Radiation Therapy (RT) and Temozolomide (TMZ) in Treating Patients With Newly Diagnosed Glioblastoma or Gliosarcoma

Last updated: May 20, 2020
Sponsor: Radiation Therapy Oncology Group
Overall Status: Completed

Phase

3

Condition

Astrocytoma

Gliomas

Glioblastoma Multiforme

Treatment

N/A

Clinical Study ID

NCT00304031
RTOG-0525
EORTC-22053
EORTC-26052
CDR0000465183
NCI-2009-00731
  • Ages 18-120
  • All Genders

Study Summary

RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy together with temozolomide may kill more tumor cells. It is not yet known which schedule of temozolomide when given together with radiation therapy is more effective in treating glioblastoma or gliosarcoma.

PURPOSE: This randomized phase III trial is studying two different schedules of temozolomide to compare how well they work when given together with radiation therapy in treating patients with newly diagnosed glioblastoma or gliosarcoma.

Eligibility Criteria

Inclusion

Inclusion criteria:

  1. Histopathologically proven diagnosis of glioblastoma. Since gliosarcoma is a variantof glioblastoma, gliosarcoma is also an eligible diagnosis.

  2. Patients must have at least 1 block of tissue available for analysis of MGMT status;fresh frozen tumor tissue acquisition is encouraged.

  3. Diagnosis must be established by open biopsy or tumor resection. Patients who haveonly had a stereotactic biopsy are not eligible.

  4. The tumor must have a supratentorial component.

  5. Patients must have recovered from the effects of surgery, postoperative infection, andother complications before study registration.

  6. A diagnostic contrast-enhanced magnetic resonance imaging (MRI) or computerizedtomography (CT) scan (if MRI is not available) of the brain must be performedpreoperatively and postoperatively. The postoperative scan must be done within 28 daysof registration and prior to the initiation of radiotherapy. Preoperative andpostoperative scans must be the same type. If CT scans were performed perioperatively,a CT and an MRI should be performed before randomization.

6.1. Patients unable to undergo MRI imaging because of non-compatible devices can beenrolled, provided pre- and post-operative contrast-enhanced CT scans are obtained andare of sufficient quality.

  1. Therapy must begin ≤ 5 weeks after the most recent brain tumor surgery.

  2. History/physical examination within 14 days prior to study registration.

  3. Neurologic examination within 14 days prior to study registration.

  4. Documentation of steroid doses within 14 days prior to study registration and stableor decreasing steroid dose within 5 days prior to registration.

  5. Karnofsky performance status of ≥ 60.

  6. Age ≥ 18 years.

  7. Complete blood count (CBC)/differential obtained within 14 days prior to studyregistration, with adequate bone marrow function as defined below: 13.1 Absoluteneutrophil count (ANC) ≥ 1500 cells/mm3. 13.2 Platelets ≥ 100,000 cells/mm3. 13.3Hemoglobin ≥ 10 g/dl. (Note: The use of transfusion or other intervention to achieveHgb ≥ 10 g/dl is acceptable.)

  8. Adequate renal function, as defined below:

14.1 Blood urea nitrogen (BUN) ≤ 25 mg/dl within 14 days prior to study registration 14.2 Creatinine ≤ 1.7 mg/dl within 14 days prior to study registration

  1. Adequate hepatic function, as defined below:

15.1 Bilirubin ≤ 2.0 mg/dl within 14 days prior to study registration 15.2 Alanineaminotransferase (ALT) ≤ 3 x normal range within 14 days prior to study registration 15.3 Aspartate aminotransferase (AST) ≤ 3 x normal range within 14 days prior to studyregistration

  1. Patients must sign a study-specific informed consent prior to study registration. If the patient's mental status precludes his/her giving informed consent, writteninformed consent may be given by the responsible family member.

  2. For females of child-bearing potential, negative serum pregnancy test within 72 hoursprior to starting temozolomide.

  3. Women of childbearing potential and male participants must practice adequate

Exclusion

Exclusion criteria:

  1. Prior invasive malignancy (except for non-melanomatous skin cancer) unless diseasefree for ≥ 3 years. (For example, carcinoma in situ of the breast, oral cavity, andcervix are all permissible).

  2. Recurrent or multifocal malignant gliomas

  3. Metastases detected below the tentorium or beyond the cranial vault.

  4. Prior chemotherapy or radiosensitizers for cancers of the head and neck region; notethat prior chemotherapy for a different cancer is allowable. Prior use of Gliadelwafers or any other intratumoral or intracavitary treatment are not permitted. SeeSection 1.

  5. Prior radiotherapy to the head or neck (except for T1 glottic cancer), resulting inoverlap of radiation fields.

  6. Severe, active co-morbidity, defined as follows:

  • 6.1. Unstable angina and/or congestive heart failure requiring hospitalization.

  • 6.2. Transmural myocardial infarction within the last 6 months.

  • 6.3. Acute bacterial or fungal infection requiring intravenous antibiotics at thetime of registration.

  • 6.4. Chronic Obstructive Pulmonary Disease exacerbation or other respiratoryillness requiring hospitalization or precluding study therapy at the time ofregistration.

  • 6.5. Hepatic insufficiency resulting in clinical jaundice and/or coagulationdefects; note, however, that laboratory tests for liver function and coagulationparameters are not required for entry into this protocol.

  • 6.6. Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers forDisease Control and Prevention (CDC) definition; note, however, that HIV testingis not required for entry into this protocol. The need to exclude patients withAIDS from this protocol is necessary because the treatments involved in thisprotocol may be significantly immunosuppressive.

  • 6.7. Major medical illnesses or psychiatric impairments that in theinvestigator's opinion will prevent administration or completion of protocoltherapy.

  • 6.8. Active connective tissue disorders, such as lupus or scleroderma, that inthe opinion of the treating physician may put the patient at high risk forradiation toxicity.

  1. Pregnancy or women of childbearing potential and men who are sexually active and notwilling/able to use medically acceptable forms of contraception; this exclusion isnecessary because the treatment involved in this study may be significantlyteratogenic.

