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A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) Versus Partial Breast Irradiation (PBI) for Women With Stage 0, I, or II Breast Cancer


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

Thank you

Trial Information

A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) Versus Partial Breast Irradiation (PBI) for Women With Stage 0, I, or II Breast Cancer


OBJECTIVES:

Primary

- Compare local tumor control in women with ductal carcinoma in situ or stage I or II
breast cancer treated with adjuvant whole breast vs partial breast irradiation
following lumpectomy.

Secondary

- Compare overall survival, recurrence-free survival, and distant disease-free survival
in patients treated with these regimens.

- Compare the cosmetic result in patients treated with these regimens.

- Compare fatigue and treatment-related symptoms in patients treated with these regimens.

- Compare perceived convenience of care in patients treated with these regimens.

- Compare acute and late toxic effects of these regimens in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
disease stage (ductal carcinoma in situ [DCIS] only vs invasive and node negative vs
invasive with 1-3 positive nodes), menopausal status (premenopausal vs postmenopausal),
hormone receptor status (estrogen receptor [ER]-positive and/or progesterone receptor
[PR]-positive vs ER-negative and PR-negative), intention to receive chemotherapy (yes vs
no). Patients are randomized to 1 of 2 treatment arms. (Patients who are 50 years of age and
over with DCIS regardless of hormone receptor status AND patients with invasive breast
cancer meeting all of the following criteria: ≥ 50 years of age, node-negative, and
hormone-receptor positive status will not be enrolled in study after 12/30/2006.)

- Arm I: Patients undergo whole-breast irradiation (WBI) once daily, 5 days a week, for
5-7 weeks.

- Arm II: Patients undergo partial-breast irradiation (PBI) twice daily on 5 days over a
period of 5-10 days. This may be delivered by intracavitary brachytherapy or 3-D
conformal radiotherapy.

Patients in both arms may receive adjuvant chemotherapy at least 2 weeks prior to initiation
of WBI OR at least 2 weeks after completion of PBI at the discretion of the treating
physician. Patients with ER-positive or PR-positive tumors may also receive hormonal
therapy, beginning 3-12 weeks after completion of adjuvant chemotherapy (or before, during,
or after completion of WBI or PBI for patients not receiving adjuvant chemotherapy) and
continuing for at least 5 years.

After completion of study treatment, patients are followed at 1 and 6 months, every 6 months
for 4.5 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 4,300 patients (2,150 per treatment arm) will be accrued for
this study within 4.6 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed ductal carcinoma in situ (DCIS*) or invasive* adenocarcinoma
of the breast

- Stage 0, I, or II disease

- Stage II tumors must be ≤ 3 cm

- Gross disease must be unifocal

- Microscopic multifocality allowed provided total pathological tumor size is
≤ 3 cm

- No proven multicentric carcinoma in more than 1 quadrant or separated by ≥ 4 cm

- No non-epithelial breast malignancies (e.g., sarcoma or lymphoma) NOTE:
*Patients who are 50 years of age and over with DCIS regardless of hormone
receptor status AND patients with invasive breast cancer meeting all of the
following criteria: ≥ 50 years of age, node-negative, and hormone-receptor
positive status will not be enrolled in study after 12/30/2006

- Prior axillary staging required for patients with invasive breast cancer, including 1
of the following:

- Sentinel node biopsy alone (if sentinel node is negative)

- Sentinel node biopsy followed by axillary dissection or sampling with ≥ 6
axillary nodes (if sentinel node is positive)

- Axillary dissection alone with ≥ 6 axillary nodes

- No more than 3 positive axillary nodes

- No axillary nodes with definite evidence of microscopic or macroscopic
extracapsular extension

- No positive non-axillary sentinel nodes (intramammary nodes are staged as
axillary nodes)

- No palpable or radiographically suspicious ipsilateral or contralateral
axillary, supraclavicular, infraclavicular, or internal mammary nodes unless
there is histologic confirmation that these nodes are negative for tumor

