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 (Other)
• Overall Status: Active, not recruiting
• CT.gov ID: NCT01349322
• Collaborator: National Cancer Institute (NCI) (NIH), NRG Oncology (Other)
• Enrollment: 2,354
• Locations: 415
• Arms: 2
• Patients Per Site: 5.7

Study Details

Study Description

Brief 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.

Condition or Disease	Intervention/Treatment	Phase
Breast Cancer	Radiation: Whole breast irradiation delivered by 3-dimensional conformal radiation therapy or intensity modulated radiation therapy; Radiation: Higher per daily radiation therapy; Radiation: Concurrent boost radiotherapy; Radiation: Standard per daily radiation therapy; Radiation: Sequential boost radiotherapy	Phase 3

Detailed Description

OBJECTIVES:

Primary

• To determine whether an accelerated course of hypofractionated whole-breast irradiation (WBI) including a concomitant boost to the tumor bed in 15 fractions following lumpectomy will prove to be non-inferior in local control to a regimen of standard WBI with a sequential boost following lumpectomy for early-stage breast cancer patients.

Secondary

• To determine whether breast-related symptoms and cosmesis from accelerated WBI that is hypofractionated (in only 3 weeks) with a concomitant boost is non-inferior to standard WBI with sequential boost.

• To determine whether the risk of late cardiac toxicity in patients with left-sided breast cancer treated with hypofractionation will be non-inferior to conventional fractionated radiation therapy (RT) based upon analysis of radiation dosimetry from CT-based treatment planning and NTCP calculations.

• To determine whether CT-based conformal methods intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for WBI are feasible in a multi-institutional setting following lumpectomy in early-stage breast cancer patients and whether dose-volume analyses can be established to assess treatment adequacy and likelihood of toxicity.

• To determine that cosmetic results and breast-related symptoms 3 years after hypofractionated breast radiation with concomitant boost will not be inferior to that obtained 3 years after WBI with sequential boost.

• To determine whether future correlative studies can identify individual gene expressions and biological host factors associated with toxicity and/or local recurrence from standard and hypofractionated WBI.

• If shown to be non-inferior, to then determine if accelerated course of hypofractionated WBI including a concomitant boost to the tumor bed in 15 fractions following lumpectomy will prove to be superior in local control to a regimen of standard WBI with a sequential boost following lumpectomy for early-stage breast cancer patients.

• To determine whether treatment costs for hypofractionated WBI with concomitant boost are not higher than WBI with sequential boost.

OUTLINE: This is a multicenter study. Patients are stratified according to age (< 50 vs. ≥ 50 years), prior chemotherapy (yes vs. no), estrogen-receptor status (+ vs. -), and histology grade (1-2 vs. 3). Patients are randomized to 1 of 2 treatment arms. Treatment begins within 9 weeks of last surgery or chemotherapy delivery.

• Arm I: Patients undergo standard whole-breast radiotherapy (WBI) comprising intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) 5 days a week for 3-5 weeks followed by a sequential radiotherapy boost to the lumpectomy area 5 days a week for 1-1½ weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.

• Arm II: Patients undergo accelerated hypofractionated WBI comprising IMRT or 3D-CRT with a concurrent boost to the lumpectomy area 5 days a week for 3 weeks. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients' tissue samples may be collected for future research studies.

After completion of study therapy, patients are followed at 1 month, at 6 months, and then yearly.

Study Design

• Study Type: Interventional
• Actual Enrollment: 2354 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• 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
• Actual Study Start Date: May 1, 2011
• Actual Primary Completion Date: Jan 25, 2022

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Arm I Patients undergo standard whole-breast radiotherapy (WBI) comprising intensity-modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) 5 days a week for 3-5 weeks followed by a sequential radiotherapy boost to the lumpectomy area 5 days a week for 1-1½ weeks in the absence of disease progression or unacceptable toxicity.	Radiation: Whole breast irradiation delivered by 3-dimensional conformal radiation therapy or intensity modulated radiation therapy; Patients undergo whole breast radiotherapy by 3D-CRT or IMRT; Radiation: Standard per daily radiation therapy; Patients undergo standard per daily radiation therapy; Radiation: Sequential boost radiotherapy; Patients undergo sequential boost radiotherapy
Experimental: Arm II Patients undergo accelerated hypofractionated WBI comprising IMRT or 3D-CRT with a concurrent boost to the lumpectomy area 5 days a week for 3 weeks in the absence of disease progression or unacceptable toxicity.	Radiation: Whole breast irradiation delivered by 3-dimensional conformal radiation therapy or intensity modulated radiation therapy; Patients undergo whole breast radiotherapy by 3D-CRT or IMRT; Radiation: Higher per daily radiation therapy; Patients undergo higher per daily radiation therapy; Radiation: Concurrent boost radiotherapy; Patients undergo concurrent boost radiotherapy

Outcome Measures

Primary Outcome Measures

1. Local control [From randomization to the date of first local failure or last follow-up. Analysis occurs after 245 local failures have been reported.]

Secondary Outcome Measures

1. Overall survival [From randomization to date of death due to any cause or last follow-up.]

2. Disease-free survival [From randomization to date of local-regional disease recurrence, distant metastases, second primary, death due to any cause or last follow-up.]

3. Distant disease-free survival [From randomization to date of distant metastases, second primary, death due to any cause or last follow-up.]

4. Changes in breast-related symptoms and side effects and cosmesis [From randomization to three years.]

5. Correlation between dose-volume data and both adverse events and efficacy [From randomization to end of follow-up.]

6. Treatment cost of accelerated course of hypofractionated WBI versus standard WBI with a sequential boost [From randomization to end of treatment.]

