Radiation Therapy With or Without Epoetin Alfa in Treating Anemic Patients With Head and Neck Cancer

Sponsor

Radiation Therapy Oncology Group (Other)

Overall Status

Completed

CT.gov ID

NCT00004917

Collaborator

National Cancer Institute (NCI) (NIH)

261

Locations

198

Duration (Months)

Study Details

Study Description

Brief Summary

RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Epoetin alfa may stimulate red blood cell production and treat anemia in patients with head and neck cancer. It is not yet known whether receiving radiation therapy with epoetin alfa is more effective than radiation therapy alone in treating anemic patients with head and neck cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of radiation therapy with or without epoetin alfa in treating anemic patients who have head and neck cancer.

Condition or Disease	Intervention/Treatment	Phase
Anemia Head and Neck Cancer	Biological: epoetin alfa Drug: cisplatin Radiation: radiation therapy	Phase 3

Detailed Description

OBJECTIVES:

Primary

Determine whether epoetin alfa given during definitive radiotherapy or chemoradiotherapy improves the local-regional control rate in anemic patients with squamous cell carcinoma of the head and neck.

Secondary

Determine whether this drug improves survival in this patient population.
Identify patterns in first failure in these patients.
Determine whether there is a significant increase in hemoglobin level between the baseline value and the value at 28 days after starting epoetin alfa in these patients.
Assess the toxicity of this regimen in these patients.

OUTLINE: This is a randomized study. Patients are stratified according to stage (I/II vs III/IV without chemotherapy vs III/IV with chemotherapy), pretreatment hemoglobin level (9.0 to less than 11.5 g/dL vs 11.5 to 13.5 g/dL), and gender. Patients are randomized to one of two treatment arms.

Arm I: Patients with stage I or II disease undergo radiotherapy once daily for 6-7 weeks. Patients with stage III or IV disease undergo radiotherapy once daily for 3.5 weeks and then twice daily (6 hours apart) for 2.5 weeks for a total of 6 weeks.
Arm II: Patients undergo radiotherapy as in arm I. Beginning 7-10 days before radiotherapy, patients receive epoetin alfa subcutaneously once weekly until the end of radiotherapy.

Patients with stage III/IV disease may receive concurrent cisplatin IV over 1-2 hours on days 1 and 22 of radiotherapy.

Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 372 patients (186 per arm) will be accrued for this study within 3.5 years.

Study Design

Study Type:

Interventional

Allocation:

Randomized

Primary Purpose:

Treatment

Official Title:

A Randomized Phase III Trial to Assess the Effect of Erythropoietin on Local-Regional Control in Anemic Patients Treated With Radiotherapy for Carcinoma of the Head and Neck

Study Start Date :

Jun 1, 2000

Actual Primary Completion Date :

Nov 1, 2007

Actual Study Completion Date :

Dec 1, 2016

Outcome Measures

Primary Outcome Measures

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed invasive squamous cell carcinoma of the head and neck, including carcinoma arising from the oral cavity, oropharynx, larynx, and hypopharynx
Stage I-IV disease
No distant metastases
No carcinoma of the nasopharynx, nasal cavity/paranasal sinuses, or salivary glands
No carcinoma in situ without an identifiable invasive component
Plan for radiotherapy in continuous course
Prior surgical exploration with gross residual disease remaining allowed
Prior neck dissection with or without biopsy of primary tumor, but no radical surgery for primary tumor, allowed
Anemia, defined as hemoglobin no greater than 13.5 g/dL for males and no greater than 12.5 g/dL for females (transfusion prior to study allowed)
No severe anemia (i.e., hemoglobin less than 9.0 g/dL)
No anemia confirmed to be due to causes other than chronic disease (e.g., iron deficiency anemia)
Not entered on other RTOG head and neck protocols

PATIENT CHARACTERISTICS:

Age:

18 and over

Performance status:

Zubrod 0-2

Life expectancy:

Not specified

Hematopoietic:

See Disease Characteristics
Stage III/IV patients receiving concurrent cisplatin:
Absolute neutrophil count at least 2,000/mm^3
Platelet count at least 100,000/mm^3