- Must have undergone lumpectomy

- Resected margins histologically free of tumor

- Re-excision of surgical margins allowed

- Target lumpectomy cavity clearly delineated AND target lumpectomy/whole breast
reference volume ≤ 30% based on postoperative pre-randomization CT scan

- Final surgery (i.e., lumpectomy, re-excision of margins, or axillary staging
procedure) within the past 42 days

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

- No Paget's disease of the nipple

- No history of invasive breast cancer or DCIS

- Prior lobular carcinoma in situ treated by surgery alone allowed

- No synchronous bilateral invasive or non-invasive breast cancer

- Partial breast irradiation deemed technically deliverable by radiation oncologist at
a credentialed facility

- Must have undergone a history and physical exam within the past 4 months AND a
bilateral mammogram within the past 6 months

- Hormone receptor status:

- Estrogen receptor (ER) status known

- Progesterone status known if ER analysis is negative

- Marginal or borderline results are considered positive

PATIENT CHARACTERISTICS:

Age

- 18 and over

Sex

- Female

Menopausal status

- Premenopausal or postmenopausal

Performance status

- Not specified

Life expectancy

- At least 10 years, excluding diagnosis of breast cancer

Hematopoietic

- Not specified

Hepatic

- Not specified

Renal

- Not specified

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective non-hormonal contraception

- No other malignancy within the past 5 years except previously treated carcinoma in
situ of the cervix or colon, melanoma in situ, or basal cell or squamous cell skin
cancer

- Deemed to be at low risk for recurrence

- No collagen vascular disease (e.g., systemic lupus erythematosus or scleroderma),
specifically dermatomyositis with a CPK level above normal, or active skin rash

- No psychiatric or addictive disorder that would preclude study therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No prior biologic therapy for this malignancy

Chemotherapy

- No prior chemotherapy for this malignancy

- No concurrent chemotherapy during study radiotherapy

Endocrine therapy

- No prior hormonal therapy for this malignancy unless total duration of hormonal
therapy was no more than 28 days before randomization

- Concurrent hormonal therapy allowed provided it is not administered during
chemotherapy

- No concurrent raloxifene, tamoxifen, or other selective estrogen receptor modulating
drugs

- No concurrent hormone replacement therapy

- No concurrent Femring^®

Radiotherapy

- No prior radiotherapy for this malignancy

- No prior breast or thoracic radiotherapy

- No concurrent brachytherapy boosts

- No concurrent intensity modulated radiotherapy

- No concurrent regional nodal irradiation

Surgery

- See Disease Characteristics

- No prior breast implants

- Patients who have had implants removed are eligible

Other

- No other concurrent anticancer therapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

In-breast tumor recurr. (IBTR) at event occurrence, every 6 mo. for 5 yrs; after 175 IBTR events are obs'd at approx. 10 yrs after study init.; after a spec. no. of events are observed at approx. 4.1 yrs after study init.; and annually thereafter

Safety Issue:

No

Principal Investigator

Frank Vicini, MD, FACR

Investigator Role:

Study Chair

Investigator Affiliation:

William Beaumont Hospital - Royal Oak Campus

Authority:

Unspecified

Study ID:

CDR0000409590

NCT ID:

NCT00103181

Start Date:

March 2005

Completion Date:

Related Keywords:

  • Breast Cancer
  • stage II breast cancer
  • ductal breast carcinoma in situ
  • breast cancer in situ
  • stage IA breast cancer
  • stage IB breast cancer
  • Breast Neoplasms
  • Carcinoma in Situ
  • Carcinoma, Intraductal, Noninfiltrating