  2. Pregnant or lactating women, due to possible adverse effects on the developing fetusor infant due to study drug;

  3. Prior allergic reaction to temozolomide.

  4. Patients treated on any other therapeutic clinical protocols within 30 days prior tostudy entry or during participation in the study.

  5. No tissue provided for histopathologic central review and MGMT status.

  6. Tissue provided by stereotactic biopsy method.

Study Design

Total Participants: 1173
Study Start date:
January 01, 2006
Estimated Completion Date:
December 31, 2016

Study Description

OBJECTIVES:

Primary

  • Determine if dose-intensifying (increasing the "dose-density") the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy as measured by overall survival of patients with newly diagnosed glioblastoma or gliosarcoma.

Secondary

  • Determine if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy as measured by progression-free survival.

  • Determine in patients with unmethylated MGMT (O-6-methylguanine-DNA methyltransferase) if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy (overall and progression-free survival) compared with patients receiving conventional temozolomide dosing.

  • Determine in patients with methylated MGMT if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy (overall and progression-free survival) compared with patients receiving conventional temozolomide dosing.

  • Determine if there is an association between tumor MGMT gene methylation status and treatment response.

  • Compare and record the toxicities of the conventional and dose-intense chemotherapy regimens.

  • Evaluate whether 6-month progression-free survival is associated with overall survival.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to recursive partitioning analysis class (III vs IV vs V), MGMT gene methylation status (methylated vs nonmethylated vs indeterminate), and radiotherapy criteria used (standard vs revised European).

After completion of study treatment, patients are followed every 3 months for 1 year, every 4 months for 2 years, and then every 6 months thereafter.

Connect with a study center

  • Tom Baker Cancer Centre - Calgary

    Calgary, Alberta T2N 4N2
    Canada

    Site Not Available

  • CancerCare Manitoba

    Winnipeg, Manitoba R3E 0V9
    Canada

    Site Not Available

  • Saint John Regional Hospital

    Saint John, New Brunswick E2L 4L2
    Canada

    Site Not Available

  • Margaret and Charles Juravinski Cancer Centre

    Hamilton, Ontario L8V 5C2
    Canada

    Site Not Available

  • Ottawa Hospital Regional Cancer Centre - General Campus

    Ottawa, Ontario K1Y 4K7
    Canada

    Site Not Available

  • Cancer Care Program at Thunder Bay Regional Health Sciences

    Thunder Bay, Ontario P7B 6V4
    Canada

    Site Not Available

  • Princess Margaret Hospital

    Toronto, Ontario M5G 2M9
    Canada

    Site Not Available

  • McGill Cancer Centre at McGill University

    Montreal, Quebec H2W 1S6
    Canada

    Site Not Available

  • Centre Hospitalier Universitaire de Quebec

    Quebec City, Quebec G1R 2J6
    Canada

    Site Not Available

  • Allan Blair Cancer Centre at Pasqua Hospital

    Regina, Saskatchewan S4T 7T1
    Canada

    Site Not Available

  • Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital

    Fairbanks, Alaska 99701
    United States

    Site Not Available

  • Arizona Oncology Services Foundation

    Phoenix, Arizona 85013
    United States

    Site Not Available

  • Mayo Clinic Scottsdale

    Scottsdale, Arizona 85259-5499
    United States

    Site Not Available

  • Arizona Oncology - Tucson

    Tucson, Arizona 85704
    United States

    Site Not Available

  • Auburn Radiation Oncology

    Auburn, California 95603
    United States

    Site Not Available

  • Providence Saint Joseph Medical Center - Burbank

    Burbank, California 91505
    United States

    Site Not Available

  • Radiation Oncology Centers - Cameron Park

    Cameron Park, California 95682
    United States

    Site Not Available

  • Mercy Cancer Center at Mercy San Juan Medical Center

    Carmichael, California 95608
    United States

    Site Not Available

  • City of Hope Comprehensive Cancer Center

    Duarte, California 91010-3000
    United States

    Site Not Available

  • Kaiser Permanente Medical Center - Los Angeles

    Los Angeles, California 90027
    United States

    Site Not Available

  • Radiation Oncology Center - Roseville

    Roseville, California 95661
    United States

    Site Not Available

  • Mercy General Hospital

    Sacramento, California 95819
    United States

    Site Not Available

  • Radiological Associates of Sacramento Medical Group, Incorporated

    Sacramento, California 95815
    United States

    Site Not Available

  • UCSF Helen Diller Family Comprehensive Cancer Center

    San Francisco, California 94115
    United States

    Site Not Available

  • Solano Radiation Oncology Center

    Vacaville, California 95687
    United States

    Site Not Available

  • Penrose Cancer Center at Penrose Hospital

    Colorado Springs, Colorado 80933
    United States

    Site Not Available

  • Poudre Valley Radiation Oncology

    Fort Collins, Colorado 80528
    United States

    Site Not Available

  • Yale Cancer Center

    New Haven, Connecticut 06520-8028
    United States

    Site Not Available

  • Tunnell Cancer Center at Beebe Medical Center

    Lewes, Delaware 19958
    United States

    Site Not Available

  • CCOP - Christiana Care Health Services

    Newark, Delaware 19713
    United States

    Site Not Available

  • Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main Campus

    Boca Raton, Florida 33486
    United States

    Site Not Available

  • University of Florida Shands Cancer Center

    Gainesville, Florida 32610-0232
    United States

    Site Not Available

  • Baptist Cancer Institute - Jacksonville

    Jacksonville, Florida 32207
    United States

    Site Not Available

  • Baptist Medical Center South

    Jacksonville, Florida 32258
    United States

    Site Not Available

  • Integrated Community Oncology Network at Southside Cancer Center

    Jacksonville, Florida 32207
    United States

    Site Not Available

  • Mayo Clinic - Jacksonville

    Jacksonville, Florida 32224
    United States

    Site Not Available

  • Integrated Community Oncology Network

    Jacksonville Beach, Florida 32250
    United States

    Site Not Available

  • Baptist Medical Center South

    Jascksonville, Florida 32258
    United States

    Site Not Available

  • Baptist-South Miami Regional Cancer Program

    Miami, Florida 33176
    United States

    Site Not Available

  • Integrated Community Oncology Network - Orange Park

    Orange Park, Florida 32073
    United States

    Site Not Available

  • Florida Cancer Center - Palatka

    Palatka, Florida 32177
    United States

    Site Not Available

  • Flagler Cancer Center

    Saint Augustine, Florida 32086
    United States

    Site Not Available

  • H. Lee Moffitt Cancer Center and Research Institute at University of South Florida