Hepatic:

Not specified

Renal:

Stage III/IV patients receiving concurrent cisplatin:
Creatinine no greater than 1.5 mg/dL
Creatinine clearance at least 50 mL/min

Cardiovascular:

No malignant or poorly controlled hypertension (e.g., symptomatic hypertension or diastolic blood pressure of 100 mm Hg or greater despite antihypertensive medication)
No unstable angina or other poorly controlled cardiac disease

Other:

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
If stage III or IV disease is present, willing to come for twice daily radiotherapy for the last 2.5 weeks of therapy
No active infection requiring IV antibiotics
No unexplained fever
No AIDS or other history of congenital or acquired immunodeficiency
No other malignancies within the past 3 years except carcinoma in situ or nonmelanomatous skin cancer
No known hypersensitivity to mammalian cell-derived products or to human albumin
No acute/subacute illness that would make the need for transfusion likely

PRIOR CONCURRENT THERAPY:

Biologic therapy:

At least 4 weeks since other prior cytokine therapy (e.g., filgrastim [G-CSF], interleukins, or interferons)
No prior epoetin alfa
No other concurrent cytokine therapy

Chemotherapy:

No prior chemotherapy
Concurrent cisplatin, paclitaxel/cisplatin, or paclitaxel/carboplatin for patients with stage III/IV disease is allowed

Endocrine therapy:

Not specified

Radiotherapy:

See Disease Characteristics
No prior radiotherapy to the head and neck

Surgery:

See Disease Characteristics

Other:

No concurrent amifostine
No concurrent transfusion

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham Comprehensive Cancer Center	Birmingham	Alabama	United States	35294-3300
2	Comprehensive Cancer Institute of Huntsville	Huntsville	Alabama	United States	35801
3	Huntsville Hospital System	Huntsville	Alabama	United States	35807
4	MBCCOP - Gulf Coast	Mobile	Alabama	United States	36688
5	Alabama Oncology, LLC	Montgomery	Alabama	United States	36106-3657
6	DCH Cancer Treatment Center	Tuscaloosa	Alabama	United States	35401
7	Foundation for Cancer Research and Education	Phoenix	Arizona	United States	85013
8	Providence Saint Joseph Medical Center - Burbank	Burbank	California	United States	91505
9	Mount Diablo Medical Center	Concord	California	United States	94524-4110
10	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010-3000
11	California Cancer Center	Fresno	California	United States	93720
12	Saint Agnes Cancer Center	Fresno	California	United States	93720
13	Sutter Health Western Division Cancer Research Group	Greenbrae	California	United States	94904
14	Loma Linda University Medical Center	Loma Linda	California	United States	92354
15	Veterans Affairs Medical Center - Long Beach	Long Beach	California	United States	90822
16	USC/Norris Comprehensive Cancer Center and Hospital	Los Angeles	California	United States	90033-0804
17	Jonsson Comprehensive Cancer Center, UCLA	Los Angeles	California	United States	90095-1714
18	CCOP - Bay Area Tumor Institute	Oakland	California	United States	94609-3305
19	Huntington Cancer Center	Pasadena	California	United States	91105
20	Robert and Beverly Lewis Family Cancer Care Center	Pomona	California	United States	91767
21	Radiation Oncology Center - Sacramento	Sacramento	California	United States	95816
22	Radiation Medical Group, Incorporated	San Diego	California	United States	92101
23	Naval Medical Center - San Diego	San Diego	California	United States	92134-3202
24	UCSF Comprehensive Cancer Center	San Francisco	California	United States	94143-0128
25	O'Connor Hospital	San Jose	California	United States	95128
26	CCOP - Santa Rosa Memorial Hospital	Santa Rosa	California	United States	95403
27	Torrance Memorial Medical Center	Torrance	California	United States	90505
28	David Grant Medical Center	Travis Air Force Base	California	United States	94535
29	Memorial Hospital Cancer Center	Colorado Springs	Colorado	United States	80909
30	University of Colorado Cancer Center	Denver	Colorado	United States	80010
31	CCOP - Colorado Cancer Research Program, Incorporated	Denver	Colorado	United States	80224
32	Saint Mary's Hospital and Medical Center	Grand Junction	Colorado	United States	81502-1628
33	Yale Comprehensive Cancer Center	New Haven	Connecticut	United States	06520-8040
34	CCOP - Christiana Care Health Services	Newark	Delaware	United States	19713
35	Sibley Memorial Hospital	Washington	District of Columbia	United States	20016
36	21st Century Oncology - Fort Myers	Fort Myers	Florida	United States	33901-8082
37	University of Florida Health Science Center	Gainesville	Florida	United States	32610-0385
38	Florida Radiation Oncology Group	Jacksonville	Florida	United States	32207
39	Holmes Regional Medical Center	Melbourne	Florida	United States	32901-3276
40	CCOP - Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
41	Veterans Affairs Medical Center - Miami	Miami	Florida	United States	33125
42	Sylvester Cancer Center, University of Miami	Miami	Florida	United States	33136
43	Baptist Hospital of Miami	Miami	Florida	United States	33256-2110
44	MD Anderson Cancer Center Orlando	Orlando	Florida	United States	32806-2134
45	Bay Medical Center	Panama City	Florida	United States	32401
46	Gulf Coast Cancer Treatment Center	Panama City	Florida	United States	32405-4587
47	Sarasota Radiation and Medical Oncology Center	Sarasota	Florida	United States	34233
48	Tallahassee Memorial Healthcare	Tallahassee	Florida	United States	32308
49	H. Lee Moffitt Cancer Center and Research Institute	Tampa	Florida	United States	33612-9497
50	Emory University Hospital - Atlanta	Atlanta	Georgia	United States	30322