Name

Location

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
Barbara Ann Karmanos Cancer Institute Detroit, Michigan  48201
Cleveland Clinic Cancer Center Cleveland, Ohio  44195
University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
CCOP - Atlanta Regional Atlanta, Georgia  30342-1701
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
CCOP - North Shore University Hospital Manhasset, New York  11030
CCOP - Illinois Oncology Research Association Peoria, Illinois  61602
CCOP - Carle Cancer Center Urbana, Illinois  61801
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
Porter Adventist Hospital Denver, Colorado  80210
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
Rush-Copley Cancer Care Center Aurora, Illinois  60507
Methodist Cancer Center at Methodist Hospital Indianapolis, Indiana  46202
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
St. John Macomb Hospital Warren, Michigan  48093
MeritCare Bemidji Bemidji, Minnesota  56601
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
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital Minneapolis, Minnesota  55407
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
MeritCare Broadway Fargo, North Dakota  58122
Aultman Cancer Center at Aultman Hospital Canton, Ohio  44710-1799
Case Comprehensive Cancer Center Cleveland, Ohio  44106-5065
St. Rita's Medical Center Lima, Ohio  45801
Natalie Warren Bryant Cancer Center at St. Francis Hospital Tulsa, Oklahoma  74136
Drexel University College of Medicine - Center City Hahnemann Campus Philadelphia, Pennsylvania  19102
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
Sanford Cancer Center at Sanford USD Medical Center Sioux Falls, South Dakota  57117-5039
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
Dean Medical Center - Madison Madison, Wisconsin  53717
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
CCOP - Ochsner New Orleans, Louisiana  70121
Rapid City Regional Hospital Rapid City, South Dakota  57709
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Bridgeport Hospital Bridgeport, Connecticut  06610
Methodist Medical Center of Illinois Peoria, Illinois  61636
Memorial Hospital of South Bend South Bend, Indiana  46601
Cape Cod Hospital Hyannis, Massachusetts  02601
Newark Beth Israel Medical Center Newark, New Jersey  07112
CCOP - Columbus Columbus, Ohio  43206
Joe Arrington Cancer Research and Treatment Center Lubbock, Texas  79410-1894
LDS Hospital Salt Lake City, Utah  84143
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
CCOP - Grand Rapids Grand Rapids, Michigan  49503
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
CCOP - Columbia River Oncology Program Portland, Oregon  97225
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
Kaiser Permanente Medical Center - Vallejo Vallejo, California  94589
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
Peninsula Regional Medical Center Salisbury, Maryland  21801
Vince Lombardi Cancer Clinic at Aurora St. Luke's Medical Center Milwaukee, Wisconsin  53201-2901
Rebecca and John Moores UCSD Cancer Center La Jolla, California  92093-0658
University of California Davis Cancer Center Sacramento, California  95817
City of Hope Comprehensive Cancer Center Duarte, California  91010
Queens Cancer Center of Queens Hospital Jamaica, New York  11432
Fletcher Allen Health Care - University Health Center Campus Burlington, Vermont  05401
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Thompson Cancer Survival Center Knoxville, Tennessee  37916
James Graham Brown Cancer Center at University of Louisville Louisville, Kentucky  40202
Blumenthal Cancer Center at Carolinas Medical Center Charlotte, North Carolina  28232-2861
Northside Hospital Cancer Center Atlanta, Georgia  30342-1611
Washington Cancer Institute at Washington Hospital Center Washington, District of Columbia  20010
Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center Baltimore, Maryland  21237
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
Central Baptist Hospital Lexington, Kentucky  40503
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