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: Female
• Accepts Healthy Volunteers: No

DISEASE CHARACTERISTICS:

• Pathologically proven diagnosis of breast cancer resected by lumpectomy and whole-breast irradiation (WBI) with boost without regional nodal irradiation planned

• Must meet one of the following three criteria:

• pStage I or II breast cancer AND at least one of the following:

• Age < 50 years or

• Positive axillary nodes or

• Lymphovascular space invasion (LVI) or

• At least 2 close resection margins (> 0 mm to ≤ 2 mm) or

• One close resection margin and extensive in-situ component (EIC) or

• Focally positive resection margins or

• Non-hormone-sensitive breast cancer (estrogen and progesterone receptor negative (ER- and PR-) or

• Grade III histology or

• Oncotype recurrence score > 25 or

• pStage 0 breast cancer with nuclear grade 3 ductal carcinoma in situ (DCIS) and patient age < 50 years or

• If multifocal breast cancer, then it must have been resected through a single lumpectomy incision with negative margins

• Breast-conserving surgery with margins defined as follows:

• 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

• Two or more close resection margins

• A focally positive resection margin

• Allowable options for mandatory axillary staging include:

• Sentinel node biopsy alone (if sentinel node is negative, pN0, pN0[IHC-,+])

• Sentinel node biopsy alone, OR followed by axillary node dissection, for clinically node-negative patients as described below:

• Microscopic sentinel node (SN) positive (pN1mic)

• One or two SNs positive (pN1) without extracapsular extension

• Negative SN biopsy after neoadjuvant chemotherapy

• Axillary node dissection is required following 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)

• CT-imaging of the ipsilateral breast within 28 days of study entry for the radiation treatment planning.

• Must be able 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)

• 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

• A mammogram of both right and left breast within only 1 time point of 90 days of the diagnostic biopsy establishing the diagnosis

• No prior invasive or in-situ carcinoma of the breast (prior LCIS is eligible)

• No American Joint Committee on Cancer (AJCC) pathologic T4, N2 or N3, or M1 breast cancer

• Must not have two or more breast cancers that are not resectable through a single lumpectomy incision

• Must not be DCIS and ≥ 50 years old

• Must not be DCIS only (without an invasive component), nuclear grade 1 or 2 and < 50 years old

• No suspicious unresected microcalcification, densities, or palpable abnormalities (in the ipsilateral or contralateral breast) unless biopsied and found to be benign

• No non-epithelial breast malignancies such as sarcoma or lymphoma

• No Paget disease of the nipple

• No male breast cancer

• Breast implants allowed

PATIENT CHARACTERISTICS:

• ANC ≥ 1,800/mm³

• Platelet count ≥ 75,000/mm³

• Hemoglobin ≥ 8.0 g/dL (transfusion or other intervention to achieve Hgb ≥ 8.0 g/dL is acceptable)

• Negative urine or serum pregnancy test within 14 days of study entry

• Women of childbearing potential must not be pregnant or nursing and willing to use medically acceptable form of contraception during radiotherapy

• No prior invasive non-breast malignancy (except non-melanomatous skin cancer or carcinoma in situ of the cervix) unless disease free for a minimum of 5 years prior to study entry

• No severely 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 past 6 months

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

• Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy 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 CDC definition

• HIV testing is not required for entry into this protocol

• No active systemic lupus, erythematosus, or any history of scleroderma or dermatomyositis with active rash

• Medical, psychiatric, or other condition that would prevent the patient from receiving the protocol therapy or providing informed consent

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics

• Study entry must be within 50 days of last breast/axillary surgery and/or last chemotherapy

• No treatment plan that includes regional-node radiotherapy

• No prior radiotherapy to the breast or prior radiation to the region of the ipsilateral breast that would result in overlap of radiation therapy fields

