Active Surveillance, Bleomycin, Etoposide, Carboplatin or Cisplatin in Treating Pediatric and Adult Patients With Germ Cell Tumors

Sponsor

Children's Oncology Group (Other)

Overall Status

Recruiting

CT.gov ID

NCT03067181

Collaborator

National Cancer Institute (NCI) (NIH)

2,059

Enrollment

570

Locations

Arms

121.7

Anticipated Duration (Months)

3.6

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This phase III trial studies how well active surveillance, bleomycin, etoposide, carboplatin or cisplatin work in treating pediatric and adult patients with germ cell tumors. Active surveillance may help doctors to monitor subjects with low risk germ cell tumors after their tumor is removed. Drugs used in chemotherapy, such as bleomycin, carboplatin, etoposide, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. The trial studies whether carboplatin or cisplatin is the preferred chemotherapy to use in treating germ cell tumors.

Condition or Disease	Intervention/Treatment	Phase
Childhood Extracranial Germ Cell Tumor Extragonadal Embryonal Carcinoma Germ Cell Tumor Malignant Germ Cell Tumor Malignant Ovarian Teratoma Stage I Ovarian Choriocarcinoma Stage I Ovarian Embryonal Carcinoma AJCC v6 and v7 Stage I Ovarian Teratoma AJCC v6 and v7 Stage I Ovarian Yolk Sac Tumor AJCC v6 and v7 Stage I Testicular Choriocarcinoma AJCC v6 and v7 Stage I Testicular Embryonal Carcinoma AJCC v6 and v7 Stage I Testicular Seminoma AJCC v6 and v7 Stage I Testicular Yolk Sac Tumor AJCC v6 and v7 Stage II Ovarian Choriocarcinoma Stage II Ovarian Embryonal Carcinoma AJCC v6 and v7 Stage II Ovarian Yolk Sac Tumor AJCC v6 and v7 Stage II Testicular Choriocarcinoma AJCC v6 and v7 Stage II Testicular Embryonal Carcinoma AJCC v6 and v7 Stage II Testicular Yolk Sac Tumor AJCC v6 and v7 Stage III Ovarian Choriocarcinoma Stage III Ovarian Embryonal Carcinoma AJCC v6 and v7 Stage III Ovarian Yolk Sac Tumor AJCC v6 and v7 Stage III Testicular Choriocarcinoma AJCC v6 and v7 Stage III Testicular Embryonal Carcinoma AJCC v6 and v7 Stage III Testicular Yolk Sac Tumor AJCC v6 and v7 Stage IV Ovarian Choriocarcinoma Stage IV Ovarian Embryonal Carcinoma AJCC v6 and v7 Stage IV Ovarian Yolk Sac Tumor AJCC v6 and v7 Testicular Mixed Choriocarcinoma and Embryonal Carcinoma Testicular Mixed Choriocarcinoma and Teratoma Testicular Mixed Choriocarcinoma and Yolk Sac Tumor	Other: Best Practice Biological: Bleomycin Sulfate Drug: Carboplatin Drug: Cisplatin Drug: Etoposide Other: Laboratory Biomarker Analysis Other: Pharmacogenomic Study Other: Quality-of-Life Assessment Other: Questionnaire Administration	Phase 3

Detailed Description

PRIMARY OBJECTIVES:

To evaluate whether a strategy of complete surgical resection followed by surveillance can maintain an overall survival rate of at least 95.7% at two years for pediatric, adolescent and adult patients with stage I (low risk) malignant germ cell tumors, and at least 95% for patients with ovarian pure immature teratoma.
To compare the event-free survival of a carboplatin versus (vs.) cisplatin-based regimen in the treatment of pediatric, adolescent and young adult patients with standard risk non-seminomatous germ cell tumors.

IIa. To compare the event free survival (EFS) of a carboplatin-based regimen (carboplatin [C] etoposide [E] bleomycin [b]) vs. a cisplatin-based regimen (cisplatin [P]Eb) in children (less than 11 years in age) with standard risk germ cell tumors (GCT).