    Tampa, Florida 33612-9497
    United States

    Site Not Available

  • Piedmont Hospital

    Atlanta, Georgia 30309
    United States

    Site Not Available

  • John B. Amos Cancer Center

    Columbus, Georgia 31904
    United States

    Site Not Available

  • Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center

    Boise, Idaho 83706
    United States

    Site Not Available

  • Northwest Community Hospital

    Arlington Heights, Illinois 60005
    United States

    Site Not Available

  • Rush-Copley Cancer Care Center

    Aurora, Illinois 60504
    United States

    Site Not Available

  • St. Joseph Medical Center

    Bloomington, Illinois 61701
    United States

    Site Not Available

  • Graham Hospital

    Canton, Illinois 61520
    United States

    Site Not Available

  • Memorial Hospital

    Carthage, Illinois 62321
    United States

    Site Not Available

  • John H. Stroger, Jr. Hospital of Cook County

    Chicago, Illinois 60612-3785
    United States

    Site Not Available

  • University of Chicago Cancer Research Center

    Chicago, Illinois 60637-1470
    United States

    Site Not Available

  • Eureka Community Hospital

    Eureka, Illinois 61530
    United States

    Site Not Available

  • Galesburg Clinic, PC

    Galesburg, Illinois 61401
    United States

    Site Not Available

  • Galesburg Cottage Hospital

    Galesburg, Illinois 61401
    United States

    Site Not Available

  • InterCommunity Cancer Center of Western Illinois

    Galesburg, Illinois 61401
    United States

    Site Not Available

  • Mason District Hospital

    Havana, Illinois 62644
    United States

    Site Not Available

  • Hopedale Medical Complex

    Hopedale, Illinois 61747
    United States

    Site Not Available

  • Joliet Oncology-Hematology Associates, Limited - West

    Joliet, Illinois 60435
    United States

    Site Not Available

  • McDonough District Hospital

    Macomb, Illinois 61455
    United States

    Site Not Available

  • Cardinal Bernardin Cancer Center at Loyola University Medical Center

    Maywood, Illinois 60153
    United States

    Site Not Available

  • BroMenn Regional Medical Center

    Normal, Illinois 61761
    United States

    Site Not Available

  • Community Cancer Center

    Normal, Illinois 61761
    United States

    Site Not Available

  • Community Hospital of Ottawa

    Ottawa, Illinois 61350
    United States

    Site Not Available

  • Oncology Hematology Associates of Central Illinois, PC - Ottawa

    Ottawa, Illinois 61350
    United States

    Site Not Available

  • Cancer Treatment Center at Pekin Hospital

    Pekin, Illinois 61554
    United States

    Site Not Available

  • CCOP - Illinois Oncology Research Association

    Peoria, Illinois 61615
    United States

    Site Not Available

  • Methodist Medical Center of Illinois

    Peoria, Illinois 61636
    United States

    Site Not Available

  • OSF St. Francis Medical Center

    Peoria, Illinois 61615-7827
    United States

    Site Not Available

  • Oncology Hematology Associates of Central Illinois, PC - Peoria

    Peoria, Illinois 61615
    United States

    Site Not Available

  • Proctor Hospital

    Peoria, Illinois 61614
    United States

    Site Not Available

  • Illinois Valley Community Hospital

    Peru, Illinois 61354
    United States

    Site Not Available

  • Perry Memorial Hospital

    Princeton, Illinois 61356
    United States

    Site Not Available

  • St. Margaret's Hospital

    Spring Valley, Illinois 61362
    United States

    Site Not Available

  • Valley Cancer Center

    Spring Valley, Illinois 61362
    United States

    Site Not Available

  • CCOP - Carle Cancer Center

    Urbana, Illinois 61801
    United States

    Site Not Available

  • Carle Cancer Center at Carle Foundation Hospital

    Urbana, Illinois 61801
    United States

    Site Not Available

  • Elkhart General Hospital

    Elkhart, Indiana 46515
    United States

    Site Not Available

  • Parkview Regional Cancer Center at Parkview Health

    Fort Wayne, Indiana 46805
    United States

    Site Not Available

  • Radiation Oncology Associates Southwest

    Fort Wayne, Indiana 46804
    United States

    Site Not Available

  • Central Indiana Cancer Centers - East

    Indianapolis, Indiana 46219
    United States

    Site Not Available

  • Howard Community Hospital

    Kokomo, Indiana 46904
    United States

    Site Not Available

  • Center for Cancer Therapy at LaPorte Hospital and Health Services

    La Porte, Indiana 46350
    United States

    Site Not Available

  • Saint Anthony Memorial Health Centers

    Michigan City, Indiana 46360
    United States

    Site Not Available

  • CCOP - Northern Indiana CR Consortium

    South Bend, Indiana 46601
    United States

    Site Not Available

  • Memorial Hospital of South Bend

    South Bend, Indiana 46601
    United States

    Site Not Available

  • Saint Joseph Regional Medical Center

    South Bend, Indiana 46617
    United States

    Site Not Available

  • South Bend Clinic

    South Bend, Indiana 46617
    United States

    Site Not Available

  • McFarland Clinic, PC

    Ames, Iowa 50010
    United States

    Site Not Available

  • CCOP - Iowa Oncology Research Association

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • John Stoddard Cancer Center at Iowa Lutheran Hospital

