Temozolomide Plus Lomustine Followed by Radiation Therapy in Treating Patients With High-Grade Malignant Glioma

Sponsor

Children's Oncology Group (Other)

Overall Status

Completed

CT.gov ID

NCT00006024

Collaborator

National Cancer Institute (NCI) (NIH)

Enrollment

235

Locations

Arm

Duration (Months)

0.1

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining more than one chemotherapy drug with radiation therapy may kill more tumor cells.

PURPOSE: Phase I trial to study the effectiveness of temozolomide plus lomustine followed by radiation therapy in treating patients who have high-grade malignant glioma.

Condition or Disease	Intervention/Treatment	Phase
Brain Tumor Central Nervous System Tumor	Drug: lomustine Drug: temozolomide	Phase 1

Detailed Description

OBJECTIVES:

Determine the maximum tolerated dose of temozolomide when administered with lomustine in patients with high-grade malignant gliomas.
Determine the dose-limiting toxic effects of this regimen in these patients.
Evaluate the feasibility of radiotherapy after this treatment regimen in this patient population.
Evaluate the radiographic responses in patients treated with this regimen.

OUTLINE: This is a multicenter, dose-escalation study of temozolomide.

Patients receive oral temozolomide on days 1-5 and oral lomustine on day 1. Treatment continues every 28 days, if blood counts have recovered, for 2 courses in the absence of disease progression or unacceptable toxicity. Patients then undergo radiotherapy on days 1-5 weekly for 6 weeks. Patients continue the same chemotherapy regimen for up to 6 more courses beginning 4 weeks after completion of radiotherapy.

Cohorts of 3-6 patients receive escalating doses of temozolomide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Patients are followed for survival.

PROJECTED ACCRUAL: A total of 3-30 patients will be accrued for this study.

Study Design

Study Type:

Interventional

Actual Enrollment :

32 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase I Study of Temozolomide and CCNU in Pediatric Patients With Newly Diagnosed Incompletely Resected Non-Brainstem High-Grade Gliomas

Study Start Date :

Nov 1, 2000

Actual Primary Completion Date :

Jan 1, 2005

Actual Study Completion Date :

Sep 1, 2006

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Pre and Post radiation Chemotherapy	Drug: lomustine Drug: temozolomide

Arm

Intervention/Treatment

Experimental: Pre and Post radiation Chemotherapy

Drug: lomustine

Drug: temozolomide

Outcome Measures

Primary Outcome Measures

Progression Free Survival [Length of study]
This trial is a phase I evaluation of temozolomide in combination with a fixed dose of CCNU with the starting dose for temozolomide

Eligibility Criteria

Criteria

Ages Eligible for Study:

3 Years to 21 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

DISEASE CHARACTERISTICS:

Histologically confirmed high-grade malignant glioma of one of the following subtypes:
Glioblastoma
Anaplastic astrocytoma
Anaplastic oligoastrocytoma
Gliomatosis cerebri
No disseminated disease or primary spinal cord malignancies
Measurable intracranial residual disease by MRI

PATIENT CHARACTERISTICS:

Age:

3 and over
Under 22 at time of diagnosis

Performance status:

Karnofsky 50-100% if over 10 years of age
Lansky 50-100% if 10 years of age or under

Life expectancy:

At least 8 weeks

Hematopoietic:

Absolute neutrophil count at least 1,000/mm^3
Platelet count at least 100,000/mm^3 (transfusion independent)
Hemoglobin at least 8.0 g/dL (RBC transfusions allowed)

Hepatic:

Bilirubin no greater than 1.5 times normal for age
SGPT no greater than 2.5 times normal for age
Albumin at least 2 g/dL

Renal:

Creatinine no greater than 1.5 times normal for age OR
Creatinine clearance or radioisotope glomerular filtration rate at least lower limit of normal for age

Pulmonary:

No dyspnea at rest
No exercise intolerance
Pulse oximetry at least 94%

Other:

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No uncontrolled infection

PRIOR CONCURRENT THERAPY:

Biologic therapy:

No prior biologic therapy
No concurrent prophylactic hematopoietic growth factors

Chemotherapy:

No prior chemotherapy

Endocrine therapy:

Prior corticosteroid therapy allowed
No concurrent corticosteroids as antiemetic

Radiotherapy:

No prior radiotherapy

Surgery:

No more than 31 days since prior maximal neurosurgical procedure

Other:

No concurrent phenobarbital or cimetidine

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham Comprehensive Cancer Center	Birmingham	Alabama	United States	35233
2	University of South Alabama Medical Center	Mobile	Alabama	United States	36604
3	Phoenix Children's Hospital	Phoenix	Arizona	United States	85016-7710
4	Arizona Cancer Center	Tucson	Arizona	United States	85724
5	University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
6	Southern California Permanente Medical Group	Downey	California	United States	90242
7	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010-3000
8	Rebecca and John Moores UCSD Cancer Center	La Jolla	California	United States	92093-0658
9	Loma Linda University Medical Center	Loma Linda	California	United States	92354
10	Jonathan Jaques Children's Cancer Center	Long Beach	California	United States	90801-1428
11	Children's Hospital Los Angeles	Los Angeles	California	United States	90027-0700
12	Cedars-Sinai Medical Center	Los Angeles	California	United States	90048
13	Jonsson Comprehensive Cancer Center, UCLA	Los Angeles	California	United States	90095-1781
14	Children's Hospital Central California	Madera	California	United States	93638-8762
15	Children's Hospital of Oakland	Oakland	California	United States	94609-1809
16	Chao Family Comprehensive Cancer Center	Orange	California	United States	92868
17	Children's Hospital of Orange County	Orange	California	United States	92868
18	Lucile Packard Children's Hospital at Stanford	Palo Alto	California	United States	94304
19	Sutter Cancer Center	Sacramento	California	United States	95816
20	University of California Davis Medical Center	Sacramento	California	United States	95817
21	Kaiser Permanente Medical Center/Kaiser Foundation Hospital - San Diego	San Diego	California	United States	92120
22	Children's Hospital San Diego	San Diego	California	United States	92123-4282
23	Kaiser Permanente Medical Center - San Francisco Geary Campus	San Francisco	California	United States	94115
24	UCSF Comprehensive Cancer Center	San Francisco	California	United States	94143-0128
25	Santa Barbara Cottage Hospital	Santa Barbara	California	United States	93102
26	Kaiser Permanente Medical Center - Santa Clara	Santa Clara	California	United States	95051-5386
27	David Grant Medical Center	Travis Air Force Base	California	United States	94535
28	Children's Hospital of Denver	Denver	Colorado	United States	80218-1088
29	Childhood Hematology/Oncology Associates	Denver	Colorado	United States	80218
30	Presbyterian-St Luke's Medical Center	Denver	Colorado	United States	80218
31	University of Connecticut Health Center	Farmington	Connecticut	United States	06360-7106
32	Yale Comprehensive Cancer Center	New Haven	Connecticut	United States	06520-8028
33	Alfred I. Dupont Institute	Wilmington	Delaware	United States	19899
34	Lombardi Cancer Center	Washington	District of Columbia	United States	20007
35	Children's National Medical Center	Washington	District of Columbia	United States	20010-2970
36	Walter Reed Army Medical Center	Washington	District of Columbia	United States	20307-5000
37	Broward General Medical Center	Fort Lauderdale	Florida	United States	33316
38	Children's Hospital of Southwest Florida	Fort Myers	Florida	United States	33908
39	Shands Hospital and Clinics, University of Florida	Gainesville	Florida	United States	32610-100277
40	Joe DiMaggio Children's Hospital at Memorial	Hollywood	Florida	United States	33021