• No intention to administer concurrent chemotherapy for current breast cancer

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham Cancer Center	Birmingham	Alabama	United States	35233
2	The Kirklin Clinic at Acton Road	Birmingham	Alabama	United States	35243
3	21st Century Oncology-Scottsdale	Scottsdale	Arizona	United States	85251
4	Mayo Clinic in Arizona	Scottsdale	Arizona	United States	85259
5	Arizona Oncology Associates-West Orange Grove	Tucson	Arizona	United States	85704
6	Banner University Medical Center - Tucson	Tucson	Arizona	United States	85719
7	CHI Saint Vincent Cancer Center Hot Springs	Hot Springs	Arkansas	United States	71913
8	University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
9	Sutter Cancer Centers Radiation Oncology Services-Auburn	Auburn	California	United States	95603
10	Sutter Cancer Centers Radiation Oncology Services-Cameron Park	Cameron Park	California	United States	95682
11	Mercy San Juan Medical Center	Carmichael	California	United States	95608
12	Enloe Medical Center	Chico	California	United States	95926
13	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010
14	Epic Care-Dublin	Dublin	California	United States	94568
15	21st Century Oncology - El Segundo	El Segundo	California	United States	90245
16	UC San Diego Moores Cancer Center	La Jolla	California	United States	92093
17	Los Angeles County-USC Medical Center	Los Angeles	California	United States	90033
18	USC / Norris Comprehensive Cancer Center	Los Angeles	California	United States	90033
19	Cedars Sinai Medical Center	Los Angeles	California	United States	90048
20	UCLA / Jonsson Comprehensive Cancer Center	Los Angeles	California	United States	90095
21	Kaiser Permanente Oakland-Broadway	Oakland	California	United States	94611
22	Kaiser Permanente-Rancho Cordova Cancer Center	Rancho Cordova	California	United States	95670
23	Rohnert Park Cancer Center	Rohnert Park	California	United States	94928
24	Sutter Cancer Centers Radiation Oncology Services-Roseville	Roseville	California	United States	95661
25	The Permanente Medical Group-Roseville Radiation Oncology	Roseville	California	United States	95678
26	Sutter Medical Center Sacramento	Sacramento	California	United States	95816
27	University of California Davis Comprehensive Cancer Center	Sacramento	California	United States	95817
28	South Sacramento Cancer Center	Sacramento	California	United States	95823
29	Santa Clara Valley Medical Center	San Jose	California	United States	95128
30	Kaiser Permanente Medical Center - Santa Clara	Santa Clara	California	United States	95051
31	City of Hope South Pasadena	South Pasadena	California	United States	91030
32	Kaiser Permanente Cancer Treatment Center	South San Francisco	California	United States	94080
33	Sutter Cancer Centers Radiation Oncology Services-Vacaville	Vacaville	California	United States	95687
34	University of Colorado Hospital	Aurora	Colorado	United States	80045
35	Penrose-Saint Francis Healthcare	Colorado Springs	Colorado	United States	80907
36	Porter Adventist Hospital	Denver	Colorado	United States	80210
37	Shaw Cancer Center	Edwards	Colorado	United States	81632
38	McKee Medical Center	Loveland	Colorado	United States	80539
39	Hartford Hospital	Hartford	Connecticut	United States	06102
40	MedStar Washington Hospital Center	Washington	District of Columbia	United States	20010
41	John Fitzgerald Kennedy Medical Center	Atlantis	Florida	United States	33462
42	Florida Hospital Memorial Medical Center	Daytona Beach	Florida	United States	32117
43	UM Sylvester Comprehensive Cancer Center at Deerfield Beach	Deerfield Beach	Florida	United States	33442
44	21st Century Oncology - Fort Walton Beach	Fort Walton Beach	Florida	United States	32547
45	University of Florida Health Science Center - Gainesville	Gainesville	Florida	United States	32610
46	Integrated Community Oncology Network-Florida Cancer Center Beaches	Jacksonville Beach	Florida	United States	32250
47	Baptist MD Anderson Cancer Center	Jacksonville	Florida	United States	32207
48	Integrated Community Oncology Network-Southside Cancer Center	Jacksonville	Florida	United States	32207
49	University of Florida Health Science Center - Jacksonville	Jacksonville	Florida	United States	32209
50	Mayo Clinic in Florida	Jacksonville	Florida	United States	32224-9980
51	Baptist Medical Center South	Jacksonville	Florida	United States	32258
52	Jackson Memorial Hospital-Holtz Children's Hospital	Miami	Florida	United States	33136
53	University of Miami Miller School of Medicine-Sylvester Cancer Center	Miami	Florida	United States	33136
54	21st Century Oncology-Orange Park	Orange Park	Florida	United States	32073
55	AdventHealth Orlando	Orlando	Florida	United States	32803
56	Orlando Health Cancer Institute	Orlando	Florida	United States	32806
57	Cancer Center of Putnam	Palatka	Florida	United States	32177
58	Integrated Community Oncology Network-Flager Cancer Center	Saint Augustine	Florida	United States	32086
59	Moffitt Cancer Center	Tampa	Florida	United States	33612
60	The Villages Regional Hospital	The Villages	Florida	United States	32159
61	Grady Health System	Atlanta	Georgia	United States	30303
62	Emory University Hospital Midtown	Atlanta	Georgia	United States	30308
63	Piedmont Hospital	Atlanta	Georgia	United States	30309
64	Emory University Hospital/Winship Cancer Institute	Atlanta	Georgia	United States	30322
65	Emory Saint Joseph's Hospital	Atlanta	Georgia	United States	30342
66	Northside Hospital	Atlanta	Georgia	United States	30342
67	Northside Hospital-Forsyth	Cumming	Georgia	United States	30041
68	Memorial Health University Medical Center	Savannah	Georgia	United States	31404
