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NCT06500455PHASE3Recruiting

Testing Longer Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients With Cancer That Has Spread to the Brain

NRG Oncology

Start Date

12/12/2024

Completion Date

6/30/2028

Summary

This phase III trial compares the effectiveness of fractionated stereotactic radiosurgery (FSRS) to usual care stereotactic radiosurgery (SRS) in treating patients with cancer that has spread from where it first started to the brain. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. FSRS delivers a high dose of radiation to the tumor over 3 treatments. SRS is a type of external radiation therapy that uses special equipment to position the patient and precisely give a single large dose of radiation to a tumor. FSRS may be more effective compared to SRS in treating patients with cancer that has spread to the brain.

Detailed Description

PRIMARY OBJECTIVE: I. To determine if the time to local failure is improved with FSRS compared to SRS in patients with intact (i.e., unresected) brain metastases. SECONDARY OBJECTIVES: I. To compare time to intracranial progression-free survival between FSRS and SRS. II. To compare overall survival between FSRS and SRS. III. To determine if the time to local failure is improved with FSRS compared to SRS, as evaluated by central review of imaging. IV. To evaluate if there is any difference in central nervous system (CNS) failure patterns (local versus \[vs.\] distant brain failure vs. both) in patients who receive FSRS compared to patients who receive SRS. V. To compare the rates of radiation necrosis in patients who receive FSRS vs. SRS. VI. To compare the time to salvage whole brain radiation therapy (WBRT) between patients who receive FSRS and those who receive SRS. VII. To compare the rates of post-treatment adverse events associated with FSRS and SRS. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients undergo SRS over 30-90 minutes for 1 fraction on study. Additionally, patients undergo computed tomography (CT) and magnetic resonance imaging (MRI) on study. ARM II: Patients undergo FSRS over 30-90 minutes for 3 fractions on study. Additionally, patients undergo CT and MRI on study. After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 1 year then every 6 months for 3 years.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * Pathologically (histologically or cytologically) proven diagnosis of one of the following solid tumor malignancies within 5 years prior to registration: * Non-small cell lung cancer * Melanoma * Breast cancer * Renal cell carcinoma * Gastrointestinal cancer * If the original histologic proof of malignancy is greater than 5 years, then more recent pathologic confirmation (e.g., from a systemic site or brain metastasis) or unequivocal imaging confirmation of extracranial metastatic disease (e.g. CT of the chest/abdomen/pelvis, positron emission tomography \[PET\]/CT, etc.) is required * Patients must have at least 1 and up to 8 total intact brain metastases detected on a contrast-enhanced MRI performed ≤ 21 days prior to registration * At least 1 of the up to 8 lesions must be a study eligible lesion, defined as lesion with a maximum diameter as measured on any orthogonal plane (axial, sagittal, coronal) of ≥ 1.0 cm and ≤ 3.0 cm * All brain metastases must be located outside of the brainstem and ≥ 5 mm from the optic nerves or optic chiasm and ≤ 3.0 cm in maximum dimension * Note: brainstem metastases per the MRI within 21 days of registration are an exclusion criterion; however, if the MRI used for treatment planning performed within 7 days of SRS/FSRS reveals a brainstem metastasis, the patient remains eligible if the patient is considered an appropriate radiosurgery candidate per the local investigator * Patients must have a diagnosis-specific graded prognostic assessment ≥ 1.5 * No more than 2 lesions planned for resection if clinically indicated * No known leptomeningeal disease (LMD) * Note: For the purposes of exclusion, LMD is a clinical diagnosis, defined as positive cerebrospinal fluid (CSF) cytology and/or unequivocal radiologic or clinical evidence of leptomeningeal involvement. Patients with leptomeningeal symptoms in the setting of leptomeningeal enhancement by imaging (MRI) would be considered to have LMD even in the absence of positive CSF cytology. In contrast, an asymptomatic or minimally symptomatic patient with mild or nonspecific leptomeningeal enhancement (MRI) would not be considered to have LMD. In that patient, CSF sampling is not required to formally exclude LMD, but can be performed at the investigator's discretion based on level of clinical suspicion * Age ≥ 18 years * Karnofsky performance status (KPS) ≥ 60 * Negative urine or serum pregnancy test (in persons of childbearing potential) within 14 days prior to registration. Childbearing potential is defined as any person who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal * No prior radiotherapy to the brain (partial or whole brain irradiation, SRS, FSRS, or prophylactic cranial irradiation \[PCI\]) * New York Heart Association Functional Classification II or better (NYHA Functional Classification III/IV are not eligible) (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification) * No active infection currently requiring intravenous (IV) antibiotic management * No hepatic insufficiency resulting in clinical jaundice and/or coagulation defects * No chronic obstructive pulmonary disease exacerbation or other acute respiratory illness precluding study therapy