41	Nemours Children's Clinic	Jacksonville	Florida	United States	32207
42	University of Miami-Jackson Memorial Hospital	Miami	Florida	United States	33136
43	Miami Children's Hospital	Miami	Florida	United States	33155-4069
44	Baptist Hospital of Miami	Miami	Florida	United States	33176-2197
45	Florida Hospital Cancer Institute	Orlando	Florida	United States	32803
46	Nemours Children's Clinic-Orlando	Orlando	Florida	United States	32806
47	Sacred Heart Children's Hospital	Pensacola	Florida	United States	32504
48	All Children's Hospital	St. Petersburg	Florida	United States	33701
49	Tampa Children's Hospital	Tampa	Florida	United States	33677-4227
50	St. Mary's Hospital	West Palm Beach	Florida	United States	33407
51	Emory University Hospital - Atlanta	Atlanta	Georgia	United States	30322
52	Children's Healthcare of Atlanta - Scottish Rite	Atlanta	Georgia	United States	30342
53	Medical College of Georgia Comprehensive Cancer Center	Augusta	Georgia	United States	30912-4000
54	Medical Center of Central Georgia	Macon	Georgia	United States	31201
55	Memorial Health University Medical Center, Inc.	Savannah	Georgia	United States	31403-3089
56	Cancer Research Center of Hawaii	Honolulu	Hawaii	United States	96813
57	MBCCOP - Hawaii	Honolulu	Hawaii	United States	96813
58	Tripler Army Medical Center	Honolulu	Hawaii	United States	96859-5000
59	Mountain States Tumor Institute	Boise	Idaho	United States	83712
60	University of Chicago Cancer Research Center	Chicago	Illinois	United States	60601
61	Rush-Presbyterian-St. Luke's Medical Center	Chicago	Illinois	United States	60612
62	University of Illinois at Chicago	Chicago	Illinois	United States	60612
63	Children's Memorial Hospital - Chicago	Chicago	Illinois	United States	60614
64	Hope Children's Hospital	Oak Lawn	Illinois	United States	60453
65	Lutheran General Hospital	Park Ridge	Illinois	United States	60068-1174
66	Saint Jude Midwest Affiliate	Peoria	Illinois	United States	61637
67	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62794-9658
68	Indiana University Cancer Center	Indianapolis	Indiana	United States	46202-5289
69	St. Vincent Hospital and Health Care Center	Indianapolis	Indiana	United States	46260
70	Raymond Blank Memorial Hospital for Children	Des Moines	Iowa	United States	50308
71	John Stoddard Cancer Center	Des Moines	Iowa	United States	50309
72	Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242-1009
73	Wesley Medical Center	Wichita	Kansas	United States	67214
74	Albert B. Chandler Medical Center, University of Kentucky	Lexington	Kentucky	United States	40536-0284
75	Kosair Children's Hospital	Louisville	Kentucky	United States	40202-3830
76	Tulane University School of Medicine	New Orleans	Louisiana	United States	70112
77	Children's Hospital of New Orleans	New Orleans	Louisiana	United States	70118
78	Ochsner Clinic	New Orleans	Louisiana	United States	70121
79	Eastern Maine Medical Center	Bangor	Maine	United States	04401
80	Maine Children's Cancer Program	Scarborough	Maine	United States	04074
81	Marlene and Stewart Greenebaum Cancer Center, University of Maryland	Baltimore	Maryland	United States	21201-1595
82	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21225
83	Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	Baltimore	Maryland	United States	21231-2410
84	Floating Hospital for Children	Boston	Massachusetts	United States	02111
85	Dana-Farber Cancer Institute	Boston	Massachusetts	United States	02115
86	Baystate Medical Center	Springfield	Massachusetts	United States	01107
87	University of Massachusetts Memorial Medical Center - University Campus	Worcester	Massachusetts	United States	01655
88	Mott Children's Hospital	Ann Arbor	Michigan	United States	48109-0914
89	Children's Hospital of Michigan	Detroit	Michigan	United States	48201
90	Henry Ford Hospital	Detroit	Michigan	United States	48202