69	Lewis Cancer and Research Pavilion at Saint Joseph's/Candler	Savannah	Georgia	United States	31405
70	Queen's Medical Center	Honolulu	Hawaii	United States	96813
71	Saint Alphonsus Cancer Care Center-Boise	Boise	Idaho	United States	83706
72	Rush - Copley Medical Center	Aurora	Illinois	United States	60504
73	Northwestern University	Chicago	Illinois	United States	60611
74	University of Chicago Comprehensive Cancer Center	Chicago	Illinois	United States	60637
75	Advocate Illinois Masonic Medical Center	Chicago	Illinois	United States	60657
76	Decatur Memorial Hospital	Decatur	Illinois	United States	62526
77	Freeport Memorial Hospital/Leonard C Ferguson Cancer Center	Freeport	Illinois	United States	61032
78	Loyola University Medical Center	Maywood	Illinois	United States	60153
79	UC Comprehensive Cancer Center at Silver Cross	New Lenox	Illinois	United States	60451
80	Carle Cancer Institute Normal	Normal	Illinois	United States	61761
81	Advocate Lutheran General Hospital	Park Ridge	Illinois	United States	60068
82	OSF Saint Francis Radiation Oncology at Peoria Cancer Center	Peoria	Illinois	United States	61615
83	OSF Saint Francis Medical Center	Peoria	Illinois	United States	61637
84	Swedish American Hospital	Rockford	Illinois	United States	61104
85	SwedishAmerican Regional Cancer Center/ACT	Rockford	Illinois	United States	61114
86	Saint John's Hospital	Springfield	Illinois	United States	62702
87	Carle Cancer Center	Urbana	Illinois	United States	61801
88	Northwestern Medicine Cancer Center Warrenville	Warrenville	Illinois	United States	60555
89	Saint Vincent Anderson Regional Hospital/Cancer Center	Anderson	Indiana	United States	46016
90	IU Health West Hospital	Avon	Indiana	United States	46123
91	Goshen Center for Cancer Care	Goshen	Indiana	United States	46526
92	Indiana University/Melvin and Bren Simon Cancer Center	Indianapolis	Indiana	United States	46202
93	IU Health Methodist Hospital	Indianapolis	Indiana	United States	46202
94	Community Cancer Center East	Indianapolis	Indiana	United States	46219
95	Community Cancer Center North	Indianapolis	Indiana	United States	46256
96	Michiana Hematology Oncology PC-Mishawaka	Mishawaka	Indiana	United States	46545
97	IU Health Ball Memorial Hospital	Muncie	Indiana	United States	47303
98	Mercy Cancer Center-West Lakes	Clive	Iowa	United States	50325
99	Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
100	Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
101	Finley Hospital	Dubuque	Iowa	United States	52001
102	University of Kansas Cancer Center	Kansas City	Kansas	United States	66160
103	Lawrence Memorial Hospital	Lawrence	Kansas	United States	66044
104	University of Kansas Cancer Center-Overland Park	Overland Park	Kansas	United States	66210
105	Kansas City NCI Community Oncology Research Program	Prairie Village	Kansas	United States	66208
106	Cotton O'Neil Cancer Center / Stormont Vail Health	Topeka	Kansas	United States	66606
107	Ascension Via Christi Hospitals Wichita	Wichita	Kansas	United States	67214
108	Wichita NCI Community Oncology Research Program	Wichita	Kansas	United States	67214
109	University of Kentucky/Markey Cancer Center	Lexington	Kentucky	United States	40536
110	Owensboro Health Mitchell Memorial Cancer Center	Owensboro	Kentucky	United States	42303
111	Tulane University Health Sciences Center	New Orleans	Louisiana	United States	70112
112	Anne Arundel Medical Center	Annapolis	Maryland	United States	21401
113	University of Maryland/Greenebaum Cancer Center	Baltimore	Maryland	United States	21201
114	Greater Baltimore Medical Center	Baltimore	Maryland	United States	21204
115	Saint Agnes Hospital	Baltimore	Maryland	United States	21229
116	Walter Reed National Military Medical Center	Bethesda	Maryland	United States	20889-5600
117	Central Maryland Radiation Oncology in Howard County	Columbia	Maryland	United States	21044
118	UM Baltimore Washington Medical Center/Tate Cancer Center	Glen Burnie	Maryland	United States	21061
119	TidalHealth Peninsula Regional	Salisbury	Maryland	United States	21801
120	Massachusetts General Hospital Cancer Center	Boston	Massachusetts	United States	02114
121	Boston Medical Center	Boston	Massachusetts	United States	02118
122	Mass General/North Shore Cancer Center	Danvers	Massachusetts	United States	01923
123	Lowell General Hospital	Lowell	Massachusetts	United States	01854
124	Newton-Wellesley Hospital	Newton	Massachusetts	United States	02462
125	University of Michigan Comprehensive Cancer Center	Ann Arbor	Michigan	United States	48109
126	GenesisCare USA - Clarkston	Clarkston	Michigan	United States	48346
127	Henry Ford Macomb Hospital-Clinton Township	Clinton Township	Michigan	United States	48038
128	Wayne State University/Karmanos Cancer Institute	Detroit	Michigan	United States	48201
129	Henry Ford Hospital	Detroit	Michigan	United States	48202
130	Ascension Saint John Hospital	Detroit	Michigan	United States	48236
131	GenesisCare USA - Farmington Hills	Farmington Hills	Michigan	United States	48334
132	Weisberg Cancer Treatment Center	Farmington Hills	Michigan	United States	48334
133	Beaumont Hospital - Farmington Hills	Farmington Hills	Michigan	United States	48336
134	McLaren Cancer Institute-Flint	Flint	Michigan	United States	48532
135	Mercy Health Saint Mary's	Grand Rapids	Michigan	United States	49503
136	Spectrum Health at Butterworth Campus	Grand Rapids	Michigan	United States	49503
137	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
138	KCC Radiation Oncology at Monroe Cancer Center	Monroe	Michigan	United States	48162
139	McLaren Cancer Institute-Northern Michigan	Petoskey	Michigan	United States	49770
140	Saint Joseph Mercy Oakland	Pontiac	Michigan	United States	48341