51	CCOP - Atlanta Regional	Atlanta	Georgia	United States	30342-1701
52	Medical Center/John B. Amos Community Cancer Center	Columbus	Georgia	United States	31901
53	Regional Radiation Oncology Center at Rome	Rome	Georgia	United States	30165
54	MBCCOP - Hawaii	Honolulu	Hawaii	United States	96813
55	Northwest Community Hospital	Arlington Heights	Illinois	United States	60005
56	Northwestern Memorial Hospital	Chicago	Illinois	United States	60611
57	CCOP - Central Illinois	Decatur	Illinois	United States	62526
58	Ingalls Memorial Hospital	Harvey	Illinois	United States	60426
59	Loyola University Medical Center	Maywood	Illinois	United States	60153
60	Lutheran General Cancer Care Center	Park Ridge	Illinois	United States	60068
61	CCOP - Scott and White Hospital	Peoria	Illinois	United States	61602
62	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61636
63	St. John's Medical Center	Anderson	Indiana	United States	46016
64	Bloomington Hospital	Bloomington	Indiana	United States	47402
65	Veterans Affairs Medical Center - Indianapolis (Roudebush)	Indianapolis	Indiana	United States	46202
66	Clarian Health Partners Inc.	Indianapolis	Indiana	United States	46206-1367
67	Community Regional Cancer Care	Indianapolis	Indiana	United States	46219
68	Ball Memorial Hospital	Muncie	Indiana	United States	47303-3499
69	CCOP - Northern Indiana CR Consortium	South Bend	Indiana	United States	46601
70	Wendt Regional Cancer Center of Finley Hospital	Dubuque	Iowa	United States	52001
71	St. Elizabeth Medical Center	Edgewood	Kentucky	United States	41017
72	Central Baptist Hospital	Lexington	Kentucky	United States	40503
73	Cancer Center at Lexington Clinic	Lexington	Kentucky	United States	40504
74	Albert B. Chandler Medical Center, University of Kentucky	Lexington	Kentucky	United States	40536-0293
75	James Graham Brown Cancer Center	Louisville	Kentucky	United States	40202
76	Louisville Radiation Oncology	Louisville	Kentucky	United States	40215
77	Merle M. Mahr Cancer Center	Madisonville	Kentucky	United States	42431
78	Mary Bird Perkins Cancer Center	Baton Rouge	Louisiana	United States	70809
79	Tulane University School of Medicine	New Orleans	Louisiana	United States	70112-2699
80	MBCCOP - LSU Health Sciences Center	New Orleans	Louisiana	United States	70112
81	CCOP - Ochsner	New Orleans	Louisiana	United States	70121
82	Maine Medical Center	Portland	Maine	United States	04102
83	Anne Arundel Oncology Center	Annapolis	Maryland	United States	21401
84	Marlene and Stewart Greenebaum Cancer Center, University of Maryland	Baltimore	Maryland	United States	21201
85	Greater Baltimore Medical Center and Cancer Center	Baltimore	Maryland	United States	21204
86	Harbor Hospital Center	Baltimore	Maryland	United States	21215-1290
87	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21215
88	St. Agnes Cancer Center	Baltimore	Maryland	United States	21229
89	Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	Baltimore	Maryland	United States	21231-2410
90	Peninsula Regional Medical Center	Salisbury	Maryland	United States	21801
91	Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute	Boston	Massachusetts	United States	02114
92	Boston Medical Center	Boston	Massachusetts	United States	02118
93	Cape Cod Hospital	Hyannis	Massachusetts	United States	02601
94	Veterans Affairs Medical Center - Boston (Jamaica Plain)	Jamaica Plain	Massachusetts	United States	02130
95	NSMC Cancer Center	Peabody	Massachusetts	United States	01960
96	CCOP - Michigan Cancer Research Consortium	Ann Arbor	Michigan	United States	48106
97	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan	United States	48109-0010
98	Barbara Ann Karmanos Cancer Institute	Detroit	Michigan	United States	48201-1379
99	Henry Ford Hospital	Detroit	Michigan	United States	48202
100	Hurley Medical Center	Flint	Michigan	United States	48503
101	McLaren Regional Cancer Center	Flint	Michigan	United States	48532-3685
102	CCOP - Kalamazoo	Kalamazoo	Michigan	United States	49007-3731
103	Marquette General Hospital	Marquette	Michigan	United States	49855
104	MidMichigan Medical Center - Midland	Midland	Michigan	United States	48670