91	St. John Hospital and Medical Center	Detroit	Michigan	United States	48236
92	Michigan State University	East Lansing	Michigan	United States	48824
93	Hurley Medical Center	Flint	Michigan	United States	48503
94	Spectrum Health and DeVos Children's Hospital	Grand Rapids	Michigan	United States	49503
95	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
96	CCOP - Beaumont	Royal Oak	Michigan	United States	48073-6769
97	William Beaumont Hospital	Royal Oak	Michigan	United States	48073-6769
98	St. Mary's/Duluth Clinic Cancer Center	Duluth	Minnesota	United States	55805-1983
99	Children's Hospitals and Clinics - Minneapolis	Minneapolis	Minnesota	United States	55404
100	Mayo Clinic Cancer Center	Rochester	Minnesota	United States	55905
101	Children's Hospitals and Clinics of Minnesota	Saint Paul	Minnesota	United States	55102
102	University of Mississippi Medical Center	Jackson	Mississippi	United States	39216-4505
103	Children's Mercy Hospital	Kansas City	Missouri	United States	64108
104	Cardinal Glennon Children's Hospital	Saint Louis	Missouri	United States	63104
105	St. Louis Children's Hospital	Saint Louis	Missouri	United States	63110
106	Children's Hospital of Omaha	Omaha	Nebraska	United States	68114
107	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198-2168
108	Sunrise Hospital and Medical Center	Las Vegas	Nevada	United States	89109-2306
109	Norris Cotton Cancer Center	Lebanon	New Hampshire	United States	03756-0002
110	Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
111	Cancer Institute of New Jersey	New Brunswick	New Jersey	United States	08903
112	Newark Beth Israel Medical Center	Newark	New Jersey	United States	07112-2094
113	St. Joseph's Hospital and Medical Center	Paterson	New Jersey	United States	07503
114	Atlantic Health System	Summit	New Jersey	United States	07901
115	University of New Mexico Cancer Research and Treatment Center	Albuquerque	New Mexico	United States	87131
116	Cancer Center of Albany Medical Center	Albany	New York	United States	12208
117	Albert Einstein Clinical Cancer Center	Bronx	New York	United States	10461
118	Brooklyn Hospital Center	Brooklyn	New York	United States	11201
119	State University of New York Health Science Center at Brooklyn College of Medicine	Brooklyn	New York	United States	11203
120	Brookdale University Hospital and Medical Center	Brooklyn	New York	United States	11212
121	Maimonides Medical Center	Brooklyn	New York	United States	11219
122	Roswell Park Cancer Institute	Buffalo	New York	United States	14263-0001
123	North Shore University Hospital	Manhasset	New York	United States	11030
124	Schneider Children's Hospital	New Hyde Park	New York	United States	11042
125	New York Presbyterian Hospital - Cornell Campus	New York	New York	United States	10021-4885
126	Memorial Sloan-Kettering Cancer Center	New York	New York	United States	10021
127	Mount Sinai School of Medicine	New York	New York	United States	10029
128	Columbia Presbyterian Hospital	New York	New York	United States	10032
129	James P. Wilmot Cancer Center	Rochester	New York	United States	14642
130	State University of New York Health Sciences Center - Stony Brook	Stony Brook	New York	United States	11790-7775
131	State University of New York - Upstate Medical University	Syracuse	New York	United States	13210
132	New York Medical College	Valhalla	New York	United States	10595
133	Mission Saint Joseph's Health System	Asheville	North Carolina	United States	28801
134	Lineberger Comprehensive Cancer Center, UNC	Chapel Hill	North Carolina	United States	27599-7295
135	Carolinas Medical Center	Charlotte	North Carolina	United States	28232-2861
136	Presbyterian Healthcare	Charlotte	North Carolina	United States	28233-3549
137	Duke Comprehensive Cancer Center	Durham	North Carolina	United States	27710