141	William Beaumont Hospital-Royal Oak	Royal Oak	Michigan	United States	48073
142	Ascension Providence Hospitals - Southfield	Southfield	Michigan	United States	48075
143	William Beaumont Hospital - Troy	Troy	Michigan	United States	48085
144	GenesisCare USA - Troy	Troy	Michigan	United States	48098
145	Saint John Macomb-Oakland Hospital	Warren	Michigan	United States	48093
146	Mayo Clinic Health System in Albert Lea	Albert Lea	Minnesota	United States	56007
147	Sanford Joe Lueken Cancer Center	Bemidji	Minnesota	United States	56601
148	Miller-Dwan Hospital	Duluth	Minnesota	United States	55805
149	Mayo Clinic Health Systems-Mankato	Mankato	Minnesota	United States	56001
150	Mayo Clinic in Rochester	Rochester	Minnesota	United States	55905
151	Coborn Cancer Center at Saint Cloud Hospital	Saint Cloud	Minnesota	United States	56303
152	Singing River Hospital	Pascagoula	Mississippi	United States	39581
153	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
154	Saint Luke's Hospital	Chesterfield	Missouri	United States	63017
155	Siteman Cancer Center at West County Hospital	Creve Coeur	Missouri	United States	63141
156	The University of Kansas Cancer Center-South	Kansas City	Missouri	United States	64131
157	University of Kansas Cancer Center - North	Kansas City	Missouri	United States	64154
158	University of Kansas Cancer Center - Lee's Summit	Lee's Summit	Missouri	United States	64064
159	Liberty Radiation Oncology Center	Liberty	Missouri	United States	64068
160	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
161	Siteman Cancer Center-South County	Saint Louis	Missouri	United States	63129
162	Siteman Cancer Center at Saint Peters Hospital	Saint Peters	Missouri	United States	63376
163	Billings Clinic Cancer Center	Billings	Montana	United States	59101
164	Benefis Healthcare- Sletten Cancer Institute	Great Falls	Montana	United States	59405
165	Kalispell Regional Medical Center	Kalispell	Montana	United States	59901
166	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
167	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198
168	Radiation Oncology Centers of Nevada Central	Las Vegas	Nevada	United States	89106
169	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89148
170	Renown Regional Medical Center	Reno	Nevada	United States	89502
171	Saint Mary's Regional Medical Center	Reno	Nevada	United States	89503
172	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
173	Memorial Sloan Kettering Basking Ridge	Basking Ridge	New Jersey	United States	07920
174	Ocean Medical Center	Brick	New Jersey	United States	08724
175	Monmouth Medical Center	Long Branch	New Jersey	United States	07740
176	Morristown Medical Center	Morristown	New Jersey	United States	07960
177	Virtua Memorial	Mount Holly	New Jersey	United States	08060
178	Jersey Shore Medical Center	Neptune	New Jersey	United States	07753
179	Saint Peter's University Hospital	New Brunswick	New Jersey	United States	08901
180	Capital Health Medical Center-Hopewell	Pennington	New Jersey	United States	08534
181	Riverview Medical Center/Booker Cancer Center	Red Bank	New Jersey	United States	07701
182	Sparta Cancer Treatment Center	Sparta	New Jersey	United States	07871
183	Overlook Hospital	Summit	New Jersey	United States	07902
184	Community Medical Center	Toms River	New Jersey	United States	08755
185	Virtua Voorhees	Voorhees	New Jersey	United States	08043
186	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
187	Memorial Medical Center - Las Cruces	Las Cruces	New Mexico	United States	88011
188	New York Oncology Hematology PC - Albany	Albany	New York	United States	12206
189	Saint Peter's Health Partners	Albany	New York	United States	12208
190	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467
191	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
192	Sands Cancer Center	Canandaigua	New York	United States	14424
193	Memorial Sloan Kettering Commack	Commack	New York	United States	11725
194	Mary Imogene Bassett Hospital	Cooperstown	New York	United States	13326
195	Hematology Oncology Associates of Central New York-East Syracuse	East Syracuse	New York	United States	13057
196	Cayuga Medical Center	Ithaca	New York	United States	14850
197	Northwell Health NCORP	Lake Success	New York	United States	11042
198	Northwell Health/Center for Advanced Medicine	Lake Success	New York	United States	11042
199	Long Island Jewish Medical Center	New Hyde Park	New York	United States	11040
200	NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center	New York	New York	United States	10032
201	Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
202	Hudson Valley Oncology Associates	Poughkeepsie	New York	United States	12601
203	Wilmot Cancer Institute Radiation Oncology at Greece	Rochester	New York	United States	14606
204	Highland Hospital	Rochester	New York	United States	14620
205	Rochester General Hospital	Rochester	New York	United States	14621
206	University of Rochester	Rochester	New York	United States	14642
207	Memorial Sloan Kettering Sleepy Hollow	Sleepy Hollow	New York	United States	10591
208	Staten Island University Hospital	Staten Island	New York	United States	10305
209	Stony Brook University Medical Center	Stony Brook	New York	United States	11794
210	Memorial Sloan Kettering Nassau	Uniondale	New York	United States	11553
211	Dickstein Cancer Treatment Center	White Plains	New York	United States	10601
212	Duke University Medical Center	Durham	North Carolina	United States	27710
213	East Carolina University	Greenville	North Carolina	United States	27834
214	The Coleman Radiation Center-Carteret General Hospital	Morehead City	North Carolina	United States	28557
215	CarolinaEast Medical Center	New Bern	North Carolina	United States	28561