IIb. To compare the EFS of a carboplatin-based regimen (BEC) vs. a cisplatin-based regimen (BEP) in adolescents and young adults (ages 11 - < 25 years) with standard risk GCT.

SECONDARY OBJECTIVES:

To compare the incidence of ototoxicity in children, adolescents and young adults with standard risk germ cell tumors treated with carboplatin-based chemotherapy as compared to cisplatin-based chemotherapy.
To refine and validate a novel patient-reported measure of hearing outcomes for children, adolescents and young adults with standard risk germ cell tumors.

EXPLORATORY OBJECTIVES:

To prospectively determine the correlation of tumor marker decline (alpha-fetoprotein [FP] and beta-human chorionic gonadotropin [HCG]) with clinical outcome in low and standard risk germ cell tumor patients.
To compare self-reported peripheral neuropathy and other patient-reported outcomes between children, adolescents and young adults with standard risk germ cell tumors treated with carboplatin-based chemotherapy as compared to cisplatin-based chemotherapy.
Assess the relationship between hearing loss as measured by audiometry with the effects of tinnitus as assessed on the Adolescent and Young Adult Hearing Screening (AYA-HEARS) instrument.
To evaluate the prognostic significance of serum micro ribonucleic acid (miRNA)s in stage I testicular cancer (seminoma and non-seminoma) patients by collecting clinical data and serum specimens for future analysis.

OUTLINE:

Patients with low-risk stage I grade 2, 3 ovarian immature teratoma or stage I non-seminoma malignant germ cell tumors (MGCT)s undergo observation and can transfer to standard risk arm when eligibility criteria are met. Patients with stage I seminoma testicular MGCT undergo observation, and those with residual/recurrent disease are treated at the discretion of their physician.

Patients with standard risk 1 are randomized into 1 of 2 arms.

ARM I (CEb): Patients receive bleomycin intravenously (IV) over 10 minutes and carboplatin IV over 1 hour on day 1. Patients also receive etoposide IV over 1-2 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

ARM II (PEb): Patients receive bleomycin IV over 10 minutes on day 1. Patients also receive etoposide IV over 1-2 hours and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

Patients with standard risk 2 are randomized into 1 of 2 arms.

ARM III (BEC): Patients receive bleomycin IV over 10 minutes on days 1, 8, and 15, etoposide IV over 1-2 hours on days 1-5, and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.

ARM IV (BEP): Patients receive bleomycin IV over 10 minutes on days 1, 8, 15, etoposide IV over 1-2 hours on days 1-5, and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 2 months for 12 months, every 3-6 months to 24 months, every 6 months for years 3-5, and then annually for up to 10 years.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

2059 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase 3 Study of Active Surveillance for Low Risk and a Randomized Trial of Carboplatin vs. Cisplatin for Standard Risk Pediatric and Adult Patients With Germ Cell Tumors

Actual Study Start Date :

May 8, 2017

Anticipated Primary Completion Date :

Jun 30, 2027

Anticipated Study Completion Date :

