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A Phase III Trial of Pelvic Radiation Therapy Versus Vaginal Cuff Brachytherapy Followed By Paclitaxel/Carboplatin Chemotherapy in Patients With High Risk, Early Stage Endometrial Carcinoma


Phase 3
18 Years
N/A
Open (Enrolling)
Female
Endometrial Cancer, Fatigue, Neurotoxicity

Thank you

Trial Information

A Phase III Trial of Pelvic Radiation Therapy Versus Vaginal Cuff Brachytherapy Followed By Paclitaxel/Carboplatin Chemotherapy in Patients With High Risk, Early Stage Endometrial Carcinoma


OBJECTIVES:

Primary

- To compare the recurrence-free survival of patients with high-risk stage I or II
endometrial carcinoma treated with pelvic radiotherapy vs vaginal cuff brachytherapy,
paclitaxel, and carboplatin.

Secondary

- To compare survival of patients treated with these regimens.

- To compare patterns of failure in patients treated with these regimens.

- To compare physical functioning, fatigue, and neurotoxicity in patients treated with
these regimens.

- To correlate primary comorbid illnesses and obesity with survival, fatigue, and
physical functioning.

- To evaluate the psychometric properties (e.g., construct validity, reliability,
sensitivity to treatment, and responsiveness over time) of the PROMIS Fatigue-SF1.

- To evaluate fatigue measurement equivalence between patients with endometrial cancer
and age-matched women from the general population of the United States.

OUTLINE: This is a multicenter study. Patients are stratified according to extent of surgery
(hysterectomy and bilateral salpingo-oophorectomy without lymph node sampling, lymph node
dissection, or lymphadenectomy vs hysterectomy and bilateral salpingo-oophorectomy with
lymph node sampling, lymph node dissection, or lymphadenectomy). Patients with stage II
disease or stage I disease with a confirmed diagnosis of clear cell and/or papillary serous
histology who are randomized to arm I are also stratified according to intent to use vaginal
cuff brachytherapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients undergo conventional or intensity-modulated pelvic radiotherapy once
daily, 5 days a week, for 5-6 weeks (total of 25-28 fractions) in the absence of
disease progression or unacceptable toxicity. Patients with stage II disease or stage I
disease with a confirmed diagnosis of clear cell and/or papillary serous histology may
also undergo 1 or 2 intravaginal (i.e., vaginal cuff) brachytherapy boost treatments.

- Arm II: Patients undergo vaginal cuff brachytherapy comprising 3-5 high-dose rate
brachytherapy treatments over approximately 2 weeks or 1 or 2 low-dose rate
brachytherapy treatments over 1-2 days. Beginning within 3 weeks after initiating
brachytherapy, patients receive paclitaxel IV over 3 hours and carboplatin IV over
30-60 minutes on day 1. Chemotherapy repeats every 21 days for up to 3 courses in the
absence of disease progression or unacceptable toxicity.

Patients complete questionnaires to assess quality of life, neurotoxicity, and fatigue at
baseline, 4 weeks, 10-11 weeks, 8 months, and 14 months.

After completion of study therapy, patients are followed periodically for up to 10 years.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Diagnosis of endometrial carcinoma, meeting 1 of the following criteria:

- Stage I disease with high-intermediate risk factors with positive or negative
cytology (e.g., grade 2 or 3 tumor, presence of lymphovascular space invasion,
and/or outer half myometrial invasion), meeting 1 of the following criteria:

- Age ≥ 70 years with 1 risk factor

- Age ≥ 50 years with 2 risk factors

- Age ≥ 18 years with 3 risk factors

- Stage II (occult or gross involvement) disease (any histology) with or without
risk factors

- Occult disease is defined as lesions that are identified as an incidental
finding after hysterectomy in the absence of gross cervical disease

- Stage I-II disease with serous or clear cell histology with or without other
risk factors allowed provided the disease is uterine-confined (with or without
cervical stromal invasion or endocervical glandular involvement), and with
peritoneal cytology negative for malignancy

- Has undergone hysterectomy and bilateral salpingo-oophorectomy (laparotomy or
laparoscopic approach, including robot-assisted) with or without pelvic and
para-aortic lymphadenectomy within the past 4-12 weeks

- If nodal dissection was not performed, pelvic and para-aortic nodes must be
clinically negative with no evidence of distant disease by post-operative,
pre-treatment CT scan/MRI