    Des Moines, Iowa 50316
    United States

    Site Not Available

  • John Stoddard Cancer Center at Iowa Methodist Medical Center

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • Medical Oncology and Hematology Associates at John Stoddard Cancer Center

    Des Moines, Iowa 50309
    United States

    Site Not Available

  • Medical Oncology and Hematology Associates at Mercy Cancer Center

    Des Moines, Iowa 50314
    United States

    Site Not Available

  • Mercy Cancer Center at Mercy Medical Center - Des Moines

    Des Moines, Iowa 50314
    United States

    Site Not Available

  • Mercy Capitol Hospital

    Des Moines, Iowa 50307
    United States

    Site Not Available

  • Mercy Cancer Center at Mercy Medical Center - North Iowa

    Mason City, Iowa 50401
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Chanute

    Chanute, Kansas 66720
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Dodge City

    Dodge City, Kansas 67801
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - El Dorado

    El Dorado, Kansas 67042
    United States

    Site Not Available

  • Cancer Center of Kansas-Independence

    Independence, Kansas 67301
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Kingman

    Kingman, Kansas 67068
    United States

    Site Not Available

  • Southwest Medical Center

    Liberal, Kansas 67901
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Newton

    Newton, Kansas 67114
    United States

    Site Not Available

  • Kansas City Cancer Centers - Southwest

    Overland Park, Kansas 66210
    United States

    Site Not Available

  • Menorah Medical Center

    Overland Park, Kansas 66209
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Parsons

    Parsons, Kansas 67357
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Pratt

    Pratt, Kansas 67124
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Salina

    Salina, Kansas 67042
    United States

    Site Not Available

  • Shawnee Mission Medical Center

    Shawnee Mission, Kansas 66204
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Wellington

    Wellington, Kansas 67152
    United States

    Site Not Available

  • Associates in Womens Health, PA - North Review

    Wichita, Kansas 67208
    United States

    Site Not Available

  • CCOP - Wichita

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Medical Arts Tower

    Wichita, Kansas 67208
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Wichita

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Via Christi Cancer Center at Via Christi Regional Medical Center