Jun 30, 2027

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm I (bleomycin, carboplatin, etoposide) Patients receive bleomycin IV over 10 minutes and carboplatin IV over 1 hour on day 1. Patients also receive etoposide IV over 1-2 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.	Biological: Bleomycin Sulfate Given IV Drug: Carboplatin Given IV Drug: Etoposide Given IV Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacogenomic Study Correlative studies Other: Quality-of-Life Assessment Ancillary studies Other: Questionnaire Administration Ancillary studies
Experimental: Arm II (bleomycin, etoposide, cisplatin) Patients receive bleomycin IV over 10 minutes on day 1. Patients also receive etoposide IV over 1-2 hours and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.	Biological: Bleomycin Sulfate Given IV Drug: Cisplatin Given IV Drug: Etoposide Given IV Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacogenomic Study Correlative studies Other: Quality-of-Life Assessment Ancillary studies Other: Questionnaire Administration Ancillary studies
Experimental: Arm III (bleomycin, etoposide, carboplatin) Patients receive bleomycin IV over 10 minutes on days 1, 8, and 15, etoposide IV over 1-2 hours on days 1-5, and carboplatin IV over 1 hour on day 1. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.	Biological: Bleomycin Sulfate Given IV Drug: Carboplatin Given IV Drug: Etoposide Given IV Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacogenomic Study Correlative studies Other: Quality-of-Life Assessment Ancillary studies Other: Questionnaire Administration Ancillary studies
Experimental: Arm IV (bleomycin, etoposide, cisplatin) Patients receive bleomycin IV over 10 minutes on days 1, 8, and 15, etoposide IV over 1-2 hours on days 1-5, and cisplatin IV over 1-3 hours on days 1-5. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.	Biological: Bleomycin Sulfate Given IV Drug: Cisplatin Given IV Drug: Etoposide Given IV Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacogenomic Study Correlative studies Other: Quality-of-Life Assessment Ancillary studies Other: Questionnaire Administration Ancillary studies
Experimental: Low-Risk (observation) Patients with low-risk stage I grade 2, 3 ovarian immature teratoma or stage I non-seminoma MGCTs undergo observation and can transfer to standard risk arm when eligibility criteria are met. Patients with stage I seminoma testicular MGCT undergo observation, and those with residual/recurrent disease are treated at the discretion of their physician.	Other: Best Practice Undergo observation Other: Laboratory Biomarker Analysis Correlative studies Other: Pharmacogenomic Study Correlative studies Other: Quality-of-Life Assessment Ancillary studies Other: Questionnaire Administration Ancillary studies

Outcome Measures

Primary Outcome Measures

Overall survival [Two years post enrollment]
The time from study entry to the date of death, or date of last contact and ascertained as alive, whichever comes first.
Event-free survival [Two years post enrollment]
The time from study entry to the date of death, date of disease progression or recurrence, date of second malignant neoplasm or date of last contact and ascertained as alive, whichever comes first.

Secondary Outcome Measures

Proportion of participants with hearing loss [8 weeks after the last dose of platin therapy]
The hearing loss is evaluated according to the International Society of Pediatric Oncology criteria.
Number of participants by understanding score category in the Adolescents and Young Adults-Hearing Screen [Baseline]
Understanding score will be rated on a 5-point Likert scale ranging from 0 = completely incorrect to 4 = completely correct.

Other Outcome Measures

Event-free survival (EFS) for participants with and without tumor marker decline [Up to 2 years]
Tumor marker decline is coded as yes versus no. The hazard ratio for participants with and without tumor marker decline will be presented. Patients who receive chemotherapy will be analyzed separately than patients in the low risk stratum.
Mean self-reported peripheral neuropathy score [Up to 12 months]
Mean self-reported neuropathy score will be compared for the two treatment regimens.