Long Island Jewish Medical Center New Hyde Park, New York  11040
Yale Cancer Center New Haven, Connecticut  06520-8028
University of Florida Shands Cancer Center Gainesville, Florida  32610-0232
St. Vincent Indianapolis Hospital Indianapolis, Indiana  46260
Breslin Cancer Center at Ingham Regional Medical Center Lansing, Michigan  48910
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Presbyterian Cancer Center at Presbyterian Hospital Charlotte, North Carolina  28233-3549
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Rhode Island Hospital Comprehensive Cancer Center Providence, Rhode Island  02903
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
Naval Medical Center - Portsmouth Portsmouth, Virginia  23708-2197
Providence Cancer Center at Sacred Heart Medical Center Spokane, Washington  99220-2555
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
Lahey Clinic Medical Center - Burlington Burlington, Massachusetts  01805
Saint Peter's University Hospital New Brunswick, New Jersey  08901-1780
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
CCOP - Hematology-Oncology Associates of Central New York East Syracuse, New York  13057
Mount Nittany Medical Center State College, Pennsylvania  16803
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
Battle Creek Health System Cancer Care Center Battle Creek, Michigan  49017
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Missoula, Montana  59802
Community Hospital of Springfield and Clark County Springfield, Ohio  45505
Utah Cancer Specialists at UCS Cancer Center Salt Lake City, Utah  84106
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
Jonsson Comprehensive Cancer Center at UCLA Los Angeles, California  90095-1781
Mountain States Tumor Institute at St. Luke's Regional Medical Center Boise, Idaho  83712-6297
Advocate Lutheran General Cancer Care Center Park Ridge, Illinois  60068-1174
Lucille P. Markey Cancer Center at University of Kentucky Lexington, Kentucky  40536-0093
CancerCare of Maine at Eastern Maine Medical Center Bangor, Maine  04401
Butterworth Hospital at Spectrum Health Grand Rapids, Michigan  49503-2560
University of Mississippi Cancer Clinic Jackson, Mississippi  39216-4505
CCOP - Nevada Cancer Research Foundation Las Vegas, Nevada  89109-2306
St. Barnabas Medical Center Cancer Center Livingston, New Jersey  07039
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Knight Cancer Institute at Oregon Health and Science University Portland, Oregon  97239-3098
Legacy Emanuel Hospital and Health Center and Children's Hospital Portland, Oregon  97227
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Virginia Commonwealth University Massey Cancer Center Richmond, Virginia  23298-0037
West Virginia University Health Sciences Center - Charleston Charleston, West Virginia  25302
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
University of Virginia Cancer Center Charlottesville, Virginia  22908
Helen and Harry Gray Cancer Center at Hartford Hospital Hartford, Connecticut  06102-5037
Elkhart General Hospital Elkhart, Indiana  46515
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Hope A Women's Cancer Center Asheville, North Carolina  28801
Cleveland Clinic Cancer Center at Fairview Hospital Cleveland, Ohio  44111
Hillcrest Cancer Center at Hillcrest Hospital Mayfield Heights, Ohio  44124
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
Lakeland Regional Cancer Center at Lakeland Regional Medical Center Lakeland, Florida  33805
All Saints Cancer Center at Wheaton Franciscan Healthcare Racine, Wisconsin  53405
Peninsula Medical Center Burlingame, California  94010
North Bay Cancer Center Fairfield, California  94533
Sutter Health - Western Division Cancer Research Group Greenbrae, California  94904
Kaiser Permanente Medical Center - Hayward Hayward, California  94545
Kaiser Permanente Medical Office -Vandever Medical Office San Diego, California  92120
California Pacific Medical Center - California Campus San Francisco, California  94118
Sutter Solano Medical Center Vallejo, California  94589
John Muir/Mt. Diablo Comprehensive Cancer Center Walnut Creek, California  94598
