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A Phase III Trial of Short Term Androgen Deprivation With Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy


Phase 3
18 Years
N/A
Open (Enrolling)
Male
Prostate Cancer

Thank you

Trial Information

A Phase III Trial of Short Term Androgen Deprivation With Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients With a Rising PSA After Radical Prostatectomy


OBJECTIVES:

Primary

- To determine whether the addition of short-term androgen deprivation (STAD) to prostate
bed radiotherapy (PBRT) improves freedom from progression (FFP) (i.e., maintenance of a
prostate-specific antigen [PSA] less than the nadir+2 ng/mL, absence of clinical
failure, and absence of death from any cause) for 5 years, over that of PBRT alone in
men treated with salvage radiotherapy after radical prostatectomy.

- To determine whether STAD, pelvic lymph node radiotherapy (PLNRT), and PBRT improves
FFP over that of STAD+PBRT and PBRT alone in men treated with salvage radiotherapy
after radical prostatectomy.

Secondary

- To compare the rates of a PSA ≥ 0.4 ng/mL and rising at 5 years after randomization
(secondary biochemical failure endpoint), the development of hormone-refractory disease
(3 rises in PSA during treatment with salvage androgen-deprivation therapy), distant
metastasis, cause-specific mortality, and overall mortality.

- To compare acute and late morbidity based on Common Toxicity Criteria for Adverse
Effects (CTCAE), v. 3.0.

- To measure the expression of cell kinetic, apoptotic pathway, and angiogenesis-related
genes in archival diagnostic tissue to better define the risk of FFP, distant failure,
cause-specific mortality, and overall mortality after salvage radiotherapy for prostate
cancer, independently of conventional clinical parameters now used.

- To quantify blood product-based proteomic and genomic (single nucleotide polymorphisms)
patterns and urine-based genomic patterns before and at different times after treatment
to better define the risk of FFP, distant failure, cause-specific mortality, and
overall mortality after salvage radiotherapy for prostate cancer, independently of
conventional clinical parameters now used.

- To assess the degree, duration, and significant differences of disease-specific
health-related quality of life (HRQOL) decrements among treatment arms.

- To assess whether mood is improved and depression is decreased with the more aggressive
therapy if it improves FFP.

- To collect paraffin-embedded tissue blocks, serum, plasma, urine, and buffy coat cells
for future translational research analyses.

Tertiary

- To assess whether an incremental gain in FFP and survival with more aggressive therapy
outweighs decrements in the primary generic domains of HRQOL (i.e., mobility, self
care, usual activities, pain/discomfort, and anxiety/depression).

- To evaluate the cost-utility of the treatment arm demonstrating the most significant
benefit (in terms of the primary outcome) in comparison with other widely accepted
cancer and non-cancer therapies.

- To assess associations between serum levels of beta-amyloid and measures of cognition
and mood and depression.

- An exploratory aim is to assess the relationship(s) between the American Urological
Association Symptom Index (AUA SI) and urinary morbidity using the CTCAE v. 3.0 grading
system.

OUTLINE: Patients are stratified according to seminal vesicle involvement (yes vs no),
prostatectomy Gleason score (≤ 7 vs 8-9), pre-radiotherapy PSA (≥ 0.1 and ≤ 1.0 ng/mL vs >
1.0 and < 2.0 ng/mL), and pathology stage (pT2 and margin negative vs all others). Patients
are randomized to 1 of 3 treatment arms.

- Arm I (prostate bed radiotherapy [PBRT] alone): Patients undergo PBRT once daily, 5
days a week, Monday through Friday, for approximately 7-8 weeks (36 to 39 fractions).

- Arm II (PBRT and short-term androgen-deprivation [STAD]): Beginning 2 months before the
start of PBRT, patients undergo STAD, using a combination of antiandrogen and
luteinizing hormone-releasing hormone (LHRH) agonist therapy, for a total of 4-6
months. Patients receive antiandrogen therapy comprising either oral flutamide 3 times
daily or oral bicalutamide once daily for at least 4 months (started within 1-14 days
prior to the LHRH agonist and ending the last day of radiotherapy ± 14 days). Patients
receive LHRH agonist injection beginning concurrently with or 2 weeks after the start
of antiandrogen therapy. LHRH agonist injection consists of analogs approved by the FDA
(or by Health Canada for Canadian institutions) (e.g., leuprolide, goserelin,
buserelin, or triptorelin) and may be given in any possible combination (may be given
as a single 4-month injection and one to two 1-month injection[s], two 3-month
injections, or a 6-month injection), such that the total LHRH agonist treatment time is
4-6 months. Approximately 2 months after beginning of STAD, patients undergo PBRT as in
arm I.