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

There is no age limit for the low risk stratum (stage I ovarian immature teratoma and stage I non-seminoma or seminoma malignant GCT [all sites])
Standard risk 1: Patient must be < 11 years of age at enrollment
Standard risk 2: Patients must be >= 11 and < 25 years of age at enrollment
Patients enrolling on one of the low risk arms must be newly diagnosed with a stage I germ cell tumor; for the standard risk arms, patients must be newly diagnosed with metastatic germ cell tumor (stage II or higher); histologic confirmation of a primary extracranial germ cell tumor in any of the categories outlined below is required of all patients at enrollment except for those who were initially diagnosed with stage I non-seminoma malignant GCT and later recur during observation post surgery off study; for these patients, if elevated tumor markers rise to > 5 x upper limit of normal (ULN) on at least 2 measurements taken at least 1 week apart, a diagnostic biopsy is not required for enrollment
Low risk stage I immature teratoma (IT); site: ovarian; stage: Children's Oncology Group (COG) stage I, Federation of Gynecology and Obstetrics (FIGO) stage IA and IB; grade: 2 or 3; histology: pure immature teratoma (may contain microscopic foci of yolk sac tumor), mixed immature and mature teratoma, (no pathological evidence of MGCT); tumor markers: alpha-FP =< 1,000 ng/mL, beta-HCG institutional normal; all ages
Low risk stage I non-seminoma MGCT; site: ovarian, testicular, or extragonadal; stage: COG stage I, FIGO stage IA and IB, American Joint Committee on Cancer (AJCC) testicular stage IA, IB and IS; histology: must contain at least one of the following: yolk sac tumor, embryonal carcinoma, or choriocarcinoma (pure or mixed); all ages
Low risk stage I seminoma-MGCT; site: testicular; stage: COG stage I; AJCC testicular stage IA IB, and IS; histology: must contain at least one of the following: may contain immature/mature teratoma; may NOT contain yolk sac tumor, embryonal carcinoma, or choriocarcinoma; all ages
Standard risk 1 (SR1); site: ovarian, testicular, or extragonadal; stage: COG stage II-IV, FIGO stage IC, FIGO stage II-IV (International Germ Cell Consensus Classification [IGCCC] criteria DO NOT apply); histology: must contain at least one of the following: yolk sac tumor, embryonal carcinoma, or choriocarcinoma; age (years) < 11
Standard risk 2 (SR2)
Site: ovarian; stage: COG stage II and III, FIGO stage IC, II and III; histology: must contain at least one of the following: yolk sac tumor, embryonal carcinoma, or choriocarcinoma; age (years) >= 11 and < 25
Site: testicular; stage: COG stage II-IV, AJCC stage II, III, IGCCC good risk; histology: must contain at least one of the following: yolk sac tumor, embryonal carcinoma, or choriocarcinoma; tumor markers: must be IGCCC good risk; post op: alpha-FP < 1,000 ng/mL, beta-HCG < 5,000 IU/mL and lactate dehydrogenase (LDH) < 3.0 x normal; age (years) >= 11 and < 25
Site: extragonadal; stage: COG stage II; histology: must contain at least one of the following: yolk sac tumor, embryonal carcinoma, or choriocarcinoma; age (years) >= 11 and < 25
Notes:
IGCCC criteria only apply to SR2 patients with a testicular primary tumor
Use post-op tumor marker levels to determine IGCCC risk group
Stage 1 seminoma patients are not eligible for the standard risk arms of the study
For the low risk stage I non-seminoma MGCT and the standard risk arms, components of yolk sac tumor, embryonal carcinoma, or choriocarcinoma can be mixed with other forms of GCT, such as seminoma or mature or immature teratoma; if yolk sac tumor is the only malignant component present, then it must be deemed by the pathologist to be greater than a "microscopic component" of yolk sac tumor
Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1, 2 or 3; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
Organ function requirements apply ONLY to patients who will receive chemotherapy (SR1 and SR2 patients)
Adequate renal function defined as:
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 OR
A serum creatinine based on age/gender as follows: (mg/dL)
1 month to < 6 months male: 0.4 female: 0.4
6 months to < 1 year male: 0.5 female: 0.5
1 to < 2 years male: 0.6 female: 0.6
2 to < 6 years male: 0.8 female: 0.8
6 to < 10 years male: 1 female: 1
10 to < 13 years male: 1.2 female: 1.2
13 to < 16 years: male: 1.5 female: 1.4
= 16 years male: 1.7 female: 1.4
Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
Serum glutamic-oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 2.5 x upper limit of normal (ULN) for age (for the purpose of this study, the ULN for SGPT is 45 U/L)
Peripheral absolute neutrophil count (ANC) >= 1,000/mm^3 AND
Platelet count >= 100,000/mm^3
Patients enrolling on the standard risk arms must be medically fit to receive protocol treatment and with no contraindications to protocol treatment
Eligibility criteria to participate in the pilot study of the AYA-Hears instrument (patient reported outcomes [PROs] of ototoxicity) Note: participants in group 1 will not receive AGCT1531 protocol-directed therapy; all other AYA-HEARS patients must be enrolled on the AGCT1531 SR2 arm in order to participate
= 11 and < 25 years old at enrollment
Able to fluently speak and read English
Has received prior cisplatin- or carboplatin-based chemotherapy regimen for malignancy including diagnoses other than germ cell tumor
Followed for cancer or survivorship care at one of the following institutions:
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Dana Farber/Harvard Cancer Center
Hospital for Sick Children
Children's Hospital of Eastern Ontario
Oregon Health and Science University
Seattle Children's Hospital
Yale University