Ella Milbank Foshay Cancer Center at Jupiter Medical Center Jupiter, Florida  33458
Charles B. Eberhart Cancer Center at DeKalb Medical Center Decatur, Georgia  30033
Kennestone Cancer Center at Wellstar Kennestone Hospital Marietta, Georgia  30060
Edward Hospital Cancer Center Naperville, Illinois  60540
Community Cancer Center Normal, Illinois  61761
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
Genesis Regional Cancer Center at Genesis Medical Center Davenport, Iowa  52803
Mary Bird Perkins Cancer Center - Baton Rouge Baton Rouge, Louisiana  70809
CentraCare Clinic - River Campus St. Cloud, Minnesota  56303
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
Forsyth Regional Cancer Center at Forsyth Medical Center Winston-Salem, North Carolina  27103
Lima Memorial Hospital Lima, Ohio  45804
Cleveland Clinic - Wooster Wooster, Ohio  44691
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Providence Cancer Center at Providence Portland Medical Center Portland, Oregon  97213-2967
Providence St. Vincent Medical Center Portland, Oregon  97225
Legacy Meridian Park Hospital Tualatin, Oregon  97062
Delaware County Regional Cancer Center at Delaware County Memorial Hospital Drexel Hill, Pennsylvania  19026
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Southwest Washington Medical Center Cancer Center Vancouver, Washington  98668
Massachusetts General Hospital Boston, Massachusetts  02114-2617
DeCesaris Cancer Institute at Anne Arundel Medical Center Annapolis, Maryland  21401
Poudre Valley Radiation Oncology Fort Collins, Colorado  80528
California Cancer Center - Woodward Park Office Fresno, California  93720
Good Shepherd Hospital Barrington, Illinois  60010
Creticos Cancer Center at Advocate Illinois Masonic Medical Center Chicago, Illinois  60657
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
Western Pennsylvania Cancer Institute at Western Pennsylvania Hospital Pittsburgh, Pennsylvania  15224-1791
West Allis Memorial Hospital West Allis, Wisconsin  53227
UAB Comprehensive Cancer Center Birmingham, Alabama  35294
Alta Bates Summit Comprehensive Cancer Center Berkeley, California  94704
Stanford Cancer Center Stanford, California  94305-5824
Ochsner Health Center - Bluebonnet Baton Rouge, Louisiana  70809
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
St. Luke's Hospital Cancer Care Center Duluth, Minnesota  55805
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
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
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at Ohio State University Comprehensive Cancer Center Columbus, Ohio  43210-1240
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
Salem Hospital Regional Cancer Care Services Salem, Oregon  97309-5014
St. Luke's Cancer Network at St. Luke's Hospital Bethlehem, Pennsylvania  18015
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
Sandra L. Maxwell Cancer Center Cedar City, Utah  84720
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center Ogden, Utah  84403
St. Joseph Cancer Center Bellingham, Washington  98225
Schiffler Cancer Center at Wheeling Hospital Wheeling, West Virginia  26003
Center for Cancer Treatment & Prevention at Sacred Heart Hospital Eau Claire, Wisconsin  54701
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center Green Bay, Wisconsin  54311
Saint Michael's Hospital Cancer Center Stevens Point, Wisconsin  54481
Aurora Medical Center Summit, Wisconsin  53066
Diagnostic and Treatment Center Weston, Wisconsin  54476
Seattle Cancer Care Alliance Seattle, Washington  98109
St. Joseph Hospital Regional Cancer Center - Orange Orange, California  92868-3849
Arizona Oncology Services Foundation Phoenix, Arizona  85013
Enloe Cancer Center at Enloe Medical Center Chico, California  95926
Robert and Beverly Lewis Family Cancer Care Center at Pomona Valley Hospital Medical Center Pomona, California  91767
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
Ruby L. Golleher Cancer Program at Presbyterian Intercommunity Hospital Whittier, California  90602
Hospital of Saint Raphael New Haven, Connecticut  06511