- Arm III (Pelvic lymph node radiotherapy [PLNRT], PBRT, and STAD): Beginning 2 months
before the start of radiotherapy, patients receive STAD therapy as in arm II.
Approximately 2 months after beginning of STAD, patients undergo PBRT and PLNRT once
daily, 5 days a week, Monday through Friday, for approximately 5 weeks (25 fractions)
followed by PBRT only once daily, 5 days a week for approximately 2-3 weeks (11-14
fractions).

Patients complete the American Urological Association Symptom Index (AUA SI) questionnaire
prior to protocol treatment, at week 6 of radiotherapy, and then periodically after
completion of study therapy.

After completion of study therapy, patients are followed up every 3 months for 1 year, every
6 months for 4 years, and then annually thereafter.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Adenocarcinoma of the prostate treated primarily with radical prostatectomy

- Pathologically proven to be lymph node-negative by pelvic lymphadenectomy (N0)
or lymph node status pathologically unknown (Nx [undissected pelvic lymph nodes
because lymph node dissection is not required])

- Any type of radical prostatectomy allowed, including retropubic, perineal,
laparoscopic, or robotically assisted

- Meets 1 of the following pathologic classifications:

- T3 N0/Nx disease with or without positive prostatectomy margins

- T2 N0/Nx disease with or without positive prostatectomy margins

- N1 patients are ineligible, as are those with pelvic lymph node enlargement ≥
1.5 cm in greatest dimension by CT scan or MRI of the pelvis, unless the
enlarged lymph node is negative

- Prostatectomy Gleason score of 9 or less

- A post-radical prostatectomy entry PSA of ≥ 0.1 and ≤ 1.0 ng/mL at least 6 weeks
after prostatectomy and within 30 days of registration

- Serum total testosterone ≥ 40% of the lower limit of normal (patients who have had a
unilateral orchiectomy are eligible as long as this requirement is met)

- No distant metastases based on history/physical examination, CT scan or MRI of the
abdomen and pelvis, and bone scan

- No palpable prostatic fossa abnormality/mass suggestive of recurrence, unless shown
by biopsy under ultrasound guidance not to contain cancer

PATIENT CHARACTERISTICS:

- Zubrod performance status 0-1

- Platelets ≥ 100,000/mm^3

- Hemoglobin ≥ 10.0 g/dL (the use of transfusion or other intervention to achieve this
is allowed)

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2 x upper limit
of normal

- No prior invasive malignancy (except nonmelanoma skin cancer) or superficial bladder
cancer unless disease free for a minimum of 5 years (e.g., carcinoma in situ of the
oral cavity is permissible)

- No severe, active co-morbidity, including any of the following:

- History of inflammatory bowel disease

- History of hepatitis B or C

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

- Transmural myocardial infarction within the past 6 months

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

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy at the time of
registration

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- Acquired immune deficiency syndrome (AIDS) based upon current Centers for
Disease Control (CDC) definition

- HIV testing is not required for entry

- No prior allergic reaction to the study drug(s) involved in this protocol

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- More than 5 years since prior chemotherapy for any other disease site

- No androgen-deprivation therapy started prior to prostatectomy for > 6 months
duration

- The use of finasteride or dutasteride (± tamsulosin) for longer periods prior to
prostatectomy is acceptable

- No androgen-deprivation therapy started after prostatectomy and prior to registration

- The use of finasteride or dutasteride (± tamsulosin) after prostatectomy is not
acceptable, it must be stopped within 3 months after prostatectomy

- No neoadjuvant chemotherapy before or after prostatectomy

- No prior cryosurgery or brachytherapy of the prostate (prostatectomy should be the
primary treatment and not a salvage procedure)

- No prior pelvic radiotherapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Freedom from progression (FFP)

Outcome Time Frame:

From date of randomization to the first occurrence of biochemical failure by the Phoenix definition (PSA >= 2 ng/ml over the nadir PSA), clinical failure (local, regional or distant) or death from any cause.