105	CCOP - Beaumont	Royal Oak	Michigan	United States	48073-6769
106	William Beaumont Hospital	Royal Oak	Michigan	United States	48073
107	William Beaumont Hospital - Troy	Troy	Michigan	United States	48098
108	Fairview University Medical Center	Minneapolis	Minnesota	United States	55455
109	Mayo Clinic Cancer Center	Rochester	Minnesota	United States	55905-0001
110	CCOP - Metro-Minnesota	Saint Louis Park	Minnesota	United States	55416
111	Ellis Fischel Cancer Center - Columbia	Columbia	Missouri	United States	65203
112	CCOP - Kansas City	Kansas City	Missouri	United States	64131
113	Mallinckrodt Institute of Radiology	Saint Louis	Missouri	United States	63108
114	St. Louis University Health Sciences Center	Saint Louis	Missouri	United States	63110-0250
115	Cancer Research for the Ozarks	Springfield	Missouri	United States	65807
116	CCOP - Cancer Research for the Ozarks	Springfield	Missouri	United States	65807
117	CCOP - Montana Cancer Consortium	Billings	Montana	United States	59101
118	CCOP - Missouri Valley Cancer Consortium	Omaha	Nebraska	United States	68106
119	Methodist Hospital Cancer Center - Omaha	Omaha	Nebraska	United States	68114
120	Nebraska Health System	Omaha	Nebraska	United States	68198-7460
121	CCOP - Southern Nevada Cancer Research Foundation	Las Vegas	Nevada	United States	89106
122	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89109
123	Norris Cotton Cancer Center	Lebanon	New Hampshire	United States	03756-0002
124	Elliot Regional Cancer Center	Manchester	New Hampshire	United States	03103
125	Veterans Affairs Medical Center - East Orange	East Orange	New Jersey	United States	07019
126	John F. Kennedy Medical Center	Edison	New Jersey	United States	08818
127	Trinitas Hospital - Jersey Street Campus	Elizabeth	New Jersey	United States	07201
128	Monmouth Medical Center	Long Branch	New Jersey	United States	07740-6395
129	South Jersey Regional Cancer Center	Millville	New Jersey	United States	08332
130	Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital	Mount Holly	New Jersey	United States	08060
131	Cancer Institute of New Jersey	New Brunswick	New Jersey	United States	08903
132	Newark Beth Israel Medical Center	Newark	New Jersey	United States	07112
133	Atlantic City Medical Center	Pomona	New Jersey	United States	08240
134	Medical Center of Princeton	Princeton	New Jersey	United States	08540
135	Valley Hospital	Ridgewood	New Jersey	United States	07450
136	Community Medical Center	Toms River	New Jersey	United States	08755
137	St. Francis Medical Center	Trenton	New Jersey	United States	08629
138	Associated Radiologists, P.A.	Warren	New Jersey	United States	07059
139	Radiation Oncology Associates of Albuquerque	Albuquerque	New Mexico	United States	87109
140	Cancer Center of Albany Medical Center	Albany	New York	United States	12208
141	State University of New York Health Science Center at Brooklyn	Brooklyn	New York	United States	11203
142	New York Methodist Hospital	Brooklyn	New York	United States	11215
143	Roswell Park Cancer Institute	Buffalo	New York	United States	14263-0001
144	Finger Lakes Radiation Oncology Center	Clifton Springs	New York	United States	14432
145	CCOP - North Shore University Hospital	Manhasset	New York	United States	11030
146	Beth Israel Medical Center	New York	New York	United States	10003
147	Herbert Irving Comprehensive Cancer Center	New York	New York	United States	10032
148	Champlain Valley Physicians Hospital Medical Center	Plattsburgh	New York	United States	12901
149	James P. Wilmot Cancer Center	Rochester	New York	United States	14642
150	CCOP - Syracuse Hematology-Oncology Associates of Central New York, P.C.	Syracuse	New York	United States	13217
151	Riverhill Radiation Oncology	Yonkers	New York	United States	10701
152	Lineberger Comprehensive Cancer Center, UNC	Chapel Hill	North Carolina	United States	27599-7295
153	Northeast Medical Center	Concord	North Carolina	United States	28025
154	East Carolina University School of Medicine	Greenville	North Carolina	United States	27858-4354