216	FirstHealth of the Carolinas-Moore Regional Hospital	Pinehurst	North Carolina	United States	28374
217	Iredell Memorial Hospital	Statesville	North Carolina	United States	28677
218	NHRMC Radiation Oncology - Supply	Supply	North Carolina	United States	28462
219	New Hanover Regional Medical Center/Zimmer Cancer Center	Wilmington	North Carolina	United States	28401
220	NHRMC Radiation Oncology - 16th Street	Wilmington	North Carolina	United States	28401
221	Sanford Bismarck Medical Center	Bismarck	North Dakota	United States	58501
222	Sanford Roger Maris Cancer Center	Fargo	North Dakota	United States	58122
223	Altru Cancer Center	Grand Forks	North Dakota	United States	58201
224	Summa Health System - Akron Campus	Akron	Ohio	United States	44304
225	Cleveland Clinic Akron General	Akron	Ohio	United States	44307
226	Summa Health System - Barberton Campus	Barberton	Ohio	United States	44203
227	UHHS-Chagrin Highlands Medical Center	Beachwood	Ohio	United States	44122
228	Geauga Hospital	Chardon	Ohio	United States	44024
229	Adena Regional Medical Center	Chillicothe	Ohio	United States	45601
230	The Christ Hospital	Cincinnati	Ohio	United States	45219
231	University of Cincinnati Cancer Center-UC Medical Center	Cincinnati	Ohio	United States	45219
232	Case Western Reserve University	Cleveland	Ohio	United States	44106
233	Cleveland Clinic Cancer Center/Fairview Hospital	Cleveland	Ohio	United States	44111
234	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
235	Ohio State University Comprehensive Cancer Center	Columbus	Ohio	United States	43210
236	Cleveland Clinic Cancer Center Independence	Independence	Ohio	United States	44131
237	Hillcrest Hospital Cancer Center	Mayfield Heights	Ohio	United States	44124
238	Summa Health Medina Medical Center	Medina	Ohio	United States	44256
239	UH Seidman Cancer Center at Lake Health Mentor Campus	Mentor	Ohio	United States	44060
240	UH Seidman Cancer Center at Southwest General Hospital	Middleburg Heights	Ohio	United States	44130
241	University Hospitals Parma Medical Center	Parma	Ohio	United States	44129
242	University Hospitals Portage Medical Center	Ravenna	Ohio	United States	44266
243	North Coast Cancer Care	Sandusky	Ohio	United States	44870
244	Cleveland Clinic Cancer Center Strongsville	Strongsville	Ohio	United States	44136
245	UHHS-Westlake Medical Center	Westlake	Ohio	United States	44145
246	Cleveland Clinic Wooster Family Health and Surgery Center	Wooster	Ohio	United States	44691
247	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
248	Natalie Warren Bryant Cancer Center at Saint Francis	Tulsa	Oklahoma	United States	74136
249	Clackamas Radiation Oncology Center	Clackamas	Oregon	United States	97015
250	Willamette Valley Cancer Center	Eugene	Oregon	United States	97401
251	Three Rivers Community Hospital	Grants Pass	Oregon	United States	97527
252	Providence Medford Medical Center	Medford	Oregon	United States	97504
253	Rogue Valley Medical Center	Medford	Oregon	United States	97504
254	Providence Portland Medical Center	Portland	Oregon	United States	97213
255	Jefferson Abington Hospital	Abington	Pennsylvania	United States	19001
256	UPMC-Heritage Valley Health System Beaver	Beaver	Pennsylvania	United States	15009
257	Bryn Mawr Hospital	Bryn Mawr	Pennsylvania	United States	19010
258	Geisinger Medical Center	Danville	Pennsylvania	United States	17822
259	Delaware County Memorial Hospital	Drexel Hill	Pennsylvania	United States	19026
260	Northeast Radiation Oncology Center	Dunmore	Pennsylvania	United States	18512
261	Pocono Medical Center	East Stroudsburg	Pennsylvania	United States	18301
262	UPMC Hillman Cancer Center Erie	Erie	Pennsylvania	United States	16505
263	Fox Chase Cancer Center Buckingham	Furlong	Pennsylvania	United States	18925
264	Adams Cancer Center	Gettysburg	Pennsylvania	United States	17325
265	UPMC Cancer Centers - Arnold Palmer Pavilion	Greensburg	Pennsylvania	United States	15601
266	Cherry Tree Cancer Center	Hanover	Pennsylvania	United States	17331
267	Penn State Milton S Hershey Medical Center	Hershey	Pennsylvania	United States	17033-0850
268	UPMC-Johnstown/John P. Murtha Regional Cancer Center	Johnstown	Pennsylvania	United States	15901
269	Lancaster General Hospital	Lancaster	Pennsylvania	United States	17602
270	Saint Mary Medical and Regional Cancer Center	Langhorne	Pennsylvania	United States	19047
271	UPMC Cancer Center at UPMC McKeesport	McKeesport	Pennsylvania	United States	15132
272	Holy Redeemer Hospital and Medical Center	Meadowbrook	Pennsylvania	United States	19046
273	Riddle Memorial Hospital	Media	Pennsylvania	United States	19063
274	Intercommunity Cancer Center	Monroeville	Pennsylvania	United States	15146
275	UPMC-Coraopolis/Heritage Valley Radiation Oncology	Moon	Pennsylvania	United States	15108
276	Allegheny Valley Hospital	Natrona Heights	Pennsylvania	United States	15065
277	UPMC Jameson	New Castle	Pennsylvania	United States	16105
278	Paoli Memorial Hospital	Paoli	Pennsylvania	United States	19301
279	University of Pennsylvania/Abramson Cancer Center	Philadelphia	Pennsylvania	United States	19104
280	Thomas Jefferson University Hospital	Philadelphia	Pennsylvania	United States	19107
281	Fox Chase Cancer Center	Philadelphia	Pennsylvania	United States	19111
282	Allegheny General Hospital	Pittsburgh	Pennsylvania	United States	15212
283	UPMC-Magee Womens Hospital	Pittsburgh	Pennsylvania	United States	15213
284	UPMC-Saint Margaret	Pittsburgh	Pennsylvania	United States	15215
285	UPMC-Shadyside Hospital	Pittsburgh	Pennsylvania	United States	15232
286	UPMC Jefferson Regional Radiation Oncology	Pittsburgh	Pennsylvania	United States	15236
