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ACTIVE NOT RECRUITING

NCT01349322

PHASE3

Higher Per Daily Treatment-Dose Radiation Therapy or Standard Per Daily Treatment Radiation Therapy in Treating Patients With Early-Stage Breast Cancer That Was Removed by Surgery

Sponsor: Radiation Therapy Oncology Group

View on ClinicalTrials.gov

Summary

RATIONALE: It is not yet know whether higher per daily radiation therapy is equally as effective as standard per daily radiation therapy in treating breast cancer. PURPOSE: This randomized phase III trial studies how well an accelerated course of higher per daily radiation therapy with concomitant boost works compared to standard per daily radiation therapy with a sequential boost in treating patients with early-stage breast cancer that was removed by surgery.

Official title: A Phase III Trial of Accelerated Whole Breast Irradiation With Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer

Key Details

Gender

FEMALE

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

2354

Start Date

2011-05-24

Completion Date

Not specified

Last Updated

2026-03-05

Healthy Volunteers

Conditions

Breast Cancer

Interventions

RADIATION

Standard fractionation whole breast irradiation

Target-based radiation using three-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) to deliver 25 fractions of 2.0 Gy for a total dose of 50.0 Gy or 16 fractions of 2.67 Gy for a total dose of 42.7 Gy. Must begin within 9 weeks of last surgery or chemotherapy delivery.

RADIATION

Hypofractionated whole breast irradiation

Target-based radiation using three-dimensional conformal radiation therapy (3D-CRT) or intensity-modulated radiation therapy (IMRT) to deliver 15 fractions of 2.67 Gy for a total dose of 40.0 Gy. Must begin within 9 weeks of last surgery or chemotherapy delivery.

RADIATION

Concurrent boost

15 fractions of 3.2 Gy for a total dose of 48 Gy to the lumpectomy cavity. Given concurrently with treatment to the entire breast. May be given by either electron beam or photon beams using either 3D-CRT or IMRT.

RADIATION

Sequential boost

6 fractions of 2.0 Gy per fraction for a total dose of 12 Gy or 7 fractions of 2.0 Gy for a total dose of 14 Gy to the lumpectomy cavity. May be given by either electron beam or photon beams using either 3D-CRT or IMRT. Begins without a treatment break after completion of the treatment to the entire breast.