155	CCOP - Southeast Cancer Control Consortium	Winston-Salem	North Carolina	United States	27104-4241
156	Comprehensive Cancer Center at Wake Forest University	Winston-Salem	North Carolina	United States	27157-1082
157	Trinity Cancer Care Center	Minot	North Dakota	United States	58701
158	Akron General Medical Center	Akron	Ohio	United States	44302
159	Akron City Hospital	Akron	Ohio	United States	44304
160	Barrett Cancer Center	Cincinnati	Ohio	United States	45219
161	Christ Hospital	Cincinnati	Ohio	United States	45219
162	Ireland Cancer Center	Cleveland	Ohio	United States	44106-5065
163	University Hospitals of Cleveland	Cleveland	Ohio	United States	44106
164	Cleveland Clinic Taussig Cancer Center	Cleveland	Ohio	United States	44195
165	CCOP - Columbus	Columbus	Ohio	United States	43206
166	Arthur G. James Cancer Hospital - Ohio State University	Columbus	Ohio	United States	43210-1240
167	CCOP - Dayton	Dayton	Ohio	United States	45429
168	Parma Community General Hospital	Parma	Ohio	United States	44129
169	CCOP - Toledo Community Hospital	Toledo	Ohio	United States	43623-3456
170	St. Anthony Hospital	Oklahoma City	Oklahoma	United States	73101
171	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
172	St. John Health System	Tulsa	Oklahoma	United States	74104
173	CCOP - Oklahoma	Tulsa	Oklahoma	United States	74136
174	CCOP - Columbia River Oncology Program	Portland	Oregon	United States	97225
175	Abington Memorial Hospital	Abington	Pennsylvania	United States	19001
176	Lehigh Valley Hospital	Allentown	Pennsylvania	United States	18105
177	St. Luke's Hospital Cancer Center	Bethlehem	Pennsylvania	United States	18015
178	Geisinger Medical Center	Danville	Pennsylvania	United States	17822-2001
179	Mercy Fitzgerald Hospital	Darby	Pennsylvania	United States	19023
180	Delaware County Memorial Hospital	Drexel Hill	Pennsylvania	United States	19026
181	Pocono Cancer Center	East Stroudsburg	Pennsylvania	United States	18301
182	Milton S. Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
183	Abramson Cancer Center of the University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104-4283
184	Veterans Affairs Medical Center - Philadelphia	Philadelphia	Pennsylvania	United States	19104
185	Kimmel Cancer Center of Thomas Jefferson University - Philadelphia	Philadelphia	Pennsylvania	United States	19107-5541
186	Fox Chase Cancer Center	Philadelphia	Pennsylvania	United States	19111
187	Albert Einstein Cancer Center	Philadelphia	Pennsylvania	United States	19141-3098
188	Allegheny General Hospital	Pittsburgh	Pennsylvania	United States	15212
189	Mercy Hospital of Pittsburgh	Pittsburgh	Pennsylvania	United States	15219
190	Western Pennsylvania Hospital	Pittsburgh	Pennsylvania	United States	15224
191	University of Pittsburgh Cancer Institute	Pittsburgh	Pennsylvania	United States	15236
192	Reading Hospital and Medical Center	Reading	Pennsylvania	United States	19612-6052
193	Mercy Hospital Cancer Center - Scranton	Scranton	Pennsylvania	United States	18501
194	Wilkes Barre General Hospital	Wilkes-Barre	Pennsylvania	United States	18764
195	CCOP - MainLine Health	Wynnewood	Pennsylvania	United States	19096
196	York Cancer Center	York	Pennsylvania	United States	17403
197	Roger Williams Medical Center/BUSM	Providence	Rhode Island	United States	02908-4735
198	CCOP - Greenville	Greenville	South Carolina	United States	29615
199	CCOP - Upstate Carolina	Spartanburg	South Carolina	United States	29303
200	Rapid City Regional Hospital	Rapid City	South Dakota	United States	57709
201	Jackson-Madison County General Hospital	Jackson	Tennessee	United States	38301-3956
202	University of Tennessee Cancer Institute	Memphis	Tennessee	United States	38103
203	Vanderbilt-Ingram Cancer Center	Nashville	Tennessee	United States	37232-5671
204	Harrington Cancer Center	Amarillo	Texas	United States	79106
205	Arlington Cancer Center	Arlington	Texas	United States	76012
206	University of Texas Medical Branch	Galveston	Texas	United States	77555-0209
207	University of Texas - MD Anderson Cancer Center	Houston	Texas	United States	77030-4009
208	Wilford Hall Medical Center	Lackland Air Force Base	Texas	United States	78236-5300