Safety Issue:

No

Principal Investigator

Alan Pollack, MD, PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Fox Chase Cancer Center

Authority:

United States: Federal Government

Study ID:

RTOG 0534

NCT ID:

NCT00567580

Start Date:

February 2008

Completion Date:

Related Keywords:

  • Prostate Cancer
  • stage IIB prostate cancer
  • stage IIA prostate cancer
  • stage III prostate cancer
  • adenocarcinoma of the prostate
  • Prostatic Neoplasms

Name

Location

Roswell Park Cancer Institute Buffalo, New York  14263
Memorial Sloan-Kettering Cancer Center New York, New York  10021
University of Michigan Comprehensive Cancer Center Ann Arbor, Michigan  48109-0752
Mayo Clinic Cancer Center Rochester, Minnesota  55905
Cardinal Bernardin Cancer Center at Loyola University Medical Center Maywood, Illinois  60153-5500
University of Chicago Cancer Research Center Chicago, Illinois  60637
Cleveland Clinic Cancer Center Cleveland, Ohio  44195
CCOP - Upstate Carolina Spartanburg, South Carolina  29303
CCOP - Wichita Wichita, Kansas  67214-3882
Hurley Medical Center Flint, Michigan  48503
CCOP - Missouri Valley Cancer Consortium Omaha, Nebraska  68131
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
CCOP - Iowa Oncology Research Association Des Moines, Iowa  50309-1016
Beth Israel Deaconess Medical Center Boston, Massachusetts  02215
CCOP - Metro-Minnesota Saint Louis Park, Minnesota  55416
Aurora Presbyterian Hospital Aurora, Colorado  80012
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Presbyterian - St. Luke's Medical Center Denver, Colorado  80218
St. Joseph Hospital Denver, Colorado  80218
Swedish Medical Center Englewood, Colorado  80110
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
George Bray Cancer Center at the Hospital of Central Connecticut - New Britain Campus New Britain, Connecticut  06050
Mercy Medical Center - Sioux City Sioux City, Iowa  51104
Siouxland Hematology-Oncology Associates, LLP Sioux City, Iowa  51101
St. Luke's Regional Medical Center Sioux City, Iowa  51104
CCOP - Michigan Cancer Research Consortium Ann Arbor, Michigan  48106
Saint Joseph Mercy Cancer Center Ann Arbor, Michigan  48106-0995
Oakwood Cancer Center at Oakwood Hospital and Medical Center Dearborn, Michigan  48123-2500
Genesys Hurley Cancer Institute Flint, Michigan  48503
Van Elslander Cancer Center at St. John Hospital and Medical Center Grosse Pointe Woods, Michigan  48236
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Sparrow Regional Cancer Center Lansing, Michigan  48912-1811
St. John Macomb Hospital Warren, Michigan  48093
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
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
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
Natalie Warren Bryant Cancer Center at St. Francis Hospital Tulsa, Oklahoma  74136
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center Wilkes-Barre, Pennsylvania  18711
University of Wisconsin Paul P. Carbone Comprehensive Cancer Center Madison, Wisconsin  53792-6164
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
CCOP - Ochsner New Orleans, Louisiana  70121
Rapid City Regional Hospital Rapid City, South Dakota  57709
Veterans Affairs Medical Center - Long Beach Long Beach, California  90822
CCOP - Bay Area Tumor Institute Oakland, California  94609-3305
Memorial Hospital of South Bend South Bend, Indiana  46601
Cape Cod Hospital Hyannis, Massachusetts  02601
CCOP - Montana Cancer Consortium Billings, Montana  59101
New York Methodist Hospital Brooklyn, New York  11215-3609
CCOP - Columbus Columbus, Ohio  43206
Albert Einstein Cancer Center Philadelphia, Pennsylvania  19141
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
CCOP - Northern Indiana CR Consortium South Bend, Indiana  46601
Saint Joseph Regional Medical Center South Bend, Indiana  46617
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire  03756-0002
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill Chapel Hill, North Carolina  27599-7570
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
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
USC/Norris Comprehensive Cancer Center and Hospital Los Angeles, California  90033-0804