Inclusion criteria: 1. Pathologically proven diagnosis of breast cancer resected by lumpectomy and whole breast irradiation with boost without regional nodal irradiation planned 2. The patient must be female 3. The patient must meet at least one of the three following criteria: * A. Pathological stage I, II Breast Cancer AND at least one of the following: * Age \< 50 years or * Positive axillary nodes or * Lymphovascular space invasion or * 2 or more close resection margins (\> 0 mm to ≤ 2 mm) or * 1 close resection margin and extensive intraductal component (EIC) \[Per College of American Pathologist (CAP) Recommendation\] or * Focally positive resection margins or * Non-hormone sensitive breast cancer (estrogen receptor (ER)- and progesterone receptor(PR)-negative) or * Grade III histology or * Oncotype recurrence score \> 25 or * B. Pathological stage 0 breast cancer with nuclear grade 3 ductal carcinoma in situ (DCIS) and patient age \<50 years or * C. Post-neoadjuvant pathological 0, I, II breast cancer resected by lumpectomy after neoadjuvant systemic therapy 4. Study entry must be within 50 days from whichever comes later: last surgery (breast or axilla) or last chemotherapy. The day of surgery is Day "0". 5. If multifocal breast cancer, then it must have been resected through a single lumpectomy incision with negative margins 6. Breast-conserving surgery with margins defined as follows: (also see 3.1.3 for eligibility) * Negative margins defined as no tumor at the resected specimen edge. * Close resection margins \> 0 mm to ≤ 2 mm. as follows: * One close resection margin and EIC (per College of American Pathologist (CAP) Recommendation) * 2 or more close resection margins. * A focally positive resection margin 7. For invasive breast cancer the axilla must be staged by one of the following: * Sentinel node biopsy alone, if sentinel node is negative, i.e. any of the following: * pN0: no regional lymph node metastasis identified histologically, * pN0(i-): pN0 and immunohistochemical (IHC) negative, or * pN0(i+): pN0 and IHc positive; * Sentinel node biopsy alone, OR followed by axillary node dissection per investigator discretion, for clinically node negative patients as described below: * microscopic sentinel node positive (pN1mic) * one or two sentinel nodes positive (pN1) without extracapsular extension * negative sentinel node biopsy after neoadjuvant chemotherapy * Axillary node dissection is required following sentinel node (SN) biopsy with a minimum total of 6 axillary nodes if any of the following exist: * for \> 2 positive SN * any positive SN biopsy after neoadjuvant chemotherapy * for clinically (by either imaging or examination) T3 disease * for extracapsular extension * Axillary dissection alone (with a minimum of 6 axillary nodes) 8. Age ≥ 18 9. CT-imaging of the ipsilateral breast within 28 days prior to study entry for the radiation treatment planning. Must be able to delineate on CT scan the extent of the target lumpectomy cavity for boost 10. Appropriate stage for protocol entry, including no clinical evidence for distant metastases, based upon the following minimum diagnostic workup: * History/physical examination, including breast exam (inspection and palpation of the breasts) and documentation of weight and Zubrod Performance Status of 0-2 within 28 days prior to study entry; * Right and left mammography within 90 days of diagnostic biopsy establishing diagnosis 11. Patients must have had ER analysis performed on the primary breast tumor prior to study entry according to current American Society of Clinical Oncology (ASCO)/ College of American Pathologists (CAP) Guideline Recommendations for hormone receptor testing. If negative for ER, assessment of PR must also be performed according to current ASCO/CAP Guideline Recommendations for hormone receptor testing (http://www.asco.org) 12. Complete blood count (CBC)/differential obtained within 14 days prior to study entry, with adequate bone marrow function defined as follows: * Absolute neutrophil count (ANC) ≥ 1,800 cells/mm3 * Platelets ≥ 75,000 cells/mm3 * Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve Hgb ≥ 8.0 g/dl is acceptable.) 13. Women of childbearing potential must have a negative urine or serum pregnancy test within 14 days of study entry 14. Women of childbearing potential must be non-pregnant and non-lactating and willing to use medically acceptable form of contraception during radiation therapy 15. Patient must provide study specific informed consent prior to study entry 16. Breast implants allowed Exclusion criteria: 1. American Joint Committee on Cancer (AJCC) pathologic T4, N2 or N3, M1 pathologic stages III or IV breast cancer 2. Treatment plan that includes regional node irradiation 3. Prior invasive non-breast malignancy (except non-melanomatous skin cancer, carcinoma in situ of the cervix) unless disease free for a minimum of 5 years prior to study entry 4. Prior invasive or in-situ carcinoma of the breast \[-prior lobular carcinoma in situ (LCIS) is eligible\] 5. Two or more breast cancers not resectable through a single lumpectomy incision 6. Bilateral breast cancer 7. DCIS only (without an invasive component) and age ≥ 50 years 8. DCIS nuclear grade 1 or 2 only (without an invasive component) and age \< 50 years 9. Invasive breast cancer and low risk for 5-year in breast recurrence after lumpectomy with negative margins that does not meet one of the eligibility factors in 3.1.3. 10. Unable to delineate on CT scan the extent of the target lumpectomy cavity for boost (Placement of surgical clips to assist in treatment planning of the boost is strongly recommended, see Section 6.4.2 for details) 11. Suspicious unresected microcalcification, densities, or palpable abnormalities (in the ipsilateral or contralateral breast) unless biopsied and found to be benign 12. Non-epithelial breast malignancies such as sarcoma or lymphoma 13. Paget's disease of the nipple 14. Male breast cancer 15. Prior radiotherapy to the breast or prior radiation to the region of the ipsilateral breast that would result in overlap of radiation therapy fields 16. Intention to administer concurrent chemotherapy for current breast cancer. 17. Severe, active co-morbidity, defined as follows: * Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months * Transmural myocardial infarction within the last 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 within 30 days before registration; * Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol * Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive 18. Pregnancy or women of childbearing potential who are sexually active and not willing/able to use medically acceptable forms of contraception 19. Active systemic lupus, erythematosus, or any history of scleroderma, dermatomyositis with active rash 20. Medical, psychiatric or other condition that would prevent the patient from receiving the protocol therapy or providing informed consent