Exclusion Criteria:

Patients with any diagnoses not listed including:
Stage I testicular cancer patients who have undergone primary RPLND (retroperitoneal lymph node dissection)
Pure dysgerminoma
Pure mature teratoma
Pure immature teratoma COG stage I, grade I
Pure immature teratoma COG stage I, grade 2,3 with alpha-fetoprotein (AFP) >= 1000 ng/mL
Pure immature teratoma COG stage II - IV or FIGO stage IC to IV
"Poor risk" GCT (age >= 11 years old and COG stage IV ovarian, COG stage III or IV EG, or IGCCC intermediate or poor risk testicular), or
Primary central nervous system (CNS) germ cell tumor
Germ cell tumor with somatic malignant transformation
Spermatocytic seminoma
Patients must have had no prior systemic therapy for the current cancer diagnosis
Patients must have had no prior radiation therapy with the exception of CNS irradiation of brain metastases; (this exception only applies to SR1 patients; any patients over age 11 with distant metastases to brain [stage IV disease] would be considered poor risk and therefore not eligible for this trial)
Patients with significant, pre-existing co-morbid respiratory disease that contraindicate the use of bleomycin are ineligible for the standard risk arms of the trial
Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs; a pregnancy test is required for female patients of childbearing potential; (this criteria applies ONLY to patients who will receive chemotherapy [SR1 and SR2 patients])
Lactating females who plan to breastfeed their infants; (this criteria applies ONLY to patients who will receive chemotherapy [SR1 and SR2 patients])
Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation; (this criteria applies ONLY to patients who will receive chemotherapy [SR1 and SR2 patients])