Interventions

PROCEDURE

Computed Tomography

RADIATION

Fractionated Stereotactic Radiation Therapy

PROCEDURE

Magnetic Resonance Imaging

RADIATION

Stereotactic Radiosurgery

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Conditions

Anatomic Stage IV Breast Cancer AJCC v8Metastatic Breast CarcinomaMetastatic Digestive System CarcinomaMetastatic Lung Non-Small Cell CarcinomaMetastatic Malignant Neoplasm in the BrainMetastatic Malignant Solid NeoplasmMetastatic MelanomaMetastatic Renal Cell CarcinomaStage IV Lung Cancer AJCC v8Stage IV Renal Cell Cancer AJCC v8

Locations

Banner University Medical Center - Tucson

Tucson, Arizona 85719

United States

University of Arizona Cancer Center-North Campus

Tucson, Arizona 85719

United States

Mercy Hospital Fort Smith

Fort Smith, Arkansas 72903

United States

University of Arkansas for Medical Sciences

Little Rock, Arkansas 72205

United States

Kaiser Permanente-Anaheim

Anaheim, California 92806

United States

Kaiser Permanente-Bellflower

Bellflower, California 90706

United States

City of Hope Corona

Corona, California 92882

United States

City of Hope Comprehensive Cancer Center

Duarte, California 91010

United States

UC San Diego Health System - Encinitas

Encinitas, California 92024

United States

UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care

Irvine, California 92612

United States

City of Hope at Irvine Lennar

Irvine, California 92618

United States

UC San Diego Moores Cancer Center

La Jolla, California 92093

United States

City of Hope Antelope Valley

Lancaster, California 93534

United States

Kaiser Permanente Los Angeles Medical Center

Los Angeles, California 90027

United States

Cedars-Sinai Medical Center

Los Angeles, California 90048

United States

Providence Queen of The Valley

Napa, California 94558

United States

Kaiser Permanente-Ontario

Ontario, California 91761

United States

UC Irvine Health/Chao Family Comprehensive Cancer Center

Orange, California 92868

United States

Stanford Cancer Institute Palo Alto

Palo Alto, California 94304

United States

UC San Diego Medical Center - Hillcrest

San Diego, California 92103

United States

Providence Medical Foundation - Santa Rosa

Santa Rosa, California 95403

United States

City of Hope South Pasadena

South Pasadena, California 91030

United States

City of Hope South Bay

Torrance, California 90503

United States

City of Hope Upland

Upland, California 91786

United States

John Muir Medical Center-Walnut Creek

Walnut Creek, California 94598

United States

UCHealth University of Colorado Hospital

Aurora, Colorado 80045

United States

UCHealth Memorial Hospital Central

Colorado Springs, Colorado 80909

United States

Memorial Hospital North

Colorado Springs, Colorado 80920

United States

Poudre Valley Hospital

Fort Collins, Colorado 80524

United States

Cancer Care and Hematology-Fort Collins

Fort Collins, Colorado 80528

United States

UCHealth Greeley Hospital

Greeley, Colorado 80631

United States

Medical Center of the Rockies

Loveland, Colorado 80538

United States

Hartford Hospital

Hartford, Connecticut 06102

United States

The Hospital of Central Connecticut

New Britain, Connecticut 06050

United States

UM Sylvester Comprehensive Cancer Center at Aventura

Aventura, Florida 33180

United States

Boca Raton Regional Hospital