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Wesley Medical Center

    Wichita, Kansas 67214
    United States

    Site Not Available

  • Cancer Center of Kansas, PA - Winfield

    Winfield, Kansas 67156
    United States

    Site Not Available

  • DeCesaris Cancer Institute at Anne Arundel Medical Center

    Annapolis, Maryland 21401
    United States

    Site Not Available

  • St. Agnes Hospital Cancer Center

    Baltimore, Maryland 21229
    United States

    Site Not Available

  • Union Hospital Cancer Program at Union Hospital

    Elkton, Maryland 21921
    United States

    Site Not Available

  • Union Hospital Cancer Program at Union Hospital

    Elkton MD, Maryland 21921
    United States

    Site Not Available

  • Hickman Cancer Center at Bixby Medical Center

    Adrian, Michigan 49221
    United States

    Site Not Available

  • CCOP - Michigan Cancer Research Consortium

    Ann Arbor, Michigan 48106
    United States

    Site Not Available

  • Saint Joseph Mercy Cancer Center

    Ann Arbor, Michigan 48106-0995
    United States

    Site Not Available

  • Oakwood Cancer Center at Oakwood Hospital and Medical Center

    Dearborn, Michigan 48123-2500
    United States

    Site Not Available

  • Josephine Ford Cancer Center at Henry Ford Hospital

    Detroit, Michigan 48202
    United States

    Site Not Available

  • Green Bay Oncology, Limited - Escanaba

    Escanaba, Michigan 49431
    United States

    Site Not Available

  • Genesys Hurley Cancer Institute

    Flint, Michigan 48503
    United States

    Site Not Available

  • Hurley Medical Center

    Flint, Michigan 48503
    United States

    Site Not Available

  • Van Elslander Cancer Center at St. John Hospital and Medical Center

    Grosse Pointe Woods, Michigan 48236
    United States

    Site Not Available

  • Dickinson County Healthcare System

    Iron Mountain, Michigan 49801
    United States

    Site Not Available

  • Foote Memorial Hospital

    Jackson, Michigan 49201
    United States

    Site Not Available

  • Borgess Medical Center

    Kalamazoo, Michigan 49001
    United States

    Site Not Available

  • Bronson Methodist Hospital

    Kalamazoo, Michigan 49007
    United States

    Site Not Available

  • West Michigan Cancer Center

    Kalamazoo, Michigan 49007-3731
    United States

    Site Not Available

  • Haematology-Oncology Associates of Ohio and Michigan, PC

    Lambertville, Michigan 48144
    United States

    Site Not Available

  • Sparrow Regional Cancer Center

    Lansing, Michigan 48912-1811
    United States

    Site Not Available

  • St. Mary Mercy Hospital

    Livonia, Michigan 48154
    United States

    Site Not Available

  • Community Cancer Center of Monroe

    Monroe, Michigan 48162
    United States

    Site Not Available

  • Mercy Memorial Hospital - Monroe

    Monroe, Michigan 48162
    United States

    Site Not Available

  • St. Joseph Mercy Oakland

    Pontiac, Michigan 48341-2985
    United States

    Site Not Available

  • Mercy Regional Cancer Center at Mercy Hospital

    Port Huron, Michigan 48060
    United States

    Site Not Available

  • William Beaumont Hospital - Royal Oak Campus

    Royal Oak, Michigan 48073
    United States

    Site Not Available

  • Seton Cancer Institute at Saint Mary's - Saginaw

    Saginaw, Michigan 48601
    United States

    Site Not Available

  • Lakeland Regional Cancer Care Center - St. Joseph

    Saint Joseph, Michigan 49085
    United States

    Site Not Available

  • Providence Cancer Institute at Providence Hospital - Southfield Campus

    Southfield, Michigan 48075
    United States

    Site Not Available

  • Lakeland Regional Cancer Care Center - St. Joseph

    St. Joseph, Michigan 49085
    United States

    Site Not Available

  • St. John Macomb Hospital

    Warren, Michigan 48093
    United States

    Site Not Available

  • Alexandria, Minnesota 56308
    United States

    Site Not Available

  • MeritCare Bemidji

    Bemidji, Minnesota 56601
    United States

    Site Not Available

  • Fairview Ridges Hospital

    Burnsville, Minnesota 55337
    United States

    Site Not Available

  • Mercy and Unity Cancer Center at Mercy Hospital

    Coon Rapids, Minnesota 55433
    United States

    Site Not Available

  • Fairview Southdale Hospital

    Edina, Minnesota 55435
    United States

    Site Not Available

  • Fergus Falls, Minnesota 56537
    United States

    Site Not Available

  • Mercy and Unity Cancer Center at Unity Hospital

    Fridley, Minnesota 55432
    United States

    Site Not Available

  • Minnesota Oncology Hematology, PA - Maplewood

    Maplewood, Minnesota 55109
    United States

    Site Not Available

  • Virginia Piper Cancer Institute at Abbott - Northwestern Hospital

    Minneapolis, Minnesota 55407
    United States

    Site Not Available

  • Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center

    Robbinsdale, Minnesota 55422-2900
    United States

    Site Not Available

  • Mayo Clinic Cancer Center

    Rochester, Minnesota 55905
    United States

    Site Not Available

  • CentraCare Clinic - River Campus

    Saint Cloud, Minnesota 56303
    United States

    Site Not Available

  • Coborn Cancer Center

    Saint Cloud, Minnesota 56303
    United States

    Site Not Available

  • CCOP - Metro-Minnesota

    Saint Louis Park, Minnesota 55416
    United States

    Site Not Available

  • Park Nicollet Cancer Center

    Saint Louis Park, Minnesota 55416
    United States

    Site Not Available

  • United Hospital

    Saint Paul, Minnesota 55102
    United States

    Site Not Available

  • Ridgeview Medical Center

    Waconia, Minnesota 55387
    United States

    Site Not Available

  • Minnesota Oncology Hematology, PA - Woodbury

    Woodbury, Minnesota 55125
    United States

    Site Not Available

  • Independence Regional Health Center

    Independence, Missouri 64050
    United States

    Site Not Available

  • St. John's Regional Medical Center

    Joplin, Missouri 64804
    United States

    Site Not Available

  • CCOP - Kansas City

    Kansas City, Missouri 64131
    United States

    Site Not Available

  • Kansas City Cancer Centers - South

    Kansas City, Missouri 64131
    United States

    Site Not Available

  • North Kansas City Hospital

    Kansas City, Missouri 64116
    United States

    Site Not Available

  • Parvin Radiation Oncology

    Kansas City, Missouri 64116
    United States

    Site Not Available

  • Research Medical Center

    Kansas City, Missouri 64132
    United States

    Site Not Available

  • Saint Luke's Cancer Institute at Saint Luke's Hospital

    Kansas City, Missouri 64111
    United States

    Site Not Available

  • St. Joseph Medical Center

    Kansas City, Missouri 64114
    United States

    Site Not Available

  • Truman Medical Center - Hospital Hill

    Kansas City, Missouri 64108
    United States

    Site Not Available

  • Liberty Hospital

    Liberty, Missouri 64068
    United States

    Site Not Available

  • Heartland Regional Medical Center

    Saint Joseph, Missouri 64506
    United States

    Site Not Available

  • CCOP - Cancer Research for the Ozarks

    Springfield, Missouri 65802
    United States

    Site Not Available

  • Hulston Cancer Center at Cox Medical Center South

    Springfield, Missouri 65807
    United States

    Site Not Available

  • St. John's Regional Health Center

    Springfield, Missouri 65804
    United States

    Site Not Available

  • Billings Clinic - Downtown

    Billings, Montana 59107-7000
    United States

    Site Not Available

  • CCOP - Montana Cancer Consortium

    Billings, Montana 59101
    United States

    Site Not Available

  • Hematology-Oncology Centers of the Northern Rockies - Billings

    Billings, Montana 59101
    United States

    Site Not Available

  • Northern Rockies Radiation Oncology Center

    Billings, Montana 59101
    United States

    Site Not Available

  • St. Vincent Healthcare Cancer Care Services

    Billings, Montana 59101
    United States

    Site Not Available

  • St. James Healthcare Cancer Care

    Butte, Montana 59701
    United States

    Site Not Available

  • Great Falls Clinic - Main Facility

    Great Falls, Montana 59405
    United States

    Site Not Available

  • Great Falls, Montana 59405
    United States

    Site Not Available

  • Northern Montana Hospital

    Havre, Montana 59501
    United States

    Site Not Available

  • Glacier Oncology, PLLC

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Kalispell Medical Oncology at KRMC

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Kalispell Regional Medical Center