138	East Carolina University School of Medicine	Greenville	North Carolina	United States	27858-4354
139	Comprehensive Cancer Center at Wake Forest University	Winston-Salem	North Carolina	United States	27157-1081
140	Dakota Cancer Institute	Fargo	North Dakota	United States	58103-4940
141	Children's Hospital Medical Center of Akron	Akron	Ohio	United States	44308
142	Children's Hospital Medical Center - Cincinnati	Cincinnati	Ohio	United States	45229-3039
143	Ireland Cancer Center	Cleveland	Ohio	United States	44106-5065
144	Cleveland Clinic Taussig Cancer Center	Cleveland	Ohio	United States	44195
145	Children's Hospital of Columbus	Columbus	Ohio	United States	43205-2696
146	Children's Medical Center - Dayton	Dayton	Ohio	United States	45404
147	Toledo Children's Hospital	Toledo	Ohio	United States	43601
148	St. Vincent Mercy Medical Center	Toledo	Ohio	United States	43608
149	Forum Health-Tod Childrens Hospital	Youngstown	Ohio	United States	44501
150	Children's Hospital of Oklahoma	Oklahoma City	Oklahoma	United States	73104
151	CCOP - Oklahoma	Tulsa	Oklahoma	United States	74136
152	Natalie Warren Bryant Cancer Center	Tulsa	Oklahoma	United States	74136
153	Doernbecher Children's Hospital	Portland	Oregon	United States	97201-3098
154	Legacy Emanuel Hospital and Health Center	Portland	Oregon	United States	97227
155	Geisinger Medical Center	Danville	Pennsylvania	United States	17822-1320
156	Milton S. Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
157	Children's Hospital of Philadelphia	Philadelphia	Pennsylvania	United States	19104
158	St. Christopher's Hospital for Children	Philadelphia	Pennsylvania	United States	19134-1095
159	Children's Hospital of Pittsburgh	Pittsburgh	Pennsylvania	United States	15213
160	Rhode Island Hospital	Providence	Rhode Island	United States	02818
161	Medical University of South Carolina	Charleston	South Carolina	United States	29425-0721
162	Palmetto Health South Carolina Cancer Center	Columbia	South Carolina	United States	29203
163	Children's Hospital of Greenville Hospital System	Greenville	South Carolina	United States	29605
164	Avera Cancer Institute	Sioux Falls	South Dakota	United States	57105-1080
165	Sioux Valley Hospital	Sioux Falls	South Dakota	United States	57117
166	East Tennessee State University Cancer Center at JCMC	Johnson City	Tennessee	United States	37604
167	East Tennessee Children's Hospital	Knoxville	Tennessee	United States	37901
168	Saint Jude Children's Research Hospital	Memphis	Tennessee	United States	38105-2794
169	Vanderbilt-Ingram Cancer Center	Nashville	Tennessee	United States	37232-6838
170	Texas Tech University Health Sciences Center School of Medicine	Amarillo	Texas	United States	79106
171	Children's Hospital of Austin	Austin	Texas	United States	78701
172	Medical City Dallas Hospital	Dallas	Texas	United States	75230
173	Simmons Cancer Center - Dallas	Dallas	Texas	United States	75235-9154
174	Cook Children's Medical Center - Fort Worth	Fort Worth	Texas	United States	76104
175	University of Texas Medical Branch	Galveston	Texas	United States	77555-0361
176	University of Texas - MD Anderson Cancer Center	Houston	Texas	United States	77030-4009
177	Baylor College of Medicine	Houston	Texas	United States	77030
178	San Antonio Military Pediatric Cancer and Blood Disorders Center	Lackland Air Force Base	Texas	United States	78236-5300
179	Covenant Children's Hospital	Lubbock	Texas	United States	79410
180	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78207
181	Methodist Health Care System	San Antonio	Texas	United States	78229-3902
182	Scott and White Memorial Hospital	Temple	Texas	United States	76508
183	Huntsman Cancer Institute	Salt Lake City	Utah	United States	84112
184	Vermont Cancer Center	Burlington	Vermont	United States	05401-3498