Boca Raton, Florida 33486

United States

UM Sylvester Comprehensive Cancer Center at Coral Gables

Coral Gables, Florida 33146

United States

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida 33442

United States

UM Sylvester Comprehensive Cancer Center at Doral

Doral, Florida 33166

United States

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida 33136

United States

Miami Cancer Institute

Miami, Florida 33176

United States

UM Sylvester Comprehensive Cancer Center at Kendall

Miami, Florida 33176

United States

UM Sylvester Comprehensive Cancer Center at Plantation

Plantation, Florida 33324

United States

Moffitt Cancer Center-International Plaza

Tampa, Florida 33607

United States

Moffitt Cancer Center - McKinley Campus

Tampa, Florida 33612

United States

Moffitt Cancer Center

Tampa, Florida 33612

United States

Moffitt Cancer Center at Wesley Chapel

Wesley Chapel, Florida 33544

United States

Emory University Hospital Midtown

Atlanta, Georgia 30308

United States

Piedmont Hospital

Atlanta, Georgia 30309

United States

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia 30322

United States

Emory Saint Joseph's Hospital

Atlanta, Georgia 30342

United States

WellStar Cobb Hospital

Austell, Georgia 30106

United States

Wellstar Kennestone Hospital

Marietta, Georgia 30060

United States

Hawaii Cancer Care Inc - Waterfront Plaza

Honolulu, Hawaii 96813

United States

Queen's Cancer Cenrer - POB I

Honolulu, Hawaii 96813

United States

Queen's Medical Center

Honolulu, Hawaii 96813

United States

University of Hawaii Cancer Center

Honolulu, Hawaii 96813

United States

Queen's Cancer Center - Kuakini

Honolulu, Hawaii 96817

United States

Kapiolani Medical Center for Women and Children

Honolulu, Hawaii 96826

United States

Castle Medical Center

Kailua, Hawaii 96734

United States

Wilcox Memorial Hospital and Kauai Medical Clinic

Lihue, Hawaii 96766

United States

Hawaii Cancer Care - Westridge

‘Aiea, Hawaii 96701

United States

The Queen's Medical Center - West Oahu

‘Ewa Beach, Hawaii 96706

United States

Centralia Oncology Clinic

Centralia, Illinois 62801

United States

Northwestern University

Chicago, Illinois 60611

United States

Rush MD Anderson Cancer Center

Chicago, Illinois 60612

United States

University of Chicago Comprehensive Cancer Center

Chicago, Illinois 60637

United States

Carle at The Riverfront

Danville, Illinois 61832

United States

Cancer Care Specialists of Illinois - Decatur

Decatur, Illinois 62526

United States

Decatur Memorial Hospital

Decatur, Illinois 62526

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Crossroads Cancer Center

Effingham, Illinois 62401

United States

Elmhurst Memorial Hospital

Elmhurst, Illinois 60126

United States

Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois 61938

United States

Loyola University Medical Center

Maywood, Illinois 60153

United States

Edward Hospital/Cancer Center

Naperville, Illinois 60540

United States

UC Comprehensive Cancer Center at Silver Cross

New Lenox, Illinois 60451

United States

Cancer Care Center of O'Fallon

O'Fallon, Illinois 62269

United States

HSHS Saint Elizabeth's Hospital

O'Fallon, Illinois 62269

United States

Northwestern Medicine Orland Park

Orland Park, Illinois 60462

United States

University of Chicago Medicine-Orland Park