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Children's Hospital of Alabama	Birmingham	Alabama	United States	35233
2	USA Health Strada Patient Care Center	Mobile	Alabama	United States	36604
3	Anchorage Associates in Radiation Medicine	Anchorage	Alaska	United States	98508
4	Anchorage Radiation Therapy Center	Anchorage	Alaska	United States	99504
5	Alaska Breast Care and Surgery LLC	Anchorage	Alaska	United States	99508
6	Alaska Oncology and Hematology LLC	Anchorage	Alaska	United States	99508
7	Alaska Women's Cancer Care	Anchorage	Alaska	United States	99508
8	Anchorage Oncology Centre	Anchorage	Alaska	United States	99508
9	Katmai Oncology Group	Anchorage	Alaska	United States	99508
10	Providence Alaska Medical Center	Anchorage	Alaska	United States	99508
11	Kingman Regional Medical Center	Kingman	Arizona	United States	86401
12	Banner Children's at Desert	Mesa	Arizona	United States	85202
13	Cancer Center at Saint Joseph's	Phoenix	Arizona	United States	85004
14	Phoenix Childrens Hospital	Phoenix	Arizona	United States	85016
15	Banner University Medical Center - Tucson	Tucson	Arizona	United States	85719
16	University of Arizona Cancer Center-North Campus	Tucson	Arizona	United States	85719
17	CHI Saint Vincent Cancer Center Hot Springs	Hot Springs	Arkansas	United States	71913
18	Arkansas Children's Hospital	Little Rock	Arkansas	United States	72202-3591
19	University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
20	Kaiser Permanente-Anaheim	Anaheim	California	United States	92806
21	Mission Hope Medical Oncology - Arroyo Grande	Arroyo Grande	California	United States	93420
22	PCR Oncology	Arroyo Grande	California	United States	93420
23	Kaiser Permanente-Bellflower	Bellflower	California	United States	90706
24	Providence Saint Joseph Medical Center/Disney Family Cancer Center	Burbank	California	United States	91505
25	Kaiser Permanente Downey Medical Center	Downey	California	United States	90242
26	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010
27	Kaiser Permanente-Fontana	Fontana	California	United States	92335
28	Loma Linda University Medical Center	Loma Linda	California	United States	92354
29	Miller Children's and Women's Hospital Long Beach	Long Beach	California	United States	90806
30	Children's Hospital Los Angeles	Los Angeles	California	United States	90027
31	Kaiser Permanente Los Angeles Medical Center	Los Angeles	California	United States	90027
32	Los Angeles County-USC Medical Center	Los Angeles	California	United States	90033
33	USC / Norris Comprehensive Cancer Center	Los Angeles	California	United States	90033
34	Cedars Sinai Medical Center	Los Angeles	California	United States	90048
35	Mattel Children's Hospital UCLA	Los Angeles	California	United States	90095
36	UCLA / Jonsson Comprehensive Cancer Center	Los Angeles	California	United States	90095
37	Valley Children's Hospital	Madera	California	United States	93636
38	Providence Queen of The Valley	Napa	California	United States	94558
39	USC Norris Oncology/Hematology-Newport Beach	Newport Beach	California	United States	92663
40	UCSF Benioff Children's Hospital Oakland	Oakland	California	United States	94609
41	Kaiser Permanente-Oakland	Oakland	California	United States	94611
42	Children's Hospital of Orange County	Orange	California	United States	92868
43	Lucile Packard Children's Hospital Stanford University	Palo Alto	California	United States	94304
44	Stanford Cancer Institute Palo Alto	Palo Alto	California	United States	94304
45	Kaiser Permanente-Roseville	Roseville	California	United States	95661
46	Sutter Medical Center Sacramento	Sacramento	California	United States	95816
47	University of California Davis Comprehensive Cancer Center	Sacramento	California	United States	95817
48	Kaiser Permanente-San Diego Mission	San Diego	California	United States	92108
49	Rady Children's Hospital - San Diego	San Diego	California	United States	92123
50	Naval Medical Center -San Diego	San Diego	California	United States	92134
51	UCSF Medical Center-Mission Bay	San Francisco	California	United States	94158
52	Pacific Central Coast Health Center-San Luis Obispo	San Luis Obispo	California	United States	93401
53	Kaiser Permanente Medical Center - Santa Clara	Santa Clara	California	United States	95051
54	Mission Hope Medical Oncology - Santa Maria	Santa Maria	California	United States	93444
55	Providence Medical Foundation - Santa Rosa	Santa Rosa	California	United States	95403