    Kalispell, Montana 59901
    United States

    Site Not Available

  • Community Medical Center

    Missoula, Montana 59801
    United States

    Site Not Available

  • Guardian Oncology and Center for Wellness

    Missoula, Montana 59804
    United States

    Site Not Available

  • Montana Cancer Center at St. Patrick Hospital and Health Sciences Center

    Missoula, Montana 59807
    United States

    Site Not Available

  • Montana Cancer Specialists at Montana Cancer Center

    Missoula, Montana 59807-7877
    United States

    Site Not Available

  • Good Samaritan Cancer Center at Good Samaritan Hospital

    Kearney, Nebraska 68848-1990
    United States

    Site Not Available

  • Cancer Resource Center - Lincoln

    Lincoln, Nebraska 68510
    United States

    Site Not Available

  • Alegant Health Cancer Center at Bergan Mercy Medical Center

    Omaha, Nebraska 68124
    United States

    Site Not Available

  • CCOP - Missouri Valley Cancer Consortium

    Omaha, Nebraska 68106
    United States

    Site Not Available

  • Creighton University Medical Center

    Omaha, Nebraska 68131-2197
    United States

    Site Not Available

  • Immanuel Medical Center

    Omaha, Nebraska 68122
    United States

    Site Not Available

  • Methodist Estabrook Cancer Center

    Omaha, Nebraska 68114
    United States

    Site Not Available

  • CCOP - Nevada Cancer Research Foundation

    Las Vegas, Nevada 89106
    United States

    Site Not Available

  • University Medical Center of Southern Nevada

    Las Vegas, Nevada 89102
    United States

    Site Not Available

  • Dartmouth - Hitchcock Concord

    Concord, New Hampshire 03301
    United States

    Site Not Available

  • Kingsbury Center for Cancer Care at Cheshire Medical Center

    Keene, New Hampshire 03431
    United States

    Site Not Available

  • Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center

    Lebanon, New Hampshire 03756-0002
    United States

    Site Not Available

  • St. Barnabas Medical Center Cancer Center

    Livingston, New Jersey 07039
    United States

    Site Not Available

  • Frederick R. and Betty M. Smith Cancer Treatment Center

    Sparta, New Jersey 07871
    United States

    Site Not Available

  • Cancer Institute of New Jersey at Cooper - Voorhees

    Voorhees, New Jersey 08043
    United States

    Site Not Available

  • New York Methodist Hospital

    Brooklyn, New York 11215
    United States

    Site Not Available

  • Monter Cancer Center of the North Shore-LIJ Health System

    Lake Success, New York 11042
    United States

    Site Not Available

  • CCOP - North Shore University Hospital

    Manhasset, New York 11030
    United States

    Site Not Available

  • Don Monti Comprehensive Cancer Center at North Shore University Hospital

    Manhasset, New York 11030
    United States

    Site Not Available

  • Long Island Jewish Medical Center

    New Hyde Park, New York 11040
    United States

    Site Not Available

  • Memorial Sloan-Kettering Cancer Center

    New York, New York 10065
    United States

    Site Not Available

  • Hudson Valley Oncology Associates

    Poughkeepsie, New York 12601
    United States

    Site Not Available

  • Lipson Cancer and Blood Center at Rochester General Hospital

    Rochester, New York 14621
    United States

    Site Not Available

  • Mission Hospitals - Memorial Campus

    Asheville, North Carolina 28801
    United States

    Site Not Available

  • Wayne Memorial Hospital, Incorporated

    Goldsboro, North Carolina 27534
    United States

    Site Not Available

  • Wayne Radiation Oncology

    Goldsboro, North Carolina 27534
    United States

    Site Not Available

  • Rutherford Hospital

    Rutherfordton, North Carolina 28139
    United States

    Site Not Available

  • Wilmed Radiation Oncology Services

    Wilson, North Carolina 27893
    United States

    Site Not Available

  • CCOP - MeritCare Hospital

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • MeritCare Broadway

    Fargo, North Dakota 58122
    United States

    Site Not Available

  • McDowell Cancer Center at Akron General Medical Center

    Akron, Ohio 44307
    United States

    Site Not Available

  • Summa Center for Cancer Care at Akron City Hospital

    Akron, Ohio 44309-2090
    United States

    Site Not Available

  • Mary Rutan Hospital

    Bellefontaine, Ohio 43311
    United States

    Site Not Available

  • Wood County Oncology Center

    Bowling Green, Ohio 43402
    United States

    Site Not Available

  • Aultman Cancer Center at Aultman Hospital

    Canton, Ohio 44710-1799
    United States

    Site Not Available

  • Adena Regional Medical Center

    Chillicothe, Ohio 45601
    United States

    Site Not Available

  • Cleveland Clinic Cancer Center at Fairview Hospital

    Cleveland, Ohio 44111
    United States

    Site Not Available

  • Cleveland Clinic Taussig Cancer Center

    Cleveland, Ohio 44195
    United States

    Site Not Available

  • CCOP - Columbus

    Columbus, Ohio 43215
    United States

    Site Not Available

  • Doctors Hospital at Ohio Health

    Columbus, Ohio 43228
    United States

    Site Not Available

  • Grant Medical Center Cancer Care

    Columbus, Ohio 43215
    United States

    Site Not Available

  • Mount Carmel Health - West Hospital

    Columbus, Ohio 43222
    United States

    Site Not Available

  • Riverside Methodist Hospital Cancer Care

    Columbus, Ohio 43214-3998
    United States

    Site Not Available

  • Grady Memorial Hospital

    Delaware, Ohio 43015
    United States

    Site Not Available

  • Cleveland Clinic Cancer Center

    Independence, Ohio 44131
    United States

    Site Not Available

  • Fairfield Medical Center

    Lancaster, Ohio 43130
    United States

    Site Not Available

  • Lima Memorial Hospital

    Lima, Ohio 45804
    United States

    Site Not Available

  • Strecker Cancer Center at Marietta Memorial Hospital

    Marietta, Ohio 45750
    United States

    Site Not Available

  • Northwest Ohio Oncology Center

    Maumee, Ohio 43537
    United States

    Site Not Available

  • St. Luke's Hospital

    Maumee, Ohio 43537
    United States

    Site Not Available

  • Licking Memorial Cancer Care Program at Licking Memorial Hospital

    Newark, Ohio 43055
    United States

    Site Not Available

  • St. Charles Mercy Hospital

    Oregon, Ohio 43616
    United States

    Site Not Available

  • Toledo Clinic - Oregon

    Oregon, Ohio 43616
    United States

    Site Not Available

  • Cancer Research UK Medical Oncology Unit at Churchill Hospital & Weatherall Institute of Molecular Medicine - Oxford