Orland Park, Illinois 60462

United States

Memorial Hospital East

Shiloh, Illinois 62269

United States

Southern Illinois University School of Medicine

Springfield, Illinois 62702

United States

Springfield Clinic

Springfield, Illinois 62702

United States

Springfield Memorial Hospital

Springfield, Illinois 62781

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

Northwestern Medicine Cancer Center Warrenville

Warrenville, Illinois 60555

United States

Northwest Cancer Center - Crown Point

Crown Point, Indiana 46307

United States

UChicago Medicine Northwest Indiana

Crown Point, Indiana 46307

United States

Northwest Oncology LLC

Dyer, Indiana 46311

United States

Goshen Center for Cancer Care

Goshen, Indiana 46526

United States

Northwest Cancer Center - Hobart

Hobart, Indiana 46342

United States

Saint Mary Medical Center

Hobart, Indiana 46342

United States

The Community Hospital

Munster, Indiana 46321

United States

Women's Diagnostic Center - Munster

Munster, Indiana 46321

United States

Northwest Cancer Center - Valparaiso

Valparaiso, Indiana 46383

United States

Mary Greeley Medical Center

Ames, Iowa 50010

United States

McFarland Clinic - Ames

Ames, Iowa 50010

United States

University of Iowa/Holden Comprehensive Cancer Center

Iowa City, Iowa 52242

United States

University of Kansas Cancer Center

Kansas City, Kansas 66160

United States

The University of Kansas Cancer Center - Olathe

Olathe, Kansas 66061

United States

University of Kansas Cancer Center-Overland Park

Overland Park, Kansas 66210

United States

Baptist Health Hardin

Elizabethtown, Kentucky 42701

United States

University of Kentucky/Markey Cancer Center

Lexington, Kentucky 40536

United States

The James Graham Brown Cancer Center at University of Louisville

Louisville, Kentucky 40202

United States

Norton Brownsboro Hospital and Medical Campus

Louisville, Kentucky 40241

United States

UofL Health Medical Center Northeast

Louisville, Kentucky 40245

United States

Owensboro Health Mitchell Memorial Cancer Center

Owensboro, Kentucky 42303

United States

MaineHealth Maine Medical Center - Portland

Portland, Maine 04102

United States

MaineHealth Cancer Care Center of York County

Sanford, Maine 04073

United States

MaineHealth Maine Medical Center- Scarborough

Scarborough, Maine 04074

United States

Maryland Proton Treatment Center

Baltimore, Maryland 21201

United States

University of Maryland/Greenebaum Cancer Center

Baltimore, Maryland 21201

United States

Sinai Hospital of Baltimore

Baltimore, Maryland 21215

United States

UM Upper Chesapeake Medical Center

Bel Air, Maryland 21014

United States

Central Maryland Radiation Oncology in Howard County

Columbia, Maryland 21044

United States

University of Maryland Shore Medical Center at Easton

Easton, Maryland 21601

United States

UM Baltimore Washington Medical Center/Tate Cancer Center

Glen Burnie, Maryland 21061

United States

UM Capital Region Medical Center

Largo, Maryland 20774

United States

William E Kahlert Regional Cancer Center/Sinai Hospital

Westminster, Maryland 21157

United States

Trinity Health Saint Joseph Mercy Hospital Ann Arbor

Ann Arbor, Michigan 48106

United States

University of Michigan Rogel Cancer Center

Ann Arbor, Michigan 48109

United States

Trinity Health IHA Medical Group Hematology Oncology - Brighton