287	UPMC-Passavant Hospital	Pittsburgh	Pennsylvania	United States	15237
288	UPMC-Saint Clair Hospital Cancer Center	Pittsburgh	Pennsylvania	United States	15243
289	Penn State Health Saint Joseph Medical Center	Reading	Pennsylvania	United States	19605
290	Grand View Hospital	Sellersville	Pennsylvania	United States	18960
291	Mount Nittany Medical Center	State College	Pennsylvania	United States	16803
292	Crozer-Chester Medical Center	Upland	Pennsylvania	United States	19013
293	UPMC Washington Hospital Radiation Oncology	Washington	Pennsylvania	United States	15301
294	Reading Hospital	West Reading	Pennsylvania	United States	19611
295	Lankenau Medical Center	Wynnewood	Pennsylvania	United States	19096
296	WellSpan Health-York Hospital	York	Pennsylvania	United States	17403
297	Prisma Health Cancer Institute - Spartanburg	Boiling Springs	South Carolina	United States	29316
298	Medical University of South Carolina	Charleston	South Carolina	United States	29425
299	Greenville Health System Cancer Institute-Andrews	Greenville	South Carolina	United States	29601
300	Prisma Health Cancer Institute - Faris	Greenville	South Carolina	United States	29605
301	Prisma Health Cancer Institute - Eastside	Greenville	South Carolina	United States	29615
302	Prisma Health Cancer Institute - Greer	Greer	South Carolina	United States	29650
303	Gibbs Cancer Center-Pelham	Greer	South Carolina	United States	29651
304	The Radiation Oncology Center-Hilton Head/Bluffton	Hilton Head Island	South Carolina	United States	29926
305	Prisma Health Cancer Institute - Seneca	Seneca	South Carolina	United States	29672
306	Spartanburg Medical Center	Spartanburg	South Carolina	United States	29303
307	Lexington Medical Center	West Columbia	South Carolina	United States	29169
308	Rapid City Regional Hospital	Rapid City	South Dakota	United States	57701
309	Avera Cancer Institute	Sioux Falls	South Dakota	United States	57105
310	Texas Oncology-Arlington South	Arlington	Texas	United States	76014
311	Texas Oncology-Austin Midtown	Austin	Texas	United States	78705
312	Texas Oncology - South Austin Cancer Center	Austin	Texas	United States	78745
313	Texas Oncology Bedford	Bedford	Texas	United States	76022
314	UT Southwestern/Simmons Cancer Center-Dallas	Dallas	Texas	United States	75390
315	Texas Oncology - Denison Cancer Center	Denison	Texas	United States	75020
316	Texas Oncology-Denton South	Denton	Texas	United States	76201
317	Brooke Army Medical Center	Fort Sam Houston	Texas	United States	78234
318	Texas Oncology - Fort Worth Cancer Center	Fort Worth	Texas	United States	76104
319	Memorial Hermann Memorial City Medical Center	Houston	Texas	United States	77024
320	Baylor Medical Center at Irving	Irving	Texas	United States	75061
321	Texas Oncology - Lewisville	Lewisville	Texas	United States	75067
322	West Texas Cancer Center	Odessa	Texas	United States	79761
323	Texas Oncology-Plano West	Plano	Texas	United States	75093
324	Texas Oncology-Seton Williamson	Round Rock	Texas	United States	78665
325	Texas Oncology - Round Rock Cancer Center	Round Rock	Texas	United States	78681
326	Cancer Care Centers of South Texas- Northeast	San Antonio	Texas	United States	78217
327	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78229
328	Texas Oncology Cancer Center Sugar Land	Sugar Land	Texas	United States	77479
329	Texas Oncology-Wichita Falls Texoma Cancer Center	Wichita Falls	Texas	United States	76310
330	Logan Regional Hospital	Logan	Utah	United States	84321
331	Intermountain Medical Center	Murray	Utah	United States	84107
332	McKay-Dee Hospital Center	Ogden	Utah	United States	84403
333	Dixie Medical Center Regional Cancer Center	Saint George	Utah	United States	84770
334	Utah Cancer Specialists-Salt Lake City	Salt Lake City	Utah	United States	84106
335	Huntsman Cancer Institute/University of Utah	Salt Lake City	Utah	United States	84112
336	Norris Cotton Cancer Center-North	Saint Johnsbury	Vermont	United States	05819
337	Inova Alexandria Hospital	Alexandria	Virginia	United States	22304
338	University of Virginia Cancer Center	Charlottesville	Virginia	United States	22908
339	Inova Fairfax Hospital	Falls Church	Virginia	United States	22042
340	Augusta Health Center for Cancer and Blood Disorders	Fishersville	Virginia	United States	22939
341	Sentara Cancer Institute at Sentara CarePlex Hospital	Hampton	Virginia	United States	23666
342	Sentara Rockingham Memorial Hospital Hahn Cancer Center	Harrisonburg	Virginia	United States	22801
343	Sentara Norfolk General Hospital	Norfolk	Virginia	United States	23507
344	Naval Medical Center - Portsmouth	Portsmouth	Virginia	United States	23708-2197
345	Virginia Commonwealth University/Massey Cancer Center	Richmond	Virginia	United States	23298
346	Sentara Virginia Beach General Hospital	Virginia Beach	Virginia	United States	23454
347	Harrison Medical Center	Bremerton	Washington	United States	98310
348	Saint Francis Hospital	Federal Way	Washington	United States	98003
349	Tri-Cities Cancer Center	Kennewick	Washington	United States	99336
350	Skagit Valley Hospital	Mount Vernon	Washington	United States	98274
351	Virginia Mason Medical Center	Seattle	Washington	United States	98101
352	Seattle Cancer Care Alliance	Seattle	Washington	United States	98109
353	Olympic Medical Cancer Care Center	Sequim	Washington	United States	98384
354	Cancer Care Northwest - Spokane South	Spokane	Washington	United States	99202
355	Cancer Care Northwest-North Spokane	Spokane	Washington	United States	99218
356	Wenatchee Valley Hospital and Clinics	Wenatchee	Washington	United States	98801
357	Edwards Comprehensive Cancer Center	Huntington	West Virginia	United States	25701
358	West Virginia University Healthcare	Morgantown	West Virginia	United States	26506