MBCCOP - LSU Health Sciences Center New Orleans, Louisiana  70112
CCOP - Virginia Mason Research Center Seattle, Washington  98101
CCOP - Northwest Tacoma, Washington  98405-0986
Utah Valley Regional Medical Center - Provo Provo, Utah  84604
Veterans Affairs Medical Center - Richmond Richmond, Virginia  23249
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
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
St. Vincent Mercy Medical Center Toledo, Ohio  43608
Bellin Memorial Hospital Green Bay, Wisconsin  54301
Josephine Ford Cancer Center at Henry Ford Hospital Detroit, Michigan  48202
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
McDowell Cancer Center at Akron General Medical Center Akron, Ohio  44307
Lake/University Ireland Cancer Center Mentor, Ohio  44060
CCOP - Toledo Community Hospital Toledo, Ohio  43623-3456
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
University of Florida Shands Cancer Center Gainesville, Florida  32610-0232
Baptist-South Miami Regional Cancer Program Miami, Florida  33176
Florida Hospital Cancer Institute at Florida Hospital Orlando Orlando, Florida  32803-1273
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
Via Christi Cancer Center at Via Christi Regional Medical Center Wichita, Kansas  67214
Mission Hospitals - Memorial Campus Asheville, North Carolina  28801
Medical University of Ohio Cancer Center Toledo, Ohio  43614
Toledo Hospital Toledo, Ohio  43606
Hollings Cancer Center at Medical University of South Carolina Charleston, South Carolina  29425
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas Dallas, Texas  75390
Naval Medical Center - Portsmouth Portsmouth, Virginia  23708-2197
St. Vincent Hospital Regional Cancer Center Green Bay, Wisconsin  54307-3508
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
Bay Area Cancer Care Center at Bay Area Medical Center Marinette, Wisconsin  54143
Somerset Medical Center Somerville, New Jersey  08876
Parma Community General Hospital Parma, Ohio  44129
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
William Beaumont Hospital - Royal Oak Campus Royal Oak, Michigan  48073
Adena Regional Medical Center Chillicothe, Ohio  54601
Doctors Hospital at Ohio Health Columbus, Ohio  43228
Riverside Methodist Hospital Cancer Care Columbus, Ohio  43214
Grady Memorial Hospital Delaware, Ohio  43015
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
Logan Regional Hospital Logan, Utah  84321
Utah Cancer Specialists at UCS Cancer Center Salt Lake City, Utah  84106
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Veterans Affairs Medical Center - Hines Hines, Illinois  60141
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
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center Los Angeles, California  90048-1865
UCSF Helen Diller Family Comprehensive Cancer Center San Francisco, California  94115
Lucille P. Markey Cancer Center at University of Kentucky Lexington, Kentucky  40536-0093
Tulane Cancer Center Office of Clinical Research Alexandria, Louisiana  71315-3198
Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute Boston, Massachusetts  02115
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis St. Louis, Missouri  63110
CCOP - Nevada Cancer Research Foundation Las Vegas, Nevada  89109-2306
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
St. Luke's - Roosevelt Hospital Center - St.Luke's Division New York, New York  10027
Oklahoma University Cancer Institute Oklahoma City, Oklahoma  73104
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
West Virginia University Health Sciences Center - Charleston Charleston, West Virginia  25302
Gundersen Lutheran Center for Cancer and Blood La Crosse, Wisconsin  54601
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
Robert H. Lurie Comprehensive Cancer Center at Northwestern University Chicago, Illinois  60611
Decatur Memorial Hospital Cancer Care Institute Decatur, Illinois  62526
Leonard C. Ferguson Cancer Center Freeport, Illinois  61032
Elkhart General Hospital Elkhart, Indiana  46515
Howard Community Hospital Kokomo, Indiana  46904
Lakeland Regional Cancer Care Center - St. Joseph St. Joseph, Michigan  49085