- Suspicious nodes that have been biopsied (re-staging surgery, fine-needle
aspiration) allowed provided they are pathologically negative

- No pathologically confirmed spread of disease to pelvic or para-aortic lymph
nodes or adnexal structures, and/or other anatomic sites, or serous or clear
cell histology and positive cytologic washings

- No recurrent disease

- No surgical or clinical stage III or IV endometrial carcinoma

- No sarcoma, carcinosarcoma (i.e., malignant mixed mullerian tumor), or non-epithelial
uterine malignancies (i.e., leiomyosarcoma of the uterine corpus)

PATIENT CHARACTERISTICS:

- GOG performance status 0-2

- ANC ≥ 1,500/mcl

- Platelet count ≥ 100,000/mcl

- Serum creatinine normal OR creatinine clearance > 50 mL/min

- Bilirubin ≤ 1.5 times upper limit of normal (ULN)

- SGOT ≤ 2.5 times ULN

- Alkaline phosphatase ≤ 2.5 times ULN

- No neuropathy (sensory or motor) > grade 1

- No other invasive malignancy within the past 5 years except non-melanoma skin cancer

- No contraindications to pelvic radiotherapy (e.g., pelvic kidney, connective tissue
disease, or inflammatory bowel disease)

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No prior non-surgical therapy for endometrial cancer, including chemotherapy,
radiotherapy (e.g., pre-operative or post-operative brachytherapy), hormonal therapy,
or biological therapy

- No prior systemic chemotherapy or radiotherapy for another malignancy

- No concurrent whole-abdominal, extended-field, or interstitial radiotherapy

- No concurrent erythropoietin therapy

- Concurrent enrollment on GOG-0210 (molecular marker study) allowed

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Duration of recurrence-free survival

Safety Issue:

No

Principal Investigator

D. Scott McMeekin, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Oklahoma University Cancer Institute

Authority:

Unspecified

Study ID:

CDR0000629591

NCT ID:

NCT00807768

Start Date:

March 2009

Completion Date:

Related Keywords:

  • Endometrial Cancer
  • Fatigue
  • Neurotoxicity
  • fatigue
  • neurotoxicity
  • endometrial clear cell carcinoma
  • endometrial papillary serous carcinoma
  • endometrial adenoacanthoma
  • endometrial adenocarcinoma
  • endometrial adenosquamous cell carcinoma
  • stage IA endometrial carcinoma
  • stage IB endometrial carcinoma
  • stage II endometrial carcinoma
  • Endometrial Neoplasms
  • Sarcoma, Endometrial Stromal
  • Fatigue
  • Adenoma
  • Neurotoxicity Syndromes