Locations (415)

University of Alabama at Birmingham Cancer Center

Birmingham, Alabama, United States

The Kirklin Clinic at Acton Road

Birmingham, Alabama, United States

21st Century Oncology-Scottsdale

Scottsdale, Arizona, United States

Mayo Clinic in Arizona

Scottsdale, Arizona, United States

Arizona Oncology Associates-West Orange Grove

Tucson, Arizona, United States

Banner University Medical Center - Tucson

Tucson, Arizona, United States

CHI Saint Vincent Cancer Center Hot Springs

Hot Springs, Arkansas, United States

University of Arkansas for Medical Sciences

Little Rock, Arkansas, United States

Sutter Cancer Centers Radiation Oncology Services-Auburn

Auburn, California, United States

Sutter Cancer Centers Radiation Oncology Services-Cameron Park

Cameron Park, California, United States

Mercy San Juan Medical Center

Carmichael, California, United States

Enloe Medical Center

Chico, California, United States

City of Hope Comprehensive Cancer Center

Duarte, California, United States

Epic Care-Dublin

Dublin, California, United States

21st Century Oncology - El Segundo

El Segundo, California, United States

UC San Diego Moores Cancer Center

La Jolla, California, United States

Los Angeles County-USC Medical Center

Los Angeles, California, United States

USC / Norris Comprehensive Cancer Center

Los Angeles, California, United States

Cedars Sinai Medical Center

Los Angeles, California, United States

UCLA / Jonsson Comprehensive Cancer Center

Los Angeles, California, United States

Kaiser Permanente Oakland-Broadway

Oakland, California, United States

Kaiser Permanente-Rancho Cordova Cancer Center

Rancho Cordova, California, United States

Rohnert Park Cancer Center

Rohnert Park, California, United States

Sutter Cancer Centers Radiation Oncology Services-Roseville

Roseville, California, United States

The Permanente Medical Group-Roseville Radiation Oncology

Roseville, California, United States

Sutter Medical Center Sacramento

Sacramento, California, United States

University of California Davis Comprehensive Cancer Center

Sacramento, California, United States

South Sacramento Cancer Center

Sacramento, California, United States

Santa Clara Valley Medical Center

San Jose, California, United States

Kaiser Permanente Medical Center - Santa Clara

Santa Clara, California, United States

City of Hope South Pasadena

South Pasadena, California, United States

Kaiser Permanente Cancer Treatment Center

South San Francisco, California, United States

Sutter Cancer Centers Radiation Oncology Services-Vacaville

Vacaville, California, United States

University of Colorado Hospital

Aurora, Colorado, United States

Penrose-Saint Francis Healthcare

Colorado Springs, Colorado, United States

Porter Adventist Hospital

Denver, Colorado, United States

Shaw Cancer Center

Edwards, Colorado, United States

McKee Medical Center

Loveland, Colorado, United States

Hartford Hospital

Hartford, Connecticut, United States

MedStar Washington Hospital Center

Washington D.C., District of Columbia, United States

John Fitzgerald Kennedy Medical Center

Atlantis, Florida, United States

Florida Hospital Memorial Medical Center

Daytona Beach, Florida, United States

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida, United States

21st Century Oncology - Fort Walton Beach

Fort Walton Beach, Florida, United States

University of Florida Health Science Center - Gainesville

Gainesville, Florida, United States

Baptist MD Anderson Cancer Center

Jacksonville, Florida, United States

Integrated Community Oncology Network-Southside Cancer Center

Jacksonville, Florida, United States

University of Florida Health Science Center - Jacksonville