Brighton, Michigan 48114

United States

Henry Ford Cancer Institute-Downriver

Brownstown, Michigan 48183

United States

Henry Ford Macomb Hospital-Clinton Township

Clinton Township, Michigan 48038

United States

Henry Ford Hospital

Detroit, Michigan 48202

United States

Trinity Health Saint Mary Mercy Livonia Hospital

Livonia, Michigan 48154

United States

Henry Ford Health Providence Novi Hospital

Novi, Michigan 48374

United States

MyMichigan Medical Center Saginaw

Saginaw, Michigan 48601

United States

MyMichigan Medical Center Tawas

Tawas City, Michigan 48764

United States

Henry Ford West Bloomfield Hospital

West Bloomfield, Michigan 48322

United States

Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus

Ypsilanti, Michigan 48197

United States

Minnesota Oncology Hematology PA-Chaska

Chaska, Minnesota 55318

United States

Fairview Clinics and Surgery Center Maple Grove

Maple Grove, Minnesota 55369

United States

Hennepin County Medical Center

Minneapolis, Minnesota 55415

United States

University of Minnesota/Masonic Cancer Center

Minneapolis, Minnesota 55455

United States

Monticello Cancer Center

Monticello, Minnesota 55362

United States

Coborn Cancer Center at Saint Cloud Hospital

Saint Cloud, Minnesota 56303

United States

Ridgeview Medical Center

Waconia, Minnesota 55387

United States

University of Mississippi Medical Center

Jackson, Mississippi 39216

United States

Siteman Cancer Center at Saint Peters Hospital

City of Saint Peters, Missouri 63376

United States

MU Health - University Hospital/Ellis Fischel Cancer Center

Columbia, Missouri 65212

United States

Siteman Cancer Center at West County Hospital

Creve Coeur, Missouri 63141

United States

Parkland Health Center - Farmington

Farmington, Missouri 63640

United States

Mercy Hospital Springfield

Springfield, Missouri 65804

United States

Washington University School of Medicine

St Louis, Missouri 63110

United States

Siteman Cancer Center-South County

St Louis, Missouri 63129

United States

Siteman Cancer Center at Christian Hospital

St Louis, Missouri 63136

United States

Nebraska Medicine-Bellevue

Bellevue, Nebraska 68123

United States

Nebraska Medicine-Village Pointe

Omaha, Nebraska 68118

United States

University of Nebraska Medical Center

Omaha, Nebraska 68198

United States

Renown Regional Medical Center

Reno, Nevada 89502

United States

Memorial Sloan Kettering Basking Ridge

Basking Ridge, New Jersey 07920

United States

Jefferson Cherry Hill Hospital

Cherry Hill, New Jersey 08002

United States

Saint Barnabas Medical Center

Livingston, New Jersey 07039

United States

Memorial Sloan Kettering Monmouth

Middletown, New Jersey 07748

United States

Memorial Sloan Kettering Bergen

Montvale, New Jersey 07645

United States

Jersey Shore Medical Center

Neptune City, New Jersey 07753

United States

Rutgers Cancer Institute of New Jersey

New Brunswick, New Jersey 08903

United States

Rutgers New Jersey Medical School

Newark, New Jersey 07101

United States

Newark Beth Israel Medical Center

Newark, New Jersey 07112

United States

The Valley Hospital - Luckow Pavilion

Paramus, New Jersey 07652

United States

Valley Health System Ridgewood Campus

Ridgewood, New Jersey 07450

United States

Sidney Kimmel Cancer Center Washington Township

Sewell, New Jersey 08080