    Salem, Ohio 44460
    United States

    Site Not Available

  • North Coast Cancer Care, Incorporated

    Sandusky, Ohio 44870
    United States

    Site Not Available

  • Community Hospital of Springfield and Clark County

    Springfield, Ohio 45505
    United States

    Site Not Available

  • Mercy Medical Center

    Springfield, Ohio 45504
    United States

    Site Not Available

  • Flower Hospital Cancer Center

    Sylvania, Ohio 43560
    United States

    Site Not Available

  • Mercy Hospital of Tiffin

    Tiffin, Ohio 44883
    United States

    Site Not Available

  • CCOP - Toledo Community Hospital

    Toledo, Ohio 43617
    United States

    Site Not Available

  • Medical University of Ohio Cancer Center

    Toledo, Ohio 43614
    United States

    Site Not Available

  • St. Vincent Mercy Medical Center

    Toledo, Ohio 43608
    United States

    Site Not Available

  • Toledo Clinic, Incorporated - Main Clinic

    Toledo, Ohio 43623
    United States

    Site Not Available

  • Toledo Hospital

    Toledo, Ohio 43606
    United States

    Site Not Available

  • Fulton County Health Center

    Wauseon, Ohio 43567
    United States

    Site Not Available

  • Mount Carmel St. Ann's Cancer Center

    Westerville, Ohio 43081
    United States

    Site Not Available

  • Cancer Treatment Center

    Wooster, Ohio 44691
    United States

    Site Not Available

  • Genesis - Good Samaritan Hospital

    Zanesville, Ohio 43701
    United States

    Site Not Available

  • Oklahoma University Cancer Institute

    Oklahoma City, Oklahoma 73104
    United States

    Site Not Available

  • Natalie Warren Bryant Cancer Center at St. Francis Hospital

    Tulsa, Oklahoma 74136
    United States

    Site Not Available

  • Willamette Valley Cancer Center - Eugene

    Eugene, Oregon 97401
    United States

    Site Not Available

  • Legacy Mount Hood Medical Center

    Gresham, Oregon 97030
    United States

    Site Not Available

  • Providence Milwaukie Hospital

    Milwaukie, Oregon 97222
    United States

    Site Not Available

  • Adventist Medical Center

    Portland, Oregon 97216
    United States

    Site Not Available

  • CCOP - Columbia River Oncology Program

    Portland, Oregon 97225
    United States

    Site Not Available

  • Legacy Emanuel Hospital and Health Center and Children's Hospital

    Portland, Oregon 97227
    United States

    Site Not Available

  • Legacy Good Samaritan Hospital & Comprehensive Cancer Center

    Portland, Oregon 97210
    United States

    Site Not Available

  • Providence Cancer Center at Providence Portland Medical Center

    Portland, Oregon 97213-2967
    United States

    Site Not Available

  • Providence St. Vincent Medical Center

    Portland, Oregon 97225
    United States

    Site Not Available

  • Salem Hospital Regional Cancer Care Services

    Salem, Oregon 97309-5014
    United States

    Site Not Available

  • Legacy Meridian Park Hospital

    Tualatin, Oregon 97062
    United States

    Site Not Available

  • Rosenfeld Cancer Center at Abington Memorial Hospital

    Abington, Pennsylvania 19001
    United States

    Site Not Available

  • Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest

    Allentown, Pennsylvania 18105
    United States

    Site Not Available

  • Bryn Mawr Hospital

    Bryn Mawr, Pennsylvania 19010
    United States

    Site Not Available

  • Geisinger Cancer Institute at Geisinger Health

    Danville, Pennsylvania 17822-0001
    United States

    Site Not Available

  • Northeast Radiation Oncology Center

    Dunmore, Pennsylvania 18512
    United States

    Site Not Available

  • Dale and Frances Hughes Cancer Center at Pocono Medical Center

    East Stroudsburg, Pennsylvania 18301
    United States

    Site Not Available

  • Penn State Cancer Institute at Milton S. Hershey Medical Center

    Hershey, Pennsylvania 17033-0850
    United States

    Site Not Available

  • Riddle Memorial Hospital Cancer Center

    Media, Pennsylvania 19063
    United States

    Site Not Available

  • Upper Delaware Valley Cancer Center

    Milford, Pennsylvania 18337
    United States

    Site Not Available

  • Intercommunity Cancer Center

    Monroeville, Pennsylvania 15146
    United States

    Site Not Available

  • Alle-Kiski Medical Center

    Natrona Heights, Pennsylvania 15065
    United States

    Site Not Available

  • Cancer Center of Paoli Memorial Hospital

    Paoli, Pennsylvania 19301-1792
    United States

    Site Not Available

  • Fox Chase Cancer Center - Philadelphia

    Philadelphia, Pennsylvania 19111-2497
    United States

    Site Not Available

  • Frankford Hospital Cancer Center - Torresdale Campus

    Philadelphia, Pennsylvania 19114
    United States

    Site Not Available

  • Kimmel Cancer Center at Thomas Jefferson University - Philadelphia

    Philadelphia, Pennsylvania 19107-5541
    United States

    Site Not Available

  • Allegheny Cancer Center at Allegheny General Hospital

    Pittsburgh, Pennsylvania 15212
    United States

    Site Not Available

  • McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center

    Reading, Pennsylvania 19612-6052
    United States

    Site Not Available

  • Somerset Oncology Center

    Somerset, Pennsylvania 15501
    United States

    Site Not Available

  • Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center

    Wilkes-Barre, Pennsylvania 18711
    United States

    Site Not Available

  • CCOP - Main Line Health

    Wynnewood, Pennsylvania 19096
    United States

    Site Not Available

  • Lankenau Cancer Center at Lankenau Hospital

    Wynnewood, Pennsylvania 19096
    United States

    Site Not Available

  • AnMed Cancer Center

    Anderson, South Carolina 29621
    United States

    Site Not Available

  • Hollings Cancer Center at Medical University of South Carolina

    Charleston, South Carolina 29425
    United States

    Site Not Available

  • CCOP - Upstate Carolina

    Spartanburg, South Carolina 29303
    United States

    Site Not Available

  • Gibbs Regional Cancer Center at Spartanburg Regional Medical Center

    Spartanburg, South Carolina 29303