Name

Location

National Naval Medical Center Bethesda, Maryland  20889
Roswell Park Cancer Institute Buffalo, New York  14263
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
MBCCOP - Hawaii Honolulu, Hawaii  96813
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
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
St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center Grand Junction, Colorado  81502
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
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center Farmington, Connecticut  06360-2875
George Bray Cancer Center at the Hospital of Central Connecticut - New Britain Campus New Britain, Connecticut  06050
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
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
Minnesota Oncology Hematology, PA - Maplewood Maplewood, Minnesota  55109
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
Minnesota Oncology Hematology, PA - Woodbury Woodbury, Minnesota  55125
MeritCare Broadway Fargo, North Dakota  58122
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
Geisinger Medical Group - Scenery Park State College, Pennsylvania  16801
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
Avera Cancer Institute Sioux Falls, South Dakota  57105
Vanderbilt-Ingram Cancer Center Nashville, Tennessee  37232-6838
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Madison, Wisconsin  53792-6164
CCOP - Ochsner New Orleans, Louisiana  70121
St. Joseph's Hospital and Medical Center Phoenix, Arizona  85001-2071
Memorial Hospital of South Bend South Bend, Indiana  46601
CCOP - Cancer Research for the Ozarks Springfield, Missouri  65807
CCOP - Montana Cancer Consortium Billings, Montana  59101
CCOP - Columbus Columbus, Ohio  43206
CCOP - Greenville Greenville, South Carolina  29615
University of Texas Medical Branch Galveston, Texas  77555-1329
LDS Hospital Salt Lake City, Utah  84143
Virginia Mason Medical Center Seattle, Washington  98111
Rush University Medical Center Chicago, Illinois  60612-3824
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Saint Joseph Regional Medical Center South Bend, Indiana  46617
Holden Comprehensive Cancer Center at University of Iowa Iowa City, Iowa  52242-1002
UMASS Memorial Cancer Center - University Campus Worcester, Massachusetts  01605-2982
Ellis Fischel Cancer Center at University of Missouri - Columbia Columbia, Missouri  65203
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill Chapel Hill, North Carolina  27599-7570
Charles M. Barrett Cancer Center at University Hospital Cincinnati, Ohio  45267-0526
Kimmel Cancer Center at Thomas Jefferson University - Philadelphia Philadelphia, Pennsylvania  19107
UPMC Cancer Center at Magee-Womens Hospital Pittsburgh, Pennsylvania  15213-3180
MultiCare Regional Cancer Center at Tacoma General Hospital Tacoma, Washington  98405
Cancer Research Center of Hawaii Honolulu, Hawaii  96813
MBCCOP - LSU Health Sciences Center New Orleans, Louisiana  70112
CCOP - St. Louis-Cape Girardeau Saint Louis, Missouri  63141
Brooke Army Medical Center Fort Sam Houston, Texas  78234-6200
CCOP - Virginia Mason Research Center Seattle, Washington  98101
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
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
Wesley Medical Center Wichita, Kansas  67214
Fletcher Allen Health Care - University Health Center Campus Burlington, Vermont  05401
John Stoddard Cancer Center at Iowa Methodist Medical Center Des Moines, Iowa  50309
Kaiser Permanente Medical Center - San Francisco Geary Campus San Francisco, California  94115
Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center Kansas City, Kansas  66160-7353
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Seattle, Washington  98104
James Graham Brown Cancer Center at University of Louisville Louisville, Kentucky  40202
Blumenthal Cancer Center at Carolinas Medical Center Charlotte, North Carolina  28232-2861
Harry and Jeanette Weinberg Cancer Institute at Franklin Square Hospital Center Baltimore, Maryland  21237
Hulston Cancer Center at Cox Medical Center South Springfield, Missouri  65807
St. John's Regional Health Center Springfield, Missouri  65804
UMDNJ University Hospital Newark, New Jersey  07103
SUNY Downstate Medical Center Brooklyn, New York  11203
Winthrop University Hospital Mineola, New York  11501
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
Lake/University Ireland Cancer Center Mentor, Ohio  44060
Women and Infants Hospital of Rhode Island Providence, Rhode Island  02905
Carilion Gynecologic Oncology Associates Roanoke, Virginia  24014
Central Baptist Hospital Lexington, Kentucky  40503
Long Island Jewish Medical Center New Hyde Park, New York  11040
Kaiser Permanente Medical Center - Oakland Sacramento, California  95825
Yale Cancer Center New Haven, Connecticut  06520-8028
Advocate Christ Medical Center Oak Lawn, Illinois  60453
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Ochsner Cancer Institute at Ochsner Clinic Foundation New Orleans, Louisiana  70121
Alvin and Lois Lapidus Cancer Institute at Sinai Hospital Baltimore, Maryland  21215