Jacksonville, Florida, United States

Mayo Clinic in Florida

Jacksonville, Florida, United States

Baptist Medical Center South

Jacksonville, Florida, United States

Integrated Community Oncology Network-Florida Cancer Center Beaches

Jacksonville Beach, Florida, United States

Jackson Memorial Hospital-Holtz Children's Hospital

Miami, Florida, United States

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida, United States

21st Century Oncology-Orange Park

Orange Park, Florida, United States

AdventHealth Orlando

Orlando, Florida, United States

Orlando Health Cancer Institute

Orlando, Florida, United States

Cancer Center of Putnam

Palatka, Florida, United States

Integrated Community Oncology Network-Flager Cancer Center

Saint Augustine, Florida, United States

Moffitt Cancer Center

Tampa, Florida, United States

The Villages Regional Hospital

The Villages, Florida, United States

Grady Health System

Atlanta, Georgia, United States

Emory University Hospital Midtown

Atlanta, Georgia, United States

Piedmont Hospital

Atlanta, Georgia, United States

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, United States

Emory Saint Joseph's Hospital

Atlanta, Georgia, United States

Northside Hospital

Atlanta, Georgia, United States

Northside Hospital-Forsyth

Cumming, Georgia, United States

Memorial Health University Medical Center

Savannah, Georgia, United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

Savannah, Georgia, United States

Queen's Medical Center

Honolulu, Hawaii, United States

Saint Alphonsus Cancer Care Center-Boise

Boise, Idaho, United States

Rush - Copley Medical Center

Aurora, Illinois, United States

Northwestern University

Chicago, Illinois, United States

University of Chicago Comprehensive Cancer Center

Chicago, Illinois, United States

Advocate Illinois Masonic Medical Center

Chicago, Illinois, United States

Decatur Memorial Hospital

Decatur, Illinois, United States

Freeport Memorial Hospital/Leonard C Ferguson Cancer Center

Freeport, Illinois, United States

Loyola University Medical Center

Maywood, Illinois, United States

UC Comprehensive Cancer Center at Silver Cross

New Lenox, Illinois, United States

Carle Cancer Institute Normal

Normal, Illinois, United States

Advocate Lutheran General Hospital

Park Ridge, Illinois, United States

OSF Saint Francis Radiation Oncology at Peoria Cancer Center

Peoria, Illinois, United States

OSF Saint Francis Medical Center

Peoria, Illinois, United States

Swedish American Hospital

Rockford, Illinois, United States

SwedishAmerican Regional Cancer Center/ACT

Rockford, Illinois, United States

Saint John's Hospital

Springfield, Illinois, United States

Carle Cancer Center

Urbana, Illinois, United States

Northwestern Medicine Cancer Center Warrenville

Warrenville, Illinois, United States

Saint Vincent Anderson Regional Hospital/Cancer Center

Anderson, Indiana, United States

IU Health West Hospital

Avon, Indiana, United States

Goshen Center for Cancer Care

Goshen, Indiana, United States

Indiana University/Melvin and Bren Simon Cancer Center

Indianapolis, Indiana, United States

IU Health Methodist Hospital

Indianapolis, Indiana, United States

Community Cancer Center East

Indianapolis, Indiana, United States

Community Cancer Center North

Indianapolis, Indiana, United States

Michiana Hematology Oncology PC-Mishawaka

Mishawaka, Indiana, United States

IU Health Ball Memorial Hospital

Muncie, Indiana, United States

Mercy Cancer Center-West Lakes

Clive, Iowa, United States

Iowa Methodist Medical Center

Des Moines, Iowa, United States

Mercy Medical Center - Des Moines

Des Moines, Iowa, United States