56	Providence Santa Rosa Memorial Hospital	Santa Rosa	California	United States	95405
57	Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center	Torrance	California	United States	90502
58	Children's Hospital Colorado	Aurora	Colorado	United States	80045
59	University of Colorado Hospital	Aurora	Colorado	United States	80045
60	Penrose-Saint Francis Healthcare	Colorado Springs	Colorado	United States	80907
61	Rocky Mountain Cancer Centers-Penrose	Colorado Springs	Colorado	United States	80907
62	UCHealth Memorial Hospital Central	Colorado Springs	Colorado	United States	80909
63	Memorial Hospital North	Colorado Springs	Colorado	United States	80920
64	Saint Francis Cancer Center	Colorado Springs	Colorado	United States	80923
65	Porter Adventist Hospital	Denver	Colorado	United States	80210
66	Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center	Denver	Colorado	United States	80218
67	Mercy Medical Center	Durango	Colorado	United States	81301
68	Southwest Oncology PC	Durango	Colorado	United States	81301
69	Poudre Valley Hospital	Fort Collins	Colorado	United States	80524
70	Cancer Care and Hematology-Fort Collins	Fort Collins	Colorado	United States	80528
71	Mountain Blue Cancer Care Center	Golden	Colorado	United States	80401
72	UCHealth Greeley Hospital	Greeley	Colorado	United States	80631
73	Rocky Mountain Cancer Centers-Lakewood	Lakewood	Colorado	United States	80228
74	Saint Anthony Hospital	Lakewood	Colorado	United States	80228
75	Littleton Adventist Hospital	Littleton	Colorado	United States	80122
76	UCHealth Lone Tree Health Center	Lone Tree	Colorado	United States	80124
77	Longmont United Hospital	Longmont	Colorado	United States	80501
78	Rocky Mountain Cancer Centers-Longmont	Longmont	Colorado	United States	80501
79	Medical Center of the Rockies	Loveland	Colorado	United States	80538
80	Parker Adventist Hospital	Parker	Colorado	United States	80138
81	Rocky Mountain Cancer Centers-Parker	Parker	Colorado	United States	80138
82	Saint Mary Corwin Medical Center	Pueblo	Colorado	United States	81004
83	Rocky Mountain Cancer Centers - Pueblo	Pueblo	Colorado	United States	81008
84	Rocky Mountain Cancer Centers-Thornton	Thornton	Colorado	United States	80260
85	Connecticut Children's Medical Center	Hartford	Connecticut	United States	06106
86	Yale University	New Haven	Connecticut	United States	06520
87	Alfred I duPont Hospital for Children	Wilmington	Delaware	United States	19803
88	Kaiser Permanente-Capitol Hill Medical Center	Washington	District of Columbia	United States	20002
89	MedStar Georgetown University Hospital	Washington	District of Columbia	United States	20007
90	Children's National Medical Center	Washington	District of Columbia	United States	20010
91	Broward Health Medical Center	Fort Lauderdale	Florida	United States	33316
92	Golisano Children's Hospital of Southwest Florida	Fort Myers	Florida	United States	33908
93	University of Florida Health Science Center - Gainesville	Gainesville	Florida	United States	32610
94	Memorial Regional Hospital/Joe DiMaggio Children's Hospital	Hollywood	Florida	United States	33021
95	Nemours Children's Clinic-Jacksonville	Jacksonville	Florida	United States	32207
96	University of Miami Miller School of Medicine-Sylvester Cancer Center	Miami	Florida	United States	33136
97	Nicklaus Children's Hospital	Miami	Florida	United States	33155
98	Miami Cancer Institute	Miami	Florida	United States	33176
99	AdventHealth Orlando	Orlando	Florida	United States	32803
100	Arnold Palmer Hospital for Children	Orlando	Florida	United States	32806
101	Nemours Children's Hospital	Orlando	Florida	United States	32827
102	Nemours Children's Clinic - Pensacola	Pensacola	Florida	United States	32504
103	Sacred Heart Hospital	Pensacola	Florida	United States	32504
104	Johns Hopkins All Children's Hospital	Saint Petersburg	Florida	United States	33701
105	Tampa General Hospital	Tampa	Florida	United States	33606
106	Saint Joseph's Hospital/Children's Hospital-Tampa	Tampa	Florida	United States	33607
107	Saint Mary's Hospital	West Palm Beach	Florida	United States	33407
108	Children's Healthcare of Atlanta - Egleston	Atlanta	Georgia	United States	30322
109	Augusta University Medical Center	Augusta	Georgia	United States	30912
110	Medical Center of Central Georgia	Macon	Georgia	United States	31201
111	Memorial Health University Medical Center	Savannah	Georgia	United States	31404
112	Straub Clinic and Hospital	Honolulu	Hawaii	United States	96813