Hackensack University Medical Center Cancer Center Hackensack, New Jersey  07601
Mount Sinai Medical Center New York, New York  10029
Stony Brook University Cancer Center Stony Brook, New York  11794-8174
SUNY Upstate Medical University Hospital Syracuse, New York  13210
Presbyterian Cancer Center at Presbyterian Hospital Charlotte, North Carolina  28233-3549
Wake Forest University Comprehensive Cancer Center Winston-Salem, North Carolina  27157-1096
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas Dallas, Texas  75390
Lahey Clinic Medical Center - Burlington Burlington, Massachusetts  01805
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
Sibley Memorial Hospital Washington, District of Columbia  20016
St. Elizabeth Medical Center Edgewood, Kentucky  41017
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Saint Anthony's Hospital at Saint Anthony's Health Center Alton, Illinois  62002
Good Samaritan Regional Health Center Mt. Vernon, Illinois  62864
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
David C. Pratt Cancer Center at St. John's Mercy St. Louis, Missouri  63141
Adena Regional Medical Center Chillicothe, Ohio  54601
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
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
Utah Cancer Specialists at UCS Cancer Center Salt Lake City, Utah  84106
Olympic Hematology and Oncology Bremerton, Washington  98310
Skagit Valley Hospital Cancer Care Center Mt. Vernon, Washington  98273
University Cancer Center at University of Washington Medical Center Seattle, Washington  98195
Group Health Central Hospital Seattle, Washington  98104
Greenebaum Cancer Center at University of Maryland Medical Center Baltimore, Maryland  21201
Zimmer Cancer Center at New Hanover Regional Medical Center Wilmington, North Carolina  28402-9025
University of South Alabama Mitchell Cancer Institute Mobile, Alabama  36604
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center Los Angeles, California  90048-1865
Jonsson Comprehensive Cancer Center at UCLA Los Angeles, California  90095-1781
UCSF Helen Diller Family Comprehensive Cancer Center San Francisco, California  94115
Kaiser Permanente Medical Center - Santa Clara Kiely Campus Santa Clara, California  95051-5386
M.D. Anderson Cancer Center at Orlando Orlando, Florida  32806
MBCCOP - Medical College of Georgia Cancer Center Augusta, Georgia  30912-3730
Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center Savannah, Georgia  31403-3089
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
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
Masonic Cancer Center at University of Minnesota Minneapolis, Minnesota  55455
University of Mississippi Cancer Clinic Jackson, Mississippi  39216-4505
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School New Brunswick, New Jersey  08903
University of New Mexico Cancer Center Albuquerque, New Mexico  87131-5636
Don Monti Comprehensive Cancer Center at North Shore University Hospital Manhasset, New York  11030
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center New York, New York  10032
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
M. D. Anderson Cancer Center at University of Texas Houston, Texas  77030-4009
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Kaiser Permanente Medical Center - Sacramento Sacramento, California  95825
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
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
Todd Cancer Institute at Long Beach Memorial Medical Center Long Beach, California  90801
Helen and Harry Gray Cancer Center at Hartford Hospital Hartford, Connecticut  06102-5037
Elkhart General Hospital Elkhart, Indiana  46515
Gynecologic Oncology of Indiana Indianapolis, Indiana  46237
Howard Community Hospital Kokomo, Indiana  46904
Maine Medical Center - Bramhall Campus Portland, Maine  04102
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
Hope A Women's Cancer Center Asheville, North Carolina  28801
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Cancer Care Associates - Saint Francis Campus Tulsa, Oklahoma  74136-1929
Rosenfeld Cancer Center at Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
All Saints Cancer Center at Wheaton Franciscan Healthcare Racine, Wisconsin  53405
Kaiser Permanente Medical Center - Hayward Hayward, California  94545
Kaiser Permanente Medical Center - Redwood City Redwood City, California  94063
Kaiser Permanente Medical Center - Richmond Richmond, California  94801
Kaiser Permanente Medical Center - Roseville Roseville, California  95661
South Sacramento Kaiser-Permanente Medical Center Sacramento, California  95823
Kaiser Permanente Medical Center - Santa Teresa San Jose, California  95119
Kaiser Foundation Hospital - San Rafael San Rafael, California  94903
Kaiser Permanente Medical Center - Santa Rosa Santa Rosa, California  95403
Kaiser Permanente Medical Center - South San Francisco South San Francisco, California  94080
Kaiser Permanente Medical Facility - Stockton Stockton, California  95210