    United States

    Site Not Available

  • Rapid City Regional Hospital

    Rapid City, South Dakota 57701
    United States

    Site Not Available

  • Avera Cancer Institute

    Sioux Falls, South Dakota 57105
    United States

    Site Not Available

  • Medical X-Ray Center, PC

    Sioux Falls, South Dakota 57105
    United States

    Site Not Available

  • Sanford Cancer Center at Sanford USD Medical Center

    Sioux Falls, South Dakota 57117-5039
    United States

    Site Not Available

  • Thompson Cancer Survival Center

    Knoxville, Tennessee 37916
    United States

    Site Not Available

  • Thompson Cancer Survival Center West

    Knoxville, Tennessee 37392
    United States

    Site Not Available

  • Thompson Cancer Survival Center at Methodist

    Oak Ridge, Tennessee 37830
    United States

    Site Not Available

  • Medical City Dallas Hospital

    Dallas, Texas 75230
    United States

    Site Not Available

  • Texas Oncology, PA at Texas Cancer Center Dallas Southwest

    Dallas, Texas 75237
    United States

    Site Not Available

  • Klabzuba Cancer Center at Harris Methodist Fort Worth Hospital

    Fort Worth, Texas 76104
    United States

    Site Not Available

  • M. D. Anderson Cancer Center at University of Texas

    Houston, Texas 77030-4009
    United States

    Site Not Available

  • Joe Arrington Cancer Research and Treatment Center

    Lubbock, Texas 79410-1894
    United States

    Site Not Available

  • Texas Oncology, PA at Texas Cancer Center - Sherman

    Sherman, Texas 75090
    United States

    Site Not Available

  • Texas Oncology, PA at Texas Oncology Cancer Center Sugar Land

    Sugar Land, Texas 77479
    United States

    Site Not Available

  • American Fork Hospital

    American Fork, Utah 84003
    United States

    Site Not Available

  • Sandra L. Maxwell Cancer Center

    Cedar City, Utah 84720
    United States

    Site Not Available

  • Jon and Karen Huntsman Cancer Center at Intermountain Medical Center

    Murray, Utah 84157
    United States

    Site Not Available

  • Val and Ann Browning Cancer Center at McKay-Dee Hospital Center

    Ogden, Utah 84403
    United States

    Site Not Available

  • Utah Valley Regional Medical Center - Provo

    Provo, Utah 84604
    United States

    Site Not Available

  • Dixie Regional Medical Center - East Campus

    Saint George, Utah 84770
    United States

    Site Not Available

  • Huntsman Cancer Institute at University of Utah

    Salt Lake City, Utah 84112
    United States

    Site Not Available

  • LDS Hospital

    Salt Lake City, Utah 84103
    United States

    Site Not Available

  • Utah Cancer Specialists at UCS Cancer Center

    Salt Lake City, Utah 84106
    United States

    Site Not Available

  • Fletcher Allen Health Care - University Health Center Campus

    Burlington, Vermont 05401
    United States

    Site Not Available

  • Norris Cotton Cancer Center - North

    Saint Johnsbury, Vermont 05819
    United States

    Site Not Available

  • Fredericksburg Oncology, Incorporated

    Fredericksburg, Virginia 22401
    United States

    Site Not Available

  • Sentara Cancer Institute at Sentara Norfolk General Hospital

    Norfolk, Virginia 23507
    United States

    Site Not Available

  • Virginia Commonwealth University Massey Cancer Center

    Richmond, Virginia 23298-0037
    United States

    Site Not Available

  • St. Joseph Cancer Center

    Bellingham, Washington 98225
    United States

    Site Not Available

  • St. Francis Hospital

    Federal Way, Washington 98003
    United States

    Site Not Available

  • Cascade Cancer Center at Evergreen Hospital Medical Center

    Kirkland, Washington 98033
    United States

    Site Not Available

  • CCOP - Virginia Mason Research Center

    Seattle, Washington 98101
    United States

    Site Not Available

  • University Cancer Center at University of Washington Medical Center

    Seattle, Washington 98195-6043
    United States

    Site Not Available

  • Southwest Washington Medical Center Cancer Center

    Vancouver, Washington 98668
    United States

    Site Not Available

  • North Star Lodge Cancer Center at Yakima Valley Memorial Hospital

    Yakima, Washington 98902
    United States

    Site Not Available

  • Theda Care Cancer Institute

    Appleton, Wisconsin 54911
    United States

    Site Not Available

  • Green Bay Oncology, Limited at St. Mary's Hospital

    Green Bay, Wisconsin 54303
    United States

    Site Not Available

  • Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center

    Green Bay, Wisconsin 54301-3526
    United States

    Site Not Available

  • St. Mary's Hospital Medical Center - Green Bay

    Green Bay, Wisconsin 54303
    United States

    Site Not Available

  • St. Vincent Hospital Regional Cancer Center

    Green Bay, Wisconsin 54307-3508
    United States

    Site Not Available

  • Gundersen Lutheran Center for Cancer and Blood

    La Crosse, Wisconsin 54601
    United States

    Site Not Available

  • University of Wisconsin Paul P. Carbone Comprehensive Cancer Center

    Madison, Wisconsin 53792-6164
    United States

    Site Not Available

  • Bay Area Cancer Care Center at Bay Area Medical Center

    Marinette, Wisconsin 54143
    United States

    Site Not Available

  • Community Memorial Hospital Cancer Care Center

    Menomonee Falls, Wisconsin 53051
    United States

    Site Not Available

  • Regional Cancer Center at Oconomowoc Memorial Hospital

    Oconomowoc, Wisconsin 53066
    United States

    Site Not Available

  • Green Bay Oncology, Limited - Oconto Falls

    Oconto Falls, Wisconsin 54154
    United States

    Site Not Available

  • Door County Cancer Center at Door County Memorial Hospital

    Sturgeon Bay, Wisconsin 54235-1495
    United States

    Site Not Available

  • Green Bay Oncology, Limited - Sturgeon Bay

    Sturgeon Bay, Wisconsin 54235
    United States

    Site Not Available

  • Waukesha Memorial Hospital Regional Cancer Center

    Waukesha, Wisconsin 53188
    United States

    Site Not Available

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