209	Joe Arrington Cancer Research and Treatment Center	Lubbock	Texas	United States	79410-1894
210	Bayshore Medical Center	Pasadena	Texas	United States	77504
211	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78284-7811
212	Utah Valley Regional Medical Center - Provo	Provo	Utah	United States	84604
213	Dixie Regional Medical Center	Saint George	Utah	United States	84770
214	University of Utah Health Sciences Center	Salt Lake City	Utah	United States	84132
215	Latter Day Saints Hospital	Salt Lake City	Utah	United States	84143
216	Green Mountain Oncology Group	Bennington	Vermont	United States	05201
217	Vermont Cancer Center	Burlington	Vermont	United States	05405-0075
218	Cancer Center at the University of Virginia	Charlottesville	Virginia	United States	22908
219	RMH Regional Cancer Center	Harrisonburg	Virginia	United States	22801
220	Naval Medical Center, Portsmouth	Portsmouth	Virginia	United States	23708-2197
221	Bon Secours - St. Mary's Hospital	Richmond	Virginia	United States	23226
222	Massey Cancer Center	Richmond	Virginia	United States	23298-0058
223	Virginia Mason Medical Center	Seattle	Washington	United States	98111
224	University of Washington Medical Center	Seattle	Washington	United States	98195-6043
225	Deaconess Medical Center	Spokane	Washington	United States	99204
226	Yakima Valley Memorial Hospital	Yakima	Washington	United States	98902
227	Schiffler Cancer Center	Wheeling	West Virginia	United States	26003
228	CCOP - St. Vincent Hospital Cancer Center, Green Bay	Green Bay	Wisconsin	United States	54301
229	St. Vincent Hospital	Green Bay	Wisconsin	United States	54307-3508
230	Gundersen Lutheran Medical Foundation	La Crosse	Wisconsin	United States	54601
231	Southern Wisconsin Radiotherapy Center	Madison	Wisconsin	United States	53713
232	University of Wisconsin Comprehensive Cancer Center	Madison	Wisconsin	United States	53792
233	Marshfield Clinic	Marshfield	Wisconsin	United States	54449
234	Community Memorial Hospital	Menomonee Falls	Wisconsin	United States	53051
235	Columbia Hospital	Milwaukee	Wisconsin	United States	53211
236	St. Luke's Medical Center	Milwaukee	Wisconsin	United States	53215
237	Medical College of Wisconsin Cancer Center	Milwaukee	Wisconsin	United States	53226
238	Veterans Affairs Medical Center - Milwaukee (Zablocki)	Milwaukee	Wisconsin	United States	53295
239	All Saints Cancer Center	Racine	Wisconsin	United States	53405
240	Waukesha Memorial Hospital Regional Cancer Center	Waukesha	Wisconsin	United States	53188
241	Tom Baker Cancer Center - Calgary	Calgary	Alberta	Canada	T2N 4N2
242	Cross Cancer Institute	Edmonton	Alberta	Canada	T6G 1Z2
243	Doctor Leon Richard Oncology Centre	Moncton	New Brunswick	Canada	E1C 8X3
244	Saint John Regional Hospital	Saint John	New Brunswick	Canada	E2L 4L2
245	Newfoundland Cancer Treatment and Research Foundation	St. Johns	Newfoundland and Labrador	Canada	A1B 3V6
246	Nova Scotia Cancer Centre	Halifax	Nova Scotia	Canada	B3H 1V7
247	Cancer Care Ontario-Hamilton Regional Cancer Centre	Hamilton	Ontario	Canada	L8V 5C2
248	Kingston Regional Cancer Centre	Kingston	Ontario	Canada	K7L 5P9
249	Cancer Care Ontario-London Regional Cancer Centre	London	Ontario	Canada	N6A 4L6
250	Ottawa Regional Cancer Centre	Ottawa	Ontario	Canada	K1H 1C4
251	Northeastern Ontario Regional Cancer Centre, Sudbury	Sudbury	Ontario	Canada	P3E 5J1
252	Northwestern Ontario Regional Cancer Centre, Thunder Bay	Thunder Bay	Ontario	Canada	P7A 7T1
253	Toronto Sunnybrook Regional Cancer Centre	Toronto	Ontario	Canada	M4N 3M5
254	Princess Margaret Hospital	Toronto	Ontario	Canada	M5G 2M9
255	CHUS-Hopital Fleurimont	Fleurimont	Quebec	Canada	J1H 5N4
256	Centre Hospitalier de l'Universite de Montreal	Montreal	Quebec	Canada	H2L 4MI
257	McGill University	Montreal	Quebec	Canada	H2W 1S6
258	Centre Hospitalier Universitaire de Quebec	Quebec City	Quebec	Canada	G1R 2J6
259	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1
260	Saskatoon Cancer Centre	Saskatoon	Saskatchewan	Canada	S7N 4H4
261	Jin Soo Lee Practice Inc.	Gyeonggi		Korea, Republic of	411-764