Kaiser Permanente Medical Center - Walnut Creek Walnut Creek, California  94596
John Muir/Mt. Diablo Comprehensive Cancer Center Walnut Creek, California  94598
St. Joseph Medical Center Bloomington, Illinois  61701
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
Oncology Hematology Associates of Central Illinois, PC - Peoria Peoria, Illinois  61615
OSF St. Francis Medical Center Peoria, Illinois  61637
Valley Cancer Center Spring Valley, Illinois  61362
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
Medical Center of Louisiana - New Orleans New Orleans, Louisiana  70112
Feist-Weiller Cancer Center at Louisiana State University Health Sciences Shreveport, Louisiana  71130-3932
Saint Francis Medical Center Cape Girardeau, Missouri  63701
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Highland Hospital of Rochester Rochester, New York  14620
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
UVMC Cancer Care Center at Upper Valley Medical Center Troy, Ohio  45373-1300
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Lankenau Cancer Center at Lankenau Hospital Wynnewood, Pennsylvania  19096
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital Yakima, Washington  98902
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
William W. Backus Hospital Norwich, Connecticut  06360
Lancaster General Hospital Lancaster, Pennsylvania  17604-3555
Palo Alto Medical Foundation Palo Alto, California  94301
Northeast Georgia Medical Center Gainesville, Georgia  30501
Mercy Cancer Center at Mercy Medical Center - North Iowa Mason City, Iowa  50401
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
UAB Comprehensive Cancer Center Birmingham, Alabama  35294
Praxair Cancer Center at Danbury Hospital Danbury, Connecticut  06810
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Tunnell Cancer Center at Beebe Medical Center Lewes, Delaware  19958
John B. Amos Cancer Center Columbus, Georgia  31904
Evanston Hospital Evanston, Illinois  60201-1781
Michiana Hematology-Oncology, PC - Elkhart Elkhart, Indiana  46514
Elkhart Clinic, LLC Elkhart, Indiana  46514-2098
Michiana Hematology Oncology PC - La Porte La Porte, Indiana  46350
Michiana Hematology-Oncology, PC - South Bend Mishawaka, Indiana  46545-1470
Michiana Hematology Oncology PC - Plymouth Plymouth, Indiana  46563
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
Menorah Medical Center Overland Park, Kansas  66209
Saint Luke's Hospital - South Overland Park, Kansas  66213
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
Michiana Hematology Oncology PC - Niles Niles, Michigan  49120
Lakeside Cancer Specialists, PLLC Saint Joseph, Michigan  49085
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
St. Joseph Medical Center Kansas City, Missouri  64114
North Kansas City Hospital Kansas City, Missouri  64116
Saint Luke's Cancer Institute at Saint Luke's Hospital Kansas City, Missouri  64111
Research Medical Center Kansas City, Missouri  64132
Saint Luke's East - Lee's Summit Lee's Summit, Missouri  64086
Liberty Hospital Liberty, Missouri  64068
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
Monter Cancer Center of the North Shore-LIJ Health System Lake Success, New York  11042
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
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Portland, Oregon  97210
Northwest Cancer Specialists at Rose Quarter Cancer Center Portland, Oregon  97227
St. Luke's Cancer Network at St. Luke's Hospital Bethlehem, Pennsylvania  18015
Geisinger Hazleton Cancer Center Hazleton, Pennsylvania  18201
Penn State Hershey Cancer Institute at Milton S. Hershey Medical Center Hershey, Pennsylvania  17033-0850
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
Jon and Karen Huntsman Cancer Center at Intermountain Medical Center Murray, Utah  84157
Val and Ann Browning Cancer Center at McKay-Dee Hospital Center Ogden, Utah  84403
Harrison Poulsbo Hematology and Onocology Poulsbo, Washington  98370
Franciscan Cancer Center at St. Joseph Medical Center Tacoma, Washington  98405-3004
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center Green Bay, Wisconsin  54311
Aurora Medical Center Summit, Wisconsin  53066
Vince Lombardi Cancer Clinic - Two Rivers Two Rivers, Wisconsin  54241
Woman's Hospital Baton Rouge, Louisiana  70815
Fox Chase Cancer Center CCOP Research Base Philadelphia, Pennsylvania  19140
Seattle Cancer Care Alliance Seattle, Washington  98109
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
Morton Plant Hospital Clearwater, Florida  33756
John H. Stroger, Jr. Hospital of Cook County Chicago, Illinois  60612-9985
Community Hospital Munster, Indiana  46321
Methodist Hospital Houston, Texas  77030
Aurora Sinai Medical Center Milwaukee, Wisconsin  53201-0342
St. Joseph Hospital Regional Cancer Center - Orange Orange, California  92868-3849
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
St. Vincent's Medical Center Bridgeport, Connecticut  06606
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Elliot Regional Cancer Center at Elliot Hospital Manchester, New Hampshire  03103
Tucker Center for Cancer Care at Orange Regional Medical Center Middletown, New York  10940-4199