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Marlton Marlton, New Jersey  08053
Fox Chase Virtua Health Cancer Program at Virtua West Jersey Voorhees, New Jersey  08043
Cleveland Clinic Cancer Center at Fairview Hospital Cleveland, Ohio  44111
Mount Carmel Health - West Hospital Columbus, Ohio  43222
Hillcrest Cancer Center at Hillcrest Hospital Mayfield Heights, Ohio  44124
Rosenfeld Cancer Center at Abington Memorial Hospital Abington, Pennsylvania  19001
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
Fox Valley Hematology and Oncology - East Grant Street Appleton, Wisconsin  54911-3496
All Saints Cancer Center at Wheaton Franciscan Healthcare Racine, Wisconsin  53405
Peninsula Medical Center Burlingame, California  94010
Sutter Health - Western Division Cancer Research Group Greenbrae, California  94904
Alta Bates Summit Medical Center - Summit Campus Oakland, California  94609
California Pacific Medical Center - California Campus San Francisco, California  94118
Sutter Solano Medical Center Vallejo, California  94589
Piedmont Hospital Atlanta, Georgia  30309
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Ingalls Cancer Care Center at Ingalls Memorial Hospital Harvey, Illinois  60426
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
Cancer Center of Kansas, PA - Dodge City Dodge City, Kansas  67801
Mary Bird Perkins Cancer Center - Baton Rouge Baton Rouge, Louisiana  70809
Medical Center of Louisiana - New Orleans New Orleans, Louisiana  70112
Hickman Cancer Center at Bixby Medical Center Adrian, Michigan  49221
Immanuel Medical Center Omaha, Nebraska  68122
Creighton University Medical Center Omaha, Nebraska  68131-2197
Kingsbury Center for Cancer Care at Cheshire Medical Center Keene, New Hampshire  03431
Cancer Institute of New Jersey at Cooper - Voorhees Voorhees, New Jersey  08043
Highland Hospital of Rochester Rochester, New York  14620
Lima Memorial Hospital Lima, Ohio  45804
Northwest Ohio Oncology Center Maumee, Ohio  43537
St. Charles Mercy Hospital Oregon, Ohio  43616
North Coast Cancer Care, Incorporated Sandusky, Ohio  44870
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Toledo Clinic, Incorporated - Main Clinic Toledo, Ohio  43623
Cleveland Clinic - Wooster Wooster, Ohio  44691
Legacy Mount Hood Medical Center Gresham, Oregon  97030
Legacy Meridian Park Hospital Tualatin, Oregon  97062
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
St. Mary Regional Cancer Center Langhorne, Pennsylvania  19047
Lankenau Cancer Center at Lankenau Hospital Wynnewood, Pennsylvania  19096
Dixie Regional Medical Center - East Campus Saint George, Utah  84770
Danville Regional Medical Center Danville, Virginia  24541
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital Yakima, Washington  98902
Massachusetts General Hospital Boston, Massachusetts  02114-2617
Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital Fairbanks, Alaska  99701
St. Anthony Central Hospital Denver, Colorado  80204-1335
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
St. Francis Hospital Federal Way, Washington  98003
Good Samaritan Cancer Center Puyallup, Washington  98371
William W. Backus Hospital Norwich, Connecticut  06360
Lancaster General Hospital Lancaster, Pennsylvania  17604-3555
California Cancer Center - Woodward Park Office Fresno, California  93720
Providence Holy Cross Cancer Center Mission Hills, California  91346-9600
Middlesex Hospital Cancer Center Middletown, Connecticut  06457
Creticos Cancer Center at Advocate Illinois Masonic Medical Center Chicago, Illinois  60657
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Cancer Resource Center - Lincoln Lincoln, Nebraska  68510
Randolph Hospital Asheboro, North Carolina  27203
Moses Cone Regional Cancer Center at Wesley Long Community Hospital Greensboro, North Carolina  27401
Annie Penn Cancer Center Reidsville, North Carolina  27320
Altru Cancer Center at Altru Hospital Grand Forks, North Dakota  58201
Cancer Treatment Center Wooster, Ohio  44691
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
St. Joseph Medical Center Reading, Pennsylvania  19604