United States

Robert Wood Johnson University Hospital Somerset

Somerville, New Jersey 08876

United States

Community Medical Center

Toms River, New Jersey 08755

United States

University of New Mexico Cancer Center

Albuquerque, New Mexico 87106

United States

New York-Presbyterian/Brooklyn Methodist Hospital

Brooklyn, New York 11215

United States

NYU Langone Hospital - Brooklyn

Brooklyn, New York 11220

United States

Memorial Sloan Kettering Commack

Commack, New York 11725

United States

The New York Hospital Medical Center of Queens

Flushing, New York 11355

United States

Memorial Sloan Kettering Westchester

Harrison, New York 10604

United States

Northwell Health/Center for Advanced Medicine

Lake Success, New York 11042

United States

NYU Langone Hospital - Long Island

Mineola, New York 11501

United States

Mount Sinai Chelsea

New York, New York 10011

United States

Laura and Isaac Perlmutter Cancer Center at NYU Langone

New York, New York 10016

United States

Mount Sinai West

New York, New York 10019

United States

Mount Sinai Hospital

New York, New York 10029

United States

Manhattan Eye Ear and Throat Hospital

New York, New York 10065

United States

Memorial Sloan Kettering Cancer Center

New York, New York 10065

United States

NYP/Weill Cornell Medical Center

New York, New York 10065

United States

Lenox Hill Hospital

New York, New York 10075

United States

Mount Sinai South Nassau

Oceanside, New York 11572

United States

University of Rochester

Rochester, New York 14642

United States

Stony Brook University Medical Center

Stony Brook, New York 11794

United States

State University of New York Upstate Medical University

Syracuse, New York 13210

United States

SUNY Upstate Medical Center-Community Campus

Syracuse, New York 13215

United States

Montefiore Medical Center-Einstein Campus

The Bronx, New York 10461

United States

Montefiore Medical Center-Weiler Hospital

The Bronx, New York 10461

United States

Montefiore Medical Center - Moses Campus

The Bronx, New York 10467

United States

Memorial Sloan Kettering Nassau

Uniondale, New York 11553

United States

Sanford Broadway Medical Center

Fargo, North Dakota 58122

United States

Sanford Roger Maris Cancer Center

Fargo, North Dakota 58122

United States

UH Seidman Cancer Center at UH Avon Health Center

Avon, Ohio 44011

United States

Indu and Raj Soin Medical Center

Beavercreek, Ohio 45431

United States

University of Cincinnati Cancer Center-UC Medical Center

Cincinnati, Ohio 45219

United States

Case Western Reserve University

Cleveland, Ohio 44106

United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio 43210

United States

Riverside Methodist Hospital

Columbus, Ohio 43214

United States

Grant Medical Center

Columbus, Ohio 43215

United States

Delaware Health Center-Grady Cancer Center

Delaware, Ohio 43015

United States

Grady Memorial Hospital

Delaware, Ohio 43015

United States

Kettering Medical Center

Kettering, Ohio 45429

United States

UH Seidman Cancer Center at Lake Health Mentor Campus

Mentor, Ohio 44060

United States

University of Cincinnati Cancer Center-West Chester

West Chester, Ohio 45069

United States

Saint Elizabeth Youngstown Hospital

Youngstown, Ohio 44501

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Clackamas Radiation Oncology Center