Finley Hospital

Dubuque, Iowa, United States

University of Kansas Cancer Center

Kansas City, Kansas, United States

Lawrence Memorial Hospital

Lawrence, Kansas, United States

University of Kansas Cancer Center-Overland Park

Overland Park, Kansas, United States

Kansas City NCI Community Oncology Research Program

Prairie Village, Kansas, United States

Cotton O'Neil Cancer Center / Stormont Vail Health

Topeka, Kansas, United States

Ascension Via Christi Hospitals Wichita

Wichita, Kansas, United States

Wichita NCI Community Oncology Research Program

Wichita, Kansas, United States

University of Kentucky/Markey Cancer Center

Lexington, Kentucky, United States

Owensboro Health Mitchell Memorial Cancer Center

Owensboro, Kentucky, United States

Tulane University Health Sciences Center

New Orleans, Louisiana, United States

Anne Arundel Medical Center

Annapolis, Maryland, United States

University of Maryland/Greenebaum Cancer Center

Baltimore, Maryland, United States

Greater Baltimore Medical Center

Baltimore, Maryland, United States

Saint Agnes Hospital

Baltimore, Maryland, United States

Walter Reed National Military Medical Center

Bethesda, Maryland, United States

Central Maryland Radiation Oncology in Howard County

Columbia, Maryland, United States

UM Baltimore Washington Medical Center/Tate Cancer Center

Glen Burnie, Maryland, United States

TidalHealth Peninsula Regional

Salisbury, Maryland, United States

Massachusetts General Hospital Cancer Center

Boston, Massachusetts, United States

Boston Medical Center

Boston, Massachusetts, United States

Mass General/North Shore Cancer Center

Danvers, Massachusetts, United States

Lowell General Hospital

Lowell, Massachusetts, United States

Newton-Wellesley Hospital

Newton, Massachusetts, United States

University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan, United States

GenesisCare USA - Clarkston

Clarkston, Michigan, United States

Henry Ford Macomb Hospital-Clinton Township

Clinton Township, Michigan, United States

Wayne State University/Karmanos Cancer Institute

Detroit, Michigan, United States

Henry Ford Hospital

Detroit, Michigan, United States

Ascension Saint John Hospital

Detroit, Michigan, United States

GenesisCare USA - Farmington Hills

Farmington Hills, Michigan, United States

Weisberg Cancer Treatment Center

Farmington Hills, Michigan, United States

Beaumont Hospital - Farmington Hills

Farmington Hills, Michigan, United States

McLaren Cancer Institute-Flint

Flint, Michigan, United States

Mercy Health Saint Mary's

Grand Rapids, Michigan, United States

Spectrum Health at Butterworth Campus

Grand Rapids, Michigan, United States

West Michigan Cancer Center

Kalamazoo, Michigan, United States

KCC Radiation Oncology at Monroe Cancer Center

Monroe, Michigan, United States

McLaren Cancer Institute-Northern Michigan

Petoskey, Michigan, United States

Saint Joseph Mercy Oakland

Pontiac, Michigan, United States

William Beaumont Hospital-Royal Oak

Royal Oak, Michigan, United States

Ascension Providence Hospitals - Southfield

Southfield, Michigan, United States

William Beaumont Hospital - Troy

Troy, Michigan, United States

GenesisCare USA - Troy

Troy, Michigan, United States

Saint John Macomb-Oakland Hospital

Warren, Michigan, United States

Mayo Clinic Health System in Albert Lea

Albert Lea, Minnesota, United States

Sanford Joe Lueken Cancer Center

Bemidji, Minnesota, United States

Miller-Dwan Hospital

Duluth, Minnesota, United States

Mayo Clinic Health Systems-Mankato

Mankato, Minnesota, United States

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Coborn Cancer Center at Saint Cloud Hospital