West Allis Memorial Hospital West Allis, Wisconsin  53227
UAB Comprehensive Cancer Center Birmingham, Alabama  35294
John B. Amos Cancer Center Columbus, Georgia  31904
Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler Savannah, Georgia  31405
Cancer Center of Kansas, PA - El Dorado El Dorado, Kansas  67042
Lawrence Memorial Hospital Lawrence, Kansas  66044
Cancer Center of Kansas, PA - Wellington Wellington, Kansas  67152
Cancer Center of Kansas, PA - Wichita Wichita, Kansas  67214
Associates in Womens Health, PA - North Review Wichita, Kansas  67208
Cancer Center of Kansas, PA - Medical Arts Tower Wichita, Kansas  67208
Cancer Center of Kansas, PA - Winfield Winfield, Kansas  67156
Greater Baltimore Medical Center Cancer Center Baltimore, Maryland  21204
Foote Memorial Hospital Jackson, Michigan  49201
St. Mary Mercy Hospital Livonia, Michigan  48154
St. Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Mercy Regional Cancer Center at Mercy Hospital Port Huron, Michigan  48060
Seton Cancer Institute at Saint Mary's - Saginaw Saginaw, Michigan  48601
St. Luke's Hospital Cancer Care Center Duluth, Minnesota  55805
Willmar Cancer Center at Rice Memorial Hospital Willmar, Minnesota  56201
Billings Clinic - Downtown Billings, Montana  59107-7000
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
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
Grant Medical Center Cancer Care Columbus, Ohio  43215
Hematology Oncology Center Elyria, Ohio  44035
Community Cancer Center Elyria, Ohio  44035
Flower Hospital Cancer Center Sylvania, Ohio  43560
St. Anne Mercy Hospital Toledo, Ohio  43623
Mount Carmel St. Ann's Cancer Center Westerville, Ohio  43081
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
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
St. Joseph Cancer Center Bellingham, Washington  98225
Franciscan Cancer Center at St. Joseph Medical Center Tacoma, Washington  98405-3004
Legacy Salmon Creek Medical Center Vancouver, Washington  98686
Aurora Medical Center Summit, Wisconsin  53066
Rocky Mountain Oncology Casper, Wyoming  82609
FirstHealth Moore Regional Community Hospital Comprehensive Cancer Center Pinehurst, North Carolina  28374
Regional Cancer Center at Memorial Medical Center Springfield, Illinois  62781-0001
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
Washington Township Hospital Fremont, California  94538
Radiological Associates of Sacramento Medical Group, Incorporated Sacramento, California  95815
Queen's Cancer Institute at Queen's Medical Center Honolulu, Hawaii  96813
Parkview Regional Cancer Center at Parkview Health Fort Wayne, Indiana  46805
Lowell General Hospital Lowell, Massachusetts  01854
Rex Cancer Center at Rex Hospital Raleigh, North Carolina  27607
Three Rivers Community Hospital Grants Pass, Oregon  97527
Dubs Cancer Center at Rogue Valley Medical Center Medford, Oregon  97504
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Martha Jefferson Hospital Cancer Care Center Charlottesville, Virginia  22901
Theda Care Cancer Institute Appleton, Wisconsin  54911
Community Memorial Hospital Cancer Care Center Menomonee Falls, Wisconsin  53051
Regional Cancer Center at Oconomowoc Memorial Hospital Oconomowoc, Wisconsin  53066
Dana-Farber/Brigham and Women's Cancer Center Boston, Massachusetts  02115
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Faris Road Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Greer Medical Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Cancer Institute at St. John's Hospital Springfield, Illinois  62701
Cancer Centers of the Carolinas - Eastside Greenville, South Carolina  29601
West Tennessee Cancer Center at Jackson-Madison County General Hospital Jackson, Tennessee  38301
Sentara Cancer Institute at Sentara Norfolk General Hospital Norfolk, Virginia  23507
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
Franklin & Edith Scarpa Regional Cancer Center at South Jersey Healthcare Vineland, New Jersey  08360
Lipson Cancer and Blood Center at Rochester General Hospital Rochester, New York  14621
Tyler Cancer Center Tyler, Texas  75702
Doctors Medical Center - San Pablo Campus San Pablo, California  94806