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Parkview Regional Cancer Center at Parkview Health Fort Wayne, Indiana  46805
MetroWest Medical Center - Framingham Union Hospital Framingham, Massachusetts  01702
Good Samaritan Cancer Center at Good Samaritan Hospital Kearney, Nebraska  68848-1990
Elliot Regional Cancer Center at Elliot Hospital Manchester, New Hampshire  03103
Dizzy Gillespie Cancer Institute at Englewood Hospital and Medical Center Englewood, New Jersey  07631
Pardee Memorial Hospital Hendersonville, North Carolina  28791
Three Rivers Community Hospital Grants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical Center Medford, Oregon  97504
Community Memorial Hospital Cancer Care Center Menomonee Falls, Wisconsin  53051
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Union Hospital of Cecil County Elkton MD, Maryland  21921
Duke Cancer Institute Durham, North Carolina  27710
Regional Cancer Center - Erie Erie, Pennsylvania  16505
MedCentral - Mansfield Hospital Mansfield, Ohio  44903
Cancer Institute at St. John's Hospital Springfield, Illinois  62701
Crozer-Chester Medical Center Upland, Pennsylvania  19013
PinnacleHealth Regional Cancer Center at Polyclinic Hospital Harrisburg, Pennsylvania  17105
Roper St. Francis Cancer Center at Roper Hospital Charleston, South Carolina  29401
University of Wisconcin Cancer Center at Aspirus Wausau Hospital Wausau, Wisconsin  54401
Solano Radiation Oncology Center Vacaville, California  95687
Integrated Community Oncology Network Jacksonville Beach, Florida  32250
Baptist Medical Center South Jascksonville, Florida  32258
Florida Cancer Center - Palatka Palatka, Florida  32177
Flagler Cancer Center Saint Augustine, Florida  32086
Lipson Cancer and Blood Center at Rochester General Hospital Rochester, New York  14621
Louisville Oncology at Norton Cancer Institute - Louisville Louisville, Kentucky  40202
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Boston University Cancer Research Center Boston, Massachusetts  02118
Desert Regional Medical Center Comprehensive Cancer Center Palm Springs, California  92262
Mercy General Hospital Sacramento, California  95819
Connecticut Oncology & Hematology - Torrington Torrington, Connecticut  06790
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
Illinois CancerCare - Bloomington Bloomington%, Illinois  61701
Illinois CancerCare - Canton Canton, Illinois  61520
Illinois CancerCare - Carthage Carthage, Illinois  62321
Alexian Brothers Radiation Oncology Elk Grove Village, Illinois  60007
Illinois CancerCare - Eureka Eureka, Illinois  61530
Illinois CancerCare - Galesburg Galesburg, Illinois  61401
Illinois CancerCare - Havana Havana, Illinois  62644
Illinois CancerCare - Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare - Macomb Macomb, Illinois  61455
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus Moline, Illinois  61265
OSF Holy Family Medical Center Monmouth, Illinois  61462
Illinois CancerCare - Monmouth Monmouth, Illinois  61462
Illinois CancerCare - Community Cancer Center Normal, Illinois  61761
Illinois CancerCare - Pekin Pekin, Illinois  61603
Illinois CancerCare - Peru Peru, Illinois  61354
Illinois CancerCare - Princeton Princeton, Illinois  61356
Illinois CancerCare - Spring Valley Spring Valley, Illinois  61362
Center for Cancer Care at Exeter Hospital Exeter, New Hampshire  03833
Franciscan Skemp Healthcare - La Crosse Campus La Crosse, Wisconsin  54601
University of Colorado Cancer Center at UC Health Sciences Center Aurora, Colorado  80045
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
High Point Regional Hospital High Point, North Carolina  27261
Providence Cancer Center at PMCC Medford, Oregon  97504
Central Maryland Oncology Center Columbia, Maryland  21044
Saint Mary's Regional Medical Center Reno, Nevada  89503
Cancer Centers of North Carolina - Raleigh Raleigh, North Carolina  27607
Mercy Regional Cancer Center at Mercy Medical Center Redding, California  96049
Memorial Hospital Cancer Center - Colorado Springs Colorado Springs, Colorado  80909
Integrated Community Oncology Network - Orange Park Orange Park, Florida  32073