Clackamas, Oregon 97015

United States

Legacy Mount Hood Medical Center

Gresham, Oregon 97030

United States

Legacy Good Samaritan Hospital and Medical Center

Portland, Oregon 97210

United States

Providence Portland Medical Center

Portland, Oregon 97213

United States

Providence Saint Vincent Medical Center

Portland, Oregon 97225

United States

Legacy Meridian Park Hospital

Tualatin, Oregon 97062

United States

Saint Luke's Cancer Center - Allentown

Allentown, Pennsylvania 18104

United States

Saint Luke's University Hospital-Bethlehem Campus

Bethlehem, Pennsylvania 18015

United States

Chambersburg Hospital

Chambersburg, Pennsylvania 17201

United States

Northeast Radiation Oncology Center

Dunmore, Pennsylvania 18512

United States

Saint Luke's Hospital-Anderson Campus

Easton, Pennsylvania 18045

United States

Penn State Milton S Hershey Medical Center

Hershey, Pennsylvania 17033-0850

United States

NRG Oncology

Philadelphia, Pennsylvania 19103

United States

University of Pennsylvania/Abramson Cancer Center

Philadelphia, Pennsylvania 19104

United States

Thomas Jefferson University Hospital

Philadelphia, Pennsylvania 19107

United States

Jefferson Torresdale Hospital

Philadelphia, Pennsylvania 19114

United States

UPMC-Presbyterian Hospital

Pittsburgh, Pennsylvania 15213

United States

UPMC-Shadyside Hospital

Pittsburgh, Pennsylvania 15232

United States

Saint Luke's Hospital - Upper Bucks Campus

Quakertown, Pennsylvania 18951

United States

Saint Luke's Hospital - Monroe Campus

Stroudsburg, Pennsylvania 18360

United States

Reading Hospital

West Reading, Pennsylvania 19611

United States

WellSpan Health-York Cancer Center

York, Pennsylvania 17403

United States

WellSpan Health-York Hospital

York, Pennsylvania 17403

United States

Saint Francis Hospital

Greenville, South Carolina 29601

United States

Saint Francis Cancer Center

Greenville, South Carolina 29607

United States

Sanford Cancer Center Oncology Clinic

Sioux Falls, South Dakota 57104

United States

Sanford USD Medical Center - Sioux Falls

Sioux Falls, South Dakota 57117-5134

United States

Vanderbilt Breast Center at One Hundred Oaks

Nashville, Tennessee 37204

United States

Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee 37232

United States

MD Anderson in The Woodlands

Conroe, Texas 77384

United States

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Houston, Texas 77030

United States

Memorial Hermann Texas Medical Center

Houston, Texas 77030

United States

UT MD Anderson Cancer Center

Houston, Texas 77030

United States

MD Anderson West Houston

Houston, Texas 77079

United States

UT MD Anderson - League City

League City, Texas 77573

United States

University of Texas Health Science Center at San Antonio

San Antonio, Texas 78229

United States

MD Anderson in Sugar Land

Sugar Land, Texas 77478

United States

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah 84112

United States

University of Vermont Medical Center

Burlington, Vermont 05401

United States

University of Vermont and State Agricultural College

Burlington, Vermont 05405

United States

University of Virginia Cancer Center

Charlottesville, Virginia 22908

United States

VCU Massey Comprehensive Cancer Center

Richmond, Virginia 23298

United States

Valley Medical Center

Renton, Washington 98055

United States

Legacy Cancer Institute Medical Oncology and Day Treatment

Vancouver, Washington 98684

United States

Legacy Salmon Creek Hospital

Vancouver, Washington 98686

United States

Langlade Hospital and Cancer Center

Antigo, Wisconsin 54409

United States

ThedaCare Regional Cancer Center

Appleton, Wisconsin 54911

United States

Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

United States

University of Wisconsin Carbone Cancer Center - Eastpark Medical Center

Madison, Wisconsin 53718

United States

University of Wisconsin Carbone Cancer Center - University Hospital

Madison, Wisconsin 53792

United States

Medical College of Wisconsin

Milwaukee, Wisconsin 53226

United States

Aspirus Cancer Care - James Beck Cancer Center

Rhinelander, Wisconsin 54501

United States

Aspirus Cancer Care - Stevens Point

Stevens Point, Wisconsin 54481

United States

Aspirus Regional Cancer Center

Wausau, Wisconsin 54401

United States

Aspirus Cancer Care - Wisconsin Rapids

Wisconsin Rapids, Wisconsin 54494

United States

CHUM - Centre Hospitalier de l'Universite de Montreal

Montreal, Quebec H2X 3E4

Canada

The Research Institute of the McGill University Health Centre (MUHC)

Montreal, Quebec H3H 2R9

Canada

Pamela Youde Nethersole Eastern Hospital

Chai Wan,

Hong Kong

Beacon Hospital

Dublin, Co Dublin 18

Ireland

Saint Lukes Hospital

Dublin, Co Dublin 6

Ireland

University College Hospital Galway

Galway, Co Galway

Ireland

Cork Radiation Oncology Associates Limited

Cork,

Ireland

Cork University Hospital

Cork,

Ireland