Boston University Cancer Research Center Boston, Massachusetts  02118
Mercy General Hospital Sacramento, California  95819
East Bay Radiation Oncology Center Castro Valley, California  94546
Contra Costa Regional Medical Center Martinez, California  94553-3156
Memorial Medical Center Modesto, California  95355
El Camino Hospital Cancer Center Mountain View, California  94040
Larry G Strieff MD Medical Corporation Oakland, California  94609
Tom K Lee, Incorporated Oakland, California  94609
Bay Area Breast Surgeons, Incorporated Oakland, California  94609
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Straub Clinic and Hospital, Incorporated Honolulu, Hawaii  96813
Hawaii Medical Center - East Honolulu, Hawaii  96817
Pacific Cancer Institute - Maui Wailuku, Hawaii  96793
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus Moline, Illinois  61265
Center for Cancer Care at Exeter Hospital Exeter, New Hampshire  03833
Valley Hospital - Ridgewood Ridgewood, New Jersey  07450
Cancer Center of Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
CCOP - Main Line Health Wynnewood, Pennsylvania  19096
AnMed Cancer Center Anderson, South Carolina  29621
Franciscan Skemp Healthcare - La Crosse Campus La Crosse, Wisconsin  54601
Cancer Care Center, Incorporated Salem, Ohio  44460
University of Colorado Cancer Center at UC Health Sciences Center Aurora, Colorado  80045
Center for Cancer Care at Goshen General Hospital Goshen, Indiana  46526
UPMC Cancer Center at UPMC Presbyterian Pittsburgh, Pennsylvania  15213
Cancer Institute of Cape Girardeau, LLC Cape Girardeau, Missouri  63703
Providence Cancer Center at PMCC Medford, Oregon  97504
Veterans Affairs Medical Center - Milwaukee Milwaukee, Wisconsin  53295
Central Maryland Oncology Center Columbia, Maryland  21044
Valley Medical Oncology Consultants - Castro Valley Castro Valley, California  94546
Valley Medical Oncology Fremont, California  94538
Cancer Care Associates Fresno, California  93720
Integrated Community Oncology Network - Orange Park Orange Park, Florida  32073
Mount Sinai Hospital Medical Center Chicago, Illinois  60608
Hudner Oncology Center at Saint Anne's Hospital - Fall River Fall River, Massachusetts  02721
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
Cancer Centers of the Carolinas - Greer Radiation Oncology Greer, South Carolina  29650
Minnesota Oncology - Maplewood Maplewood, Minnesota  55109
Humphrey Cancer Center at North Memorial Outpatient Center Robbinsdale, Minnesota  55422-2900
Minnesota Oncology - Woodbury Woodbury, Minnesota  55125
UPMC Cancer Center at Beaver Medical Center Beaver, Pennsylvania  15009
UPMC Cancer Center at Jefferson Regional Medical Center Clairton, Pennsylvania  15025
UPMC Cancer Center - Arnold Palmer Pavilion Greensburg, Pennsylvania  15601
UPMC Cancer Center at the John P. Murtha Pavilion Johnstown, Pennsylvania  15901
UPMC - Moon Moon Township, Pennsylvania  15108
UPMC Cancer Center - Natrona Heights Natrona Heights, Pennsylvania  15065
Jameson Memorial Hospital - North Campus New Castle, Pennsylvania  16105
UPMC - Shadyside Pittsburgh, Pennsylvania  15213-2582
UPMC Cancer Center at UPMC St. Margaret Pittsburgh, Pennsylvania  15215
UPMC Cancer Center at UPMC Passavant Pittsburgh, Pennsylvania  15237
Washington Hospital Cancer Center Washington, Pennsylvania  15301
Emory Crawford Long Hospital Atlanta, Georgia  30308
Holy Cross Hospital Silver Spring, Maryland  20910
New York Oncology Hematology, PC at Albany Regional Cancer Care Albany, New York  12208
Central Wisconsin Cancer Program at Agnesian HealthCare Fond du Lac, Wisconsin  54935
Auburn Radiation Oncology Auburn, California  95603
Radiation Oncology Centers - Cameron Park Cameron Park, California  95682
Radiation Oncology Center - Roseville Roseville, California  95661
Hudson Valley Oncology Associates Poughkeepsie, New York  12601
Inova Alexandria Hospital Alexandria, Virginia  22304
Mercy Cancer Center at Mercy San Juan Medical Center Carmichael, California  95608
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
Barnes-Jewish West County Hospital Saint Louis, Missouri  63141