Saint Cloud, Minnesota, United States

Singing River Hospital

Pascagoula, Mississippi, United States

Saint Francis Medical Center

Cape Girardeau, Missouri, United States

Saint Luke's Hospital

Chesterfield, Missouri, United States

Siteman Cancer Center at Saint Peters Hospital

City of Saint Peters, Missouri, United States

Siteman Cancer Center at West County Hospital

Creve Coeur, Missouri, United States

The University of Kansas Cancer Center-South

Kansas City, Missouri, United States

University of Kansas Cancer Center - North

Kansas City, Missouri, United States

University of Kansas Cancer Center - Lee's Summit

Lee's Summit, Missouri, United States

Liberty Radiation Oncology Center

Liberty, Missouri, United States

Washington University School of Medicine

St Louis, Missouri, United States

Siteman Cancer Center-South County

St Louis, Missouri, United States

Billings Clinic Cancer Center

Billings, Montana, United States

Benefis Healthcare- Sletten Cancer Institute

Great Falls, Montana, United States

Kalispell Regional Medical Center

Kalispell, Montana, United States

Nebraska Methodist Hospital

Omaha, Nebraska, United States

University of Nebraska Medical Center

Omaha, Nebraska, United States

Radiation Oncology Centers of Nevada Central

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada

Las Vegas, Nevada, United States

Renown Regional Medical Center

Reno, Nevada, United States

Saint Mary's Regional Medical Center

Reno, Nevada, United States

Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, United States

Memorial Sloan Kettering Basking Ridge

Basking Ridge, New Jersey, United States

Ocean Medical Center

Brick, New Jersey, United States

Monmouth Medical Center

Long Branch, New Jersey, United States

Morristown Medical Center

Morristown, New Jersey, United States

Virtua Memorial

Mount Holly, New Jersey, United States

Jersey Shore Medical Center

Neptune City, New Jersey, United States

Saint Peter's University Hospital

New Brunswick, New Jersey, United States

Capital Health Medical Center-Hopewell

Pennington, New Jersey, United States

Riverview Medical Center/Booker Cancer Center

Red Bank, New Jersey, United States

Sparta Cancer Treatment Center

Sparta, New Jersey, United States

Overlook Hospital

Summit, New Jersey, United States

Community Medical Center

Toms River, New Jersey, United States

Virtua Voorhees

Voorhees Township, New Jersey, United States

University of New Mexico Cancer Center

Albuquerque, New Mexico, United States

Memorial Medical Center - Las Cruces

Las Cruces, New Mexico, United States

New York Oncology Hematology PC - Albany

Albany, New York, United States

Saint Peter's Health Partners

Albany, New York, United States

Roswell Park Cancer Institute

Buffalo, New York, United States

Sands Cancer Center

Canandiaqua, New York, United States

Memorial Sloan Kettering Commack

Commack, New York, United States

Mary Imogene Bassett Hospital

Cooperstown, New York, United States

Hematology Oncology Associates of Central New York-East Syracuse

East Syracuse, New York, United States

Cayuga Medical Center

Ithaca, New York, United States

Northwell Health NCORP

Lake Success, New York, United States

Northwell Health/Center for Advanced Medicine

Lake Success, New York, United States

Long Island Jewish Medical Center

New Hyde Park, New York, United States

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, United States

Memorial Sloan Kettering Cancer Center

New York, New York, United States

Hudson Valley Oncology Associates

Poughkeepsie, New York, United States

Wilmot Cancer Institute Radiation Oncology at Greece

Rochester, New York, United States

Highland Hospital

Rochester, New York, United States

Rochester General Hospital

Rochester, New York, United States

University of Rochester

Rochester, New York, United States

Memorial Sloan Kettering Sleepy Hollow

Sleepy Hollow, New York, United States

Staten Island University Hospital

Staten Island, New York, United States

Stony Brook University Medical Center

Stony Brook, New York, United States

Montefiore Medical Center - Moses Campus

The Bronx, New York, United States

Memorial Sloan Kettering Nassau

Uniondale, New York, United States

Dickstein Cancer Treatment Center

White Plains, New York, United States

Duke University Medical Center

Durham, North Carolina, United States

East Carolina University

Greenville, North Carolina, United States

The Coleman Radiation Center-Carteret General Hospital

Morehead City, North Carolina, United States

CarolinaEast Medical Center

New Bern, North Carolina, United States

FirstHealth of the Carolinas-Moore Regional Hospital

Pinehurst, North Carolina, United States

Iredell Memorial Hospital

Statesville, North Carolina, United States

NHRMC Radiation Oncology - Supply

Supply, North Carolina, United States

New Hanover Regional Medical Center/Zimmer Cancer Center

Wilmington, North Carolina, United States

NHRMC Radiation Oncology - 16th Street

Wilmington, North Carolina, United States

Sanford Bismarck Medical Center

Bismarck, North Dakota, United States

Sanford Roger Maris Cancer Center

Fargo, North Dakota, United States

Altru Cancer Center

Grand Forks, North Dakota, United States

Summa Health System - Akron Campus

Akron, Ohio, United States

Cleveland Clinic Akron General

Akron, Ohio, United States

Summa Health System - Barberton Campus

Barberton, Ohio, United States

UHHS-Chagrin Highlands Medical Center

Beachwood, Ohio, United States

Geauga Hospital

Chardon, Ohio, United States

Adena Regional Medical Center

Chillicothe, Ohio, United States

The Christ Hospital

Cincinnati, Ohio, United States

University of Cincinnati Cancer Center-UC Medical Center

Cincinnati, Ohio, United States

Case Western Reserve University

Cleveland, Ohio, United States

Cleveland Clinic Cancer Center/Fairview Hospital

Cleveland, Ohio, United States

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Cleveland Clinic Cancer Center Independence