185	Cancer Center at the University of Virginia	Charlottesville	Virginia	United States	22908
186	Inova Fairfax Hospital	Falls Church	Virginia	United States	22042-3300
187	Children's Hospital of the King's Daughters	Norfolk	Virginia	United States	23507
188	Naval Medical Center, Portsmouth	Portsmouth	Virginia	United States	23708-5100
189	Massey Cancer Center	Richmond	Virginia	United States	23298-0037
190	Carilion Medical Center for Children	Roanoke	Virginia	United States	24013
191	Children's Hospital and Regional Medical Center - Seattle	Seattle	Washington	United States	98105
192	Fred Hutchinson Cancer Research Center	Seattle	Washington	United States	98109-1024
193	Group Health Cooperative	Seattle	Washington	United States	98112
194	Deaconess Medical Center	Spokane	Washington	United States	99210-0248
195	Mary Bridge Children's Health Center	Tacoma	Washington	United States	98415-0299
196	Madigan Army Medical Center	Tacoma	Washington	United States	98431-5000
197	West Virginia University - Charleston	Charleston	West Virginia	United States	25302
198	Cabell-Huntington Hospital, Inc	Huntington	West Virginia	United States	25701
199	West Virginia University Hospitals	Morgantown	West Virginia	United States	26506-9300
200	Bellin Memorial Hospital	Green Bay	Wisconsin	United States	54301
201	CCOP - St. Vincent Hospital Cancer Center, Green Bay	Green Bay	Wisconsin	United States	54301
202	St. Vincent Hospital	Green Bay	Wisconsin	United States	54307-9070
203	Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
204	University of Wisconsin Hospital and Clinics	Madison	Wisconsin	United States	53792-0001
205	Marshfield Clinic	Marshfield	Wisconsin	United States	54449-5772
206	Midwest Children's Cancer Center	Milwaukee	Wisconsin	United States	53226
207	Sydney Children's Hospital	Randwick	New South Wales	Australia	2031
208	Children's Hospital at Westmead	Westmead	New South Wales	Australia	2145
209	Royal Children's Hospital	Brisbane	Queensland	Australia	4029
210	Women's and Children's Hospital	North Adelaide	South Australia	Australia	5006
211	Royal Children's Hospital	Parkville	Victoria	Australia	3052
212	Princess Margaret Hospital for Children	Perth	Western Australia	Australia	6001
213	Alberta Children's Hospital	Calgary	Alberta	Canada	T2T 5C7
214	Cross Cancer Institute	Edmonton	Alberta	Canada	T6G 1Z2
215	British Columbia Children's Hospital	Vancouver	British Columbia	Canada	V6H 3V4
216	CancerCare Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
217	Janeway Children's Health and Rehabilitation Centre	St. John's	Newfoundland and Labrador	Canada	A1B 3V6
218	IWK Health Centre	Halifax	Nova Scotia	Canada	B3J 3G9
219	Children's Hospital	Hamilton	Ontario	Canada	L8N 3Z5
220	Children's Hospital of Western Ontario	London	Ontario	Canada	N6C 2V5
221	Children's Hospital of Eastern Ontario	Ottawa	Ontario	Canada	K1H 8L1
222	Hospital for Sick Children	Toronto	Ontario	Canada	M5G 1X8
223	McGill University Health Center - Montreal Children's Hospital	Montreal	Quebec	Canada	H3H 1P3
224	Hopital Sainte Justine	Montreal	Quebec	Canada	H3T 1C5
225	Centre Hospitalier de L'Universite Laval	Sainte Foy	Quebec	Canada	GIV 4G2
226	Laval University Medical Center	Sainte-Foy	Quebec	Canada	G1V 4G2
227	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1
228	Saskatoon Cancer Centre	Saskatoon	Saskatchewan	Canada	S7N 4H4
229	Academisch Ziekenhuis Groningen	Groningen		Netherlands	9700 RB
230	Starship Children's Hospital	Auckland		New Zealand
231	University of Puerto Rico School of Medicine Medical Sciences Campus	San Juan		Puerto Rico	00936-5067
232	San Jorge Childrens Hospital	Santurce		Puerto Rico	00912
233	Swiss Pediatric Oncology Group Bern	Bern		Switzerland	CH 3010
234	Swiss Pediatric Oncology Group Geneva	Geneva		Switzerland	CH 1211
235	Swiss Pediatric Oncology Group Lausanne	Lausanne		Switzerland	CH 1011