Siteman Cancer Center at Barnes-Jewish St. Peters Hospital - St. Peters Saint Peters, Missouri  63376
Sands Cancer Center Canandiaqua, New York  14424
University Radiation Oncology at Parkridge Hospital Rochester, New York  14626
Coleman Radiation Oncology Center at Carter General Hospital Morehead City, North Carolina  28557
CarolinaEast Cancer Care New Bern, North Carolina  28560
South Atlantic Radiation Oncology, LLC Supply, North Carolina  28462
Coastal Carolina Radiation Oncology Center Wilmington, North Carolina  28401
Norris Cotton Cancer Center - North Saint Johnsbury, Vermont  05819
Langlade Memorial Hospital Antigo, Wisconsin  54409
Integrated Community Oncology Network at Southside Cancer Center Jacksonville, Florida  32207
Southwest General Health Center Middleburgh Heights, Ohio  44130
UHHS Chagrin Highlands Medical Center Orange Villager, Ohio  44122
UHHS Westlake Medical Center Westlaker, Ohio  44145
Longview Cancer Center Longview, Texas  75601
Piedmont Fayette Hospital Fayetteville, Georgia  30214
Lakeside Hospital Omaha, Nebraska  68130
University of New Mexico Cancer Center - South Las Cruces, New Mexico  88011
Cleveland Clinic Foundation - Strongsville Strongsville, Ohio  44136
Riverview UW Cancer Center at Riverview Hospital Wisconsin Rapids, Wisconsin  54494
Roger Maris Cancer Center at MeritCare Hospital Fargo, North Dakota  58122
Capital Health Regional Cancer Center Trenton, New Jersey  08618
Dyson Center for Cancer Care at Vassar Brothers Medical Center Poughkeepsie, New York  12601-3990
AtlantiCare Cancer Care Institute at AtlantiCare Regional Medical Center - Mainland Campus Pomona, New Jersey  08240
Saint Helena Hospital Saint Helena, California  94574
Northeast Radiation Oncology Center Dunmore, Pennsylvania  18512
New Mexico Cancer Center Albuquerque, New Mexico  87109
Southern Ohio Medical Center Cancer Center Portsmouth, Ohio  45662
Arizona Center for Cancer Care - Peoria Peoria, Arizona  85381
Feather River Hospital Cancer Center Paradise, California  95969
Radiation Oncology Associates Southwest Fort Wayne, Indiana  46804
Henry Ford Macomb Hospital Clinton Township, Michigan  48038
McLaren Cancer Institute Flint, Michigan  48532
Willamette Valley Cancer Center - Eugene Eugene, Oregon  97401
Intercommunity Cancer Center Monroeville, Pennsylvania  15146
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 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
Alle-Kiski Medical Center Natrona Heights, Pennsylvania  15065
Memorial Sloan-Kettering Cancer Center at Phelps Memorial Hospital Center Sleepy Hollow, New York  10591
Nebraska Medical Center Omaha, Nebraska  68198
Upper Delaware Valley Cancer Center Milford, Pennsylvania  18337
Arizona Oncology - Tucson Tucson, Arizona  85704
Rocky Mountain Cancer Centers - Aurora Aurora, Colorado  80012
Norton Suburban Hospital Louisville, Kentucky  40207
UPMC Cancer Center at UPMC McKeesport McKeesport, Pennsylvania  15132
UPMC Cancer Center - Upper St. Clair Pittsburgh, Pennsylvania  15243
Door County Cancer Center at Door County Memorial Hospital Sturgeon Bay, Wisconsin  54235-1495
Adams Cancer Center Gettysburg, Pennsylvania  17325
Tate Cancer Center at Baltimore Washington Medical Center Glen Burnie, Maryland  21061
Saint Elizabeth Cancer Institute at Saint Elizabeth Regional Medical Center Lincoln, Nebraska  68510
D.N. Greenwald Center Mukwonago, Wisconsin  53149
Coastal Cancer Center at Sentara Virginia Beach General Hospital Virginia Beach, Virginia  23454
Veterans Affairs Medical Center - Tampa Tampa, Florida  33612
Northside Hospital-Forsyth Cumming, Georgia  30041
Memorial Sloan-Kettering Cancer Center - Basking Ridge Basking Ridge, New Jersey  07920
Stich Radiation Center at NewYork-Presbyterian Hospital/Weill Cornell Medical Center New York, New York  10021
Memorial Sloan-Kettering Cancer Center - Rockville Centre Rockville Centre, New York  11570
Tony Teramana Cancer Center Steubenville, Ohio  43952
Hilton Head Radiation Oncology Center Hilton Head Island, South Carolina  29926
Memorial Hermann Hospital - Memorial City Houston, Texas  77024
Texas Oncology, PA - Wichita Falls Wichita Falls, Texas  76310
Beloit Memorial Hospital Beloit, Wisconsin  53511