359	Wheeling Hospital/Schiffler Cancer Center	Wheeling	West Virginia	United States	26003
360	Langlade Hospital and Cancer Center	Antigo	Wisconsin	United States	54409
361	ThedaCare Regional Medical Center - Appleton	Appleton	Wisconsin	United States	54911
362	Beloit Memorial Hospital	Beloit	Wisconsin	United States	53511
363	Mayo Clinic Health System Eau Claire Hospital-Luther Campus	Eau Claire	Wisconsin	United States	54703
364	Saint Agnes Hospital/Agnesian Cancer Center	Fond Du Lac	Wisconsin	United States	54935
365	Bellin Memorial Hospital	Green Bay	Wisconsin	United States	54301
366	Saint Vincent Hospital Cancer Center Green Bay	Green Bay	Wisconsin	United States	54301
367	Saint Vincent Hospital Cancer Center at Saint Mary's	Green Bay	Wisconsin	United States	54303
368	Aurora BayCare Medical Center	Green Bay	Wisconsin	United States	54311
369	UW Cancer Center Johnson Creek	Johnson Creek	Wisconsin	United States	53038
370	Gundersen Lutheran Medical Center	La Crosse	Wisconsin	United States	54601
371	Mayo Clinic Health System-Franciscan Healthcare	La Crosse	Wisconsin	United States	54601
372	University of Wisconsin Hospital and Clinics	Madison	Wisconsin	United States	53792
373	Bay Area Medical Center	Marinette	Wisconsin	United States	54143
374	Froedtert Menomonee Falls Hospital	Menomonee Falls	Wisconsin	United States	53051
375	Ascension Columbia Saint Mary's Hospital Ozaukee	Mequon	Wisconsin	United States	53097
376	Ascension Columbia Saint Mary's Hospital - Milwaukee	Milwaukee	Wisconsin	United States	53211
377	Aurora Saint Luke's Medical Center	Milwaukee	Wisconsin	United States	53215
378	Medical College of Wisconsin	Milwaukee	Wisconsin	United States	53226
379	Ascension All Saints Hospital	Racine	Wisconsin	United States	53405
380	Vince Lombardi Cancer Clinic-Sheboygan	Sheboygan	Wisconsin	United States	53081
381	Saint Vincent Hospital Cancer Center at Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235-1495
382	Aurora Medical Center in Summit	Summit	Wisconsin	United States	53066
383	Vince Lombardi Cancer Clinic-Two Rivers	Two Rivers	Wisconsin	United States	54241
384	ProHealth Waukesha Memorial Hospital	Waukesha	Wisconsin	United States	53188
385	Aspirus Regional Cancer Center	Wausau	Wisconsin	United States	54401
386	Aurora West Allis Medical Center	West Allis	Wisconsin	United States	53227
387	Cross Cancer Institute	Edmonton	Alberta	Canada	T6G 1Z2
388	BCCA-Vancouver Cancer Centre	Vancouver	British Columbia	Canada	V5Z 4E6
389	CancerCare Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
390	Atlantic Health Sciences Corporation-Saint John Regional Hospital	Saint John	New Brunswick	Canada	E2L 4L2
391	Grand River Regional Cancer Centre at Grand River Hospital	Kitchener	Ontario	Canada	N2G 1G3
392	London Regional Cancer Program	London	Ontario	Canada	N6A 4L6
393	Stronach Regional Health Centre at Southlake	Newmarket	Ontario	Canada	L3Y 2P9
394	Ottawa Hospital and Cancer Center-General Campus	Ottawa	Ontario	Canada	K1H 8L6
395	Ottawa Hospital-Civic Campus	Ottawa	Ontario	Canada	K1Y 4E9
396	Irving Greenberg Family Cancer Centre	Ottawa	Ontario	Canada	K2H 8P4
397	Windsor Regional Cancer Centre	Windsor	Ontario	Canada	N8W 2X3
398	Hopital de la Cite-de-la-Sante	Laval	Quebec	Canada	H7M 3L9
399	CIUSSSEMTL-Hopital Maisonneuve-Rosemont	Montreal	Quebec	Canada	H1T 2M4
400	CHUM - Hopital Notre-Dame	Montreal	Quebec	Canada	H2L 4M1
401	McGill University Department of Oncology	Montreal	Quebec	Canada	H2W 1S6
402	CHUM - Centre Hospitalier de l'Universite de Montreal	Montreal	Quebec	Canada	H2X 3E4
403	The Research Institute of the McGill University Health Centre (MUHC)	Montreal	Quebec	Canada	H3H 2R9
404	CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)	Quebec City	Quebec	Canada	G1R 2J6
405	Centre Hospitalier Universitaire de Sherbrooke-Fleurimont	Sherbrooke	Quebec	Canada	J1H 5N4
406	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1
407	Pamela Youde Nethersole Eastern Hospital	Chai Wan		Hong Kong
408	Rabin Medical Center	Petach Tikva		Israel	49100
409	Chaim Sheba Medical Center	Tel Hashomer		Israel	52621
410	Shizuoka Cancer Center	Shizuoka City	Suntou	Japan	411-8777
411	National Cancer Center-Korea	Goyang-si	Gyeonggi-do	Korea, Republic of	410-769
412	Yonsei University Health System-Severance Hospital	Seoul		Korea, Republic of	120-752
413	National University Hospital Singapore	Singapore		Singapore	119074
414	National Cancer Centre Singapore	Singapore		Singapore	169610
415	Kantonsspital Aarau	Aarau		Switzerland	5001

Sponsors and Collaborators

• Radiation Therapy Oncology Group
• National Cancer Institute (NCI)
• NRG Oncology

Investigators

• Principal Investigator: Frank A. Vicini, MD, FACR, St. Joseph Mercy Oakland
• Study Chair: Gary M. Freedman, MD, University of Pennsylvania
• Study Chair: Julia R. White, MD, Ohio State University
• Study Chair: Douglas W. Arthur, MD, Virginia Commonwealth University

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Radiation Therapy Oncology Group
• ClinicalTrials.gov Identifier: NCT01349322
• Other Study ID Numbers: RTOG-1005; NCI-2011-02669; CDR0000700069; NCT03553797
• First Posted: May 6, 2011
• Last Update Posted: Apr 8, 2022
• Last Verified: Apr 1, 2022

• Keywords provided by Radiation Therapy Oncology Group: stage IA breast cancer; stage IB breast cancer; stage II breast cancer; estrogen receptor-negative breast cancer; estrogen receptor-positive breast cancer; progesterone receptor-negative breast cancer; progesterone receptor-positive breast cancer; ductal breast carcinoma in situ
• Additional relevant MeSH terms: Breast Neoplasms

Study Results

No Results Posted as of Apr 8, 2022