Independence, Ohio, United States

Hillcrest Hospital Cancer Center

Mayfield Heights, Ohio, United States

Summa Health Medina Medical Center

Medina, Ohio, United States

UH Seidman Cancer Center at Lake Health Mentor Campus

Mentor, Ohio, United States

UH Seidman Cancer Center at Southwest General Hospital

Middleburg Heights, Ohio, United States

University Hospitals Parma Medical Center

Parma, Ohio, United States

University Hospitals Portage Medical Center

Ravenna, Ohio, United States

North Coast Cancer Care

Sandusky, Ohio, United States

Cleveland Clinic Cancer Center Strongsville

Strongsville, Ohio, United States

UHHS-Westlake Medical Center

Westlake, Ohio, United States

Cleveland Clinic Wooster Family Health and Surgery Center

Wooster, Ohio, United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, United States

Natalie Warren Bryant Cancer Center at Saint Francis

Tulsa, Oklahoma, United States

Clackamas Radiation Oncology Center

Clackamas, Oregon, United States

Willamette Valley Cancer Center

Eugene, Oregon, United States

Three Rivers Community Hospital

Grants Pass, Oregon, United States

Providence Medford Medical Center

Medford, Oregon, United States

Rogue Valley Medical Center

Medford, Oregon, United States

Providence Portland Medical Center

Portland, Oregon, United States

Jefferson Abington Hospital

Abington, Pennsylvania, United States

UPMC-Heritage Valley Health System Beaver

Beaver, Pennsylvania, United States

Bryn Mawr Hospital

Bryn Mawr, Pennsylvania, United States

Geisinger Medical Center

Danville, Pennsylvania, United States

Delaware County Memorial Hospital

Drexel Hill, Pennsylvania, United States

Northeast Radiation Oncology Center

Dunmore, Pennsylvania, United States

Pocono Medical Center

East Stroudsburg, Pennsylvania, United States

UPMC Hillman Cancer Center Erie

Erie, Pennsylvania, United States

Fox Chase Cancer Center Buckingham

Furlong, Pennsylvania, United States

Adams Cancer Center

Gettysburg, Pennsylvania, United States

UPMC Cancer Centers - Arnold Palmer Pavilion

Greensburg, Pennsylvania, United States

Cherry Tree Cancer Center

Hanover, Pennsylvania, United States

Penn State Milton S Hershey Medical Center

Hershey, Pennsylvania, United States

UPMC-Johnstown/John P. Murtha Regional Cancer Center

Johnstown, Pennsylvania, United States

Lancaster General Hospital

Lancaster, Pennsylvania, United States

Saint Mary Medical and Regional Cancer Center

Langhorne, Pennsylvania, United States

UPMC Cancer Center at UPMC McKeesport

McKeesport, Pennsylvania, United States

Holy Redeemer Hospital and Medical Center

Meadowbrook, Pennsylvania, United States

Riddle Memorial Hospital

Media, Pennsylvania, United States

Intercommunity Cancer Center

Monroeville, Pennsylvania, United States

UPMC-Coraopolis/Heritage Valley Radiation Oncology

Moon Township, Pennsylvania, United States

Allegheny Valley Hospital

Natrona Heights, Pennsylvania, United States

UPMC Jameson

New Castle, Pennsylvania, United States

Paoli Memorial Hospital

Paoli, Pennsylvania, United States

University of Pennsylvania/Abramson Cancer Center

Philadelphia, Pennsylvania, United States

Thomas Jefferson University Hospital

Philadelphia, Pennsylvania, United States

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Allegheny General Hospital