Florida  33136
Grady Health System Atlanta, Georgia  30303
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331
Kaiser Permanente Oakland-Broadway Oakland, California  94611
Kaiser Permanente-Rancho Cordova Cancer Center Rancho Cardova, California  95670
The Permanente Medical Group-Roseville Radiation Oncology Roseville, California  95678
Kaiser Permanente Radiation Oncology Cancer Treatment Center Santa Clara, California  95051
Kaiser Permanente Cancer Treatment Center South San Francisco, California  94080
Central DuPage Hospital Cancer Center Warrenville, Illinois  60555
Saint John's Health System Cancer Center Anderson, Indiana  46016
Kansas City CCOP Prairie Village, Kansas  66208
Owensboro Mercy Medical Center Owensboro, Kentucky  42303
Kansas City Cancer Center - South Kansas City, Missouri  64131
Kansas City Cancer Center-Lee's Summit Lee's Summit, Missouri  64064
The Christ Hospital Cincinnati, Ohio  45219
UHHS-Chagrin Highlands Medical Center Orange Village, Ohio  44122
UHHS-Westlake Medical Center Westlake, Ohio  44145
Gundersen Lutheran La Crosse, Wisconsin  54601
New York Oncology Hematology PC - Albany Albany, New York  12206
Lexington Medical Center West Columbia, South Carolina  29169
Community Regional Cancer Care-East Radiation Oncology Indianapolis, Indiana  46219
Community Regional Cancer Care-North Indianapolis, Indiana  46256
New Hanover Radiation Oncology Center Wilmington, North Carolina  28401
Robinson Radiation Oncology Ravenna, Ohio  44266
Los Angeles County-USC Medical Center Los Angeles, California  90033
Aurora Saint Luke's Medical Center Milwaukee, Wisconsin  53215
Northside Hospital-Forsyth Cumming, Georgia  30041
Beloit Memorial Hospital Beloit, Wisconsin  53511
Aurora West Allis Medical Center West Allis, Wisconsin  53227
Texas Oncology - Lewisville Lewisville, Texas  75067
The Kirklin Clinic at Acton Road Birmingham, Alabama  35243
Enloe Medical Center Chico, California  95926
Carle Foundation - Carle Cancer Center Urbana, Illinois  61801
Michiana Hematology Oncology PC-Mishawaka Mishawaka, Indiana  46545-1470
Hematology Oncology Associates of Central New York PC East Syracuse, New York  13057
Texas Oncology-Wichita Falls Texoma Cancer Center Wichita Fall, Texas  76310
Summa Akron City Hospital Akron, Ohio  44304
Barnes West County Hospital Saint Louis, Missouri  63141
Siteman Cancer Center - Saint Peters Saint Peters, Missouri  63376
Door County Cancer Center Sturgeon Bay, Wisconsin  54235-1495
Indiana University Health Goshen Center For Cancer Care Goshen, Indiana  46526
Texas Oncology-Arlington South Arlington, Texas  76014
South Atlantic Radiation Oncology Supply, North Carolina  28462
City of Hope- South Pasadena Cancer Center South Pasadena, California  91030
Texas Oncology-Denton South Denton, Texas  76210
North Shore-LIJ Health System CCOP Manhasset, New York  11030
Riverview Medical Center/Booker Cancer Center Red Bank, New Jersey  07701
Cleveland Clinic Cancer Center/Fairview Hospital Cleveland, Ohio  44111
Cancer Specialists of North Florida-Baptist South Jascksonville, Florida  32258
Cancer Specialists of North Florida-Putnam Palatka, Florida  32177
Cancer Specialists of North Florida-Saint Augustine Saint Augustine, Florida  32086
IU Health Methodist Hospital Indianapolis, Indiana  46202
Memorial Sloan-Kettering Cancer Center at Suffolk Commack, New York  11725
Mayo Clinic Health System-Franciscan Healthcare La Crosse, Wisconsin  54601
Auburn Radiation Oncology Center Auburn, California  95603
Marshall Radiation Oncology Center Cameron Park, California  95682
Mercy San Juan Medical Center Carmichael, California  95608
Roseville Radiation Oncology Center Roseville, California  95661
Norris Cotton Cancer Center-North Saint Johnsbury, Vermont  05819
IU Health Ball Memorial Hospital Muncie, Indiana  47303
Rockingham Memorial Hospital Hahn Cancer Center Harrisonburg, Virginia  22801
Holy Redeemer Hospital and Medical Center Meadowbrook, Pennsylvania  19046
Cleveland Clinic Cancer Center-Strongsville Strongsville, Ohio  44136
Capital Health Medical Center-Hopewell Pennington, New Jersey  08534
Cape Radiation Oncology Cape Girardeau, Missouri  63703
LC Ferguson Cancer Center Freeport, Illinois  61032
Memorial Sloan Kettering Cancer Center at Basking Ridge Basking Ridge, New Jersey  07920
Memorial Sloan-Kettering Cancer Center Rockville Centre Rockville Centre, New York  11570
Memorial Sloan-Kettering Cancer Center at Phelps Sleepy Hollow, New York  10591
Arizona Oncology Associates-West Orange Grove Tucson, Arizona  85704
University Radiation Oncology Rochester, New York  14626
Texas Oncology PA - Bedford Bedford, Texas  76022
The Klabzuba Cancer Center Fort Worth, Texas  76104
Texas Oncology Cancer Center Sugar Land Sugar Land, Texas  77479
Central Maryland Radiation Oncology in Howard County Columbia, Maryland  21044
Saint John's Hospital Springfield, Illinois  62702
Cancer Care Centers of South Texas- Northeast San Antonio, Texas  78217
Radiation Oncology Centers of Las Vegas - Tonopah Las Vegas, Nevada  89106
Saint Peters Hospital-Albany Albany, New York  12208
21st Century Oncology-Scottsdale Scottsdale, Arizona  85251
John Fitzgerald Kennedy Medical Center Atlantis, Florida  33462
University of Miami Sylvester Comprehensive Cancer Center at Deerfield Beach Deerfield Beach, Florida  33442
IU Health West Avon, Indiana  46123
Tate Cancer Center Glen Burnie, Maryland  21061
21st Century Oncology-Farmington Hills Farmington Hills, Michigan  48334
Cayuga Medical Center Ithaca, New York  14850
The Coleman Radiation Center-Carteret General Hospital Morehead City, North Carolina  28557
CarolinaEast Health System-Medical Center New Bern, North Carolina  28560
The Radiation Oncology Center-Hilton Head/Bluffton Hilton Head Island, South Carolina  29926
Memorial Hermann Memorial City Medical Center Houston, Texas  77024
Augusta Health Cancer Center Fishersville, Virginia  22939