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
Frankford Hospital Cancer Center - Torresdale Campus Philadelphia, Pennsylvania  19114
Cancer Care Center at John Muir Health - Concord Campus Concord, California  94524-4110
Central Maine Comprehensive Cancer Center at Central Maine Medical Center Lewiston, Maine  04240
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
Minnesota Oncology - Woodbury Woodbury, Minnesota  55125
Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main Campus Boca Raton, Florida  33486
Community Hospital of the Monterey Peninsula Comprehensive Cancer Center Monterey, California  93940
UPMC Cancer Center at Beaver Medical Center Beaver, Pennsylvania  15009
UPMC - Shadyside Pittsburgh, Pennsylvania  15213-2582
Holy Cross Hospital Silver Spring, Maryland  20910
New York Oncology Hematology, PC at Albany Regional Cancer Care Albany, New York  12208
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Centers - Cameron Park Cameron Park, California  95682
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
Bassett Healthcare Regional Cancer Program at Mary Imogene Bassett Hospital Cooperstown, New York  13326
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
CCOP - Kansas City Prairie Village, Kansas  66208
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Renown Institute for Cancer at Renown Regional Medical Center Reno, Nevada  89502
Sands Cancer Center Canandiaqua, New York  14424
University Radiation Oncology at Parkridge Hospital Rochester, New York  14626
Coastal Carolina Radiation Oncology Center Wilmington, North Carolina  28401
Norwalk Hospital Norwalk, Connecticut  06856
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Kootenai Cancer Center - Coeur d'Alene Coeur d'Alene, Idaho  83814
Integrated Community Oncology Network at Southside Cancer Center Jacksonville, Florida  32207
Central Dupage Cancer Center Warrenville, Illinois  60555
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
St. Francis Regional Cancer Center Trenton, New Jersey  08629
Northeast Radiation Oncology Center Dunmore, Pennsylvania  18512
Texas Oncology, PA at Texas Cancer Center Round Rock Round Rock, Texas  78681
Sharp Memorial Hospital Cancer Center San Diego, California  92123
Norristown Regional Cancer Center Norristown, Pennsylvania  19401
Arizona Center for Cancer Care - Peoria Peoria, Arizona  85381
Arizona Breast Cancer Specialists Scottsdale, Arizona  85258
Feather River Hospital Cancer Center Paradise, California  95969
Good Samaritan Cancer Care Center at Advocate Good Samaritan Hospital Downers Grove, Illinois  60515-1500
Illinois CancerCare - Cottage Galesburg, Illinois  61401
Radiation Oncology Associates Southwest Fort Wayne, Indiana  46804
Central Indiana Cancer Centers - East Indianapolis, Indiana  46219
Henry Ford Macomb Hospital Clinton Township, Michigan  48038
McLaren Cancer Institute Flint, Michigan  48532
Kansas City Cancer Centers - North Kansas City, Missouri  64154
Payson Center for Cancer Care at Concord Hospital Concord, New Hampshire  03301
Seacoast Cancer Center at Wentworth - Douglass Hospital Dover, New Hampshire  03820
Trinitas Comprehensive Cancer Center at Trinitas Hospital Elizabeth, New Jersey  07207
Cayuga Medical Center of Ithaca Ithaca, New York  14850
Saint Francis Hospital Cancer Center Poughkeepsie, New York  12601
Willamette Valley Cancer Center - Eugene Eugene, Oregon  97401
Intercommunity Cancer Center Monroeville, Pennsylvania  15146
Northmain Radiation Oncology Providence, Rhode Island  02904
Georgetown Memorial Hospital Georgetown, South Carolina  29440
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
Baylor Medical Center at Irving Irving, Texas  75061
Texas Oncology, PA at Lake Vista Cancer Center Lewisville, Texas  75067
Cancer Care Centers of South Texas - Northeast San Antonio, Texas  78217
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
Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital Center Sleepy Hollow, New York  10591
Memorial Sloan-Kettering Cancer Center - Basking Ridge Basking Ridge, New Jersey  07920