Bethesda North Hospital Cincinnati, Ohio  45242
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Union Hospital of Cecil County Elkton MD, Maryland  21921
Duke Cancer Institute Durham, North Carolina  27710
Cancer Centers of the Carolinas - Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Pacific Gynecology Specialists Seattle, Washington  98104
Cancer Centers of the Carolinas - Eastside Greenville, South Carolina  29601
MBCCOP - Meharry Medical College - Nashville Nashville, Tennessee  37208-3599
Providence Cancer Center Anchorage, Alaska  99508
Rockwood Clinic Cancer Treatment Center Spokane, Washington  99204-2967
Solano Radiation Oncology Center Vacaville, California  95687
Tyler Cancer Center Tyler, Texas  75702
Gynecologic Oncology Hinsdale, Illinois  60521
Women's Cancer Center - La Canada Las Vegas, Nevada  89169
Good Samaritan Hospital Cancer Treatment Center Cincinnati, Ohio  45220
Mercy General Hospital Sacramento, California  95819
Valley Hospital - Ridgewood Ridgewood, New Jersey  07450
United States Air Force Medical Center - Wright-Patterson Wright-Patterson AFB, Ohio  45433-5529
Cancer Center of Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
CCOP - Main Line Health Wynnewood, Pennsylvania  19096
AnMed Cancer Center Anderson, South Carolina  29621
U.T. Medical Center Cancer Institute Knoxville, Tennessee  37920-6999
Fountain Valley, California  92708
Olive View - UCLA Medical Center Foundation Sylmar, California  91342
University of Colorado Cancer Center at UC Health Sciences Center Aurora, Colorado  80045
Cancer Centers of North Carolina - Raleigh Raleigh, North Carolina  27607
Jersey Shore Cancer Center at Jersey Shore University Medical Center Neptune, New Jersey  07754-0397
Duke Health Raleigh Hospital Raleigh, North Carolina  27609
Northwest Hospital and Medical Center Seattle, Washington  98133
Cancer Care Center at John Muir Health - Concord Campus Concord, California  94524-4110
Cancer Centers of the Carolinas - Greer Radiation Oncology Greer, South Carolina  29650
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Lakeview Hospital Stillwater, Minnesota  55082
West Texas Cancer Center Odessa, Texas  79761
Central Georgia Gynecologic Oncology Macon, Georgia  31201
Oncology Hematology Care, Incorporated - Blue Ash Cincinnati, Ohio  45242
St. Mary Regional Cancer Center at St. Mary Medical Center Walla Walla, Washington  99362
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Centers - Cameron Park Cameron Park, California  95682
Radiation Oncology Center - Roseville Roseville, California  95661
Harrison Medical Center Bremerton, Washington  98310
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
Kaiser Permanente - Division of Research - Oakland Oakland, California  94611
Rohnert Park Cancer Center Rohnert Park, California  94928
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
Florida Gynecologic Oncology - Fort Myers Fort Myers, Florida  33905
Gynecologic Oncology of West Michigan Grand Rapids, Michigan  49546
Southwest Gynecologic Oncology Associates, Incorporated Albuquerque, New Mexico  87102
Women's Cancer Care Associates Albany, New York  12208
Black Hills Obstetrics & Gynecology LLP Rapid City, South Dakota  57701
Aurora Women's Pavilion of West Allis Memorial Hospital West Allis, Wisconsin  53227
Vince Lombardi Cancer Clinic - Oshkosh Oshkosh, Wisconsin  54904
Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center Burbank, California  91505
Tufts Medical Center Cancer Center Boston, Massachusetts  02111
Longview Cancer Center Longview, Texas  75601
Chattanooga GYN-Oncology Chattanooga, Tennessee  37403
Central Dupage Cancer Center Warrenville, Illinois  60555
University of New Mexico Cancer Center - South Las Cruces, New Mexico  88011
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
Roger Maris Cancer Center at MeritCare Hospital Fargo, North Dakota  58122
Central Indiana Cancer Centers - East Indianapolis, Indiana  46219
Willamette Valley Cancer Center - Eugene Eugene, Oregon  97401
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
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
Women's Cancer Associates Saint Petersburg, Florida  33701
New York Hospital Medical Center of Queens - Fresh Meadows Fresh Meadows, New York  11365
Arizona Oncology - Tucson Tucson, Arizona  85704
Arizona Cancer Center at University Medical Center North Tucson, Arizona  85719
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331
Providence Regional Cancer Partnership Everett, Washington  98201
St. Vincent Oncology Center Indianapolis, Indiana  46260
Texas Oncology, PA at Texas Cancer Center - Arlington South Arlington, Texas  76014
All Saints Episcopal Hospital - Fort Worth Fort Worth, Texas  76104
Leonard Lawson Cancer Center at Pikeville Medical Center Pikeville, Kentucky  41501
Women's Institute for Gynecologic Cancer and Special Pelvic Surgery Phillipsburg, New Jersey  08865
PeaceHealth Medical Group, PC at St. Joseph Hospital Bellingham, Washington  98226
Olympic Medical Cancer Center Sequim, Washington  98382