113	Kaiser Permanente Moanalua Medical Center	Honolulu	Hawaii	United States	96819
114	Kapiolani Medical Center for Women and Children	Honolulu	Hawaii	United States	96826
115	Tripler Army Medical Center	Honolulu	Hawaii	United States	96859
116	Saint Luke's Cancer Institute - Boise	Boise	Idaho	United States	83712
117	Saint Luke's Cancer Institute - Fruitland	Fruitland	Idaho	United States	83619
118	Saint Luke's Cancer Institute - Meridian	Meridian	Idaho	United States	83642
119	Saint Luke's Cancer Institute - Nampa	Nampa	Idaho	United States	83686
120	Saint Luke's Cancer Institute - Twin Falls	Twin Falls	Idaho	United States	83301
121	Rush - Copley Medical Center	Aurora	Illinois	United States	60504
122	Illinois CancerCare-Bloomington	Bloomington	Illinois	United States	61704
123	Illinois CancerCare-Canton	Canton	Illinois	United States	61520
124	Memorial Hospital of Carbondale	Carbondale	Illinois	United States	62902
125	SIH Cancer Institute	Carterville	Illinois	United States	62918
126	Illinois CancerCare-Carthage	Carthage	Illinois	United States	62321
127	Centralia Oncology Clinic	Centralia	Illinois	United States	62801
128	Lurie Children's Hospital-Chicago	Chicago	Illinois	United States	60611
129	John H Stroger Jr Hospital of Cook County	Chicago	Illinois	United States	60612
130	Rush University Medical Center	Chicago	Illinois	United States	60612
131	University of Illinois	Chicago	Illinois	United States	60612
132	University of Chicago Comprehensive Cancer Center	Chicago	Illinois	United States	60637
133	Carle on Vermilion	Danville	Illinois	United States	61832
134	Cancer Care Specialists of Illinois - Decatur	Decatur	Illinois	United States	62526
135	Decatur Memorial Hospital	Decatur	Illinois	United States	62526
136	Illinois CancerCare-Dixon	Dixon	Illinois	United States	61021
137	Carle Physician Group-Effingham	Effingham	Illinois	United States	62401
138	Crossroads Cancer Center	Effingham	Illinois	United States	62401
139	Illinois CancerCare-Eureka	Eureka	Illinois	United States	61530
140	NorthShore University HealthSystem-Evanston Hospital	Evanston	Illinois	United States	60201
141	Illinois CancerCare-Galesburg	Galesburg	Illinois	United States	61401
142	Western Illinois Cancer Treatment Center	Galesburg	Illinois	United States	61401
143	NorthShore University HealthSystem-Glenbrook Hospital	Glenview	Illinois	United States	60026
144	NorthShore University HealthSystem-Highland Park Hospital	Highland Park	Illinois	United States	60035
145	Illinois CancerCare-Kewanee Clinic	Kewanee	Illinois	United States	61443
146	Illinois CancerCare-Macomb	Macomb	Illinois	United States	61455
147	Carle Physician Group-Mattoon/Charleston	Mattoon	Illinois	United States	61938
148	Loyola University Medical Center	Maywood	Illinois	United States	60153
149	Cancer Care Center of O'Fallon	O'Fallon	Illinois	United States	62269
150	Advocate Children's Hospital-Oak Lawn	Oak Lawn	Illinois	United States	60453
151	Illinois CancerCare-Ottawa Clinic	Ottawa	Illinois	United States	61350
152	Advocate Children's Hospital-Park Ridge	Park Ridge	Illinois	United States	60068
153	Illinois CancerCare-Pekin	Pekin	Illinois	United States	61554
154	OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center	Pekin	Illinois	United States	61554
155	Illinois CancerCare-Peoria	Peoria	Illinois	United States	61615
156	OSF Saint Francis Radiation Oncology at Peoria Cancer Center	Peoria	Illinois	United States	61615
157	Methodist Medical Center of Illinois	Peoria	Illinois	United States	61636
158	OSF Saint Francis Medical Center	Peoria	Illinois	United States	61637
159	Saint Jude Midwest Affiliate	Peoria	Illinois	United States	61637
160	Illinois CancerCare-Peru	Peru	Illinois	United States	61354
161	Valley Radiation Oncology	Peru	Illinois	United States	61354
162	Illinois CancerCare-Princeton	Princeton	Illinois	United States	61356
163	North Shore Medical Center	Skokie	Illinois	United States	60076
164	Saint John's Hospital	Springfield	Illinois	United States	62702
165	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62702
166	Springfield Clinic	Springfield	Illinois	United States	62702
167	Memorial Medical Center	Springfield	Illinois	United States	62781
168	Southwest Illinois Health Services LLP	Swansea	Illinois	United States	62226
169	Carle Cancer Center	Urbana	Illinois	United States	61801
170	The Carle Foundation Hospital	Urbana	Illinois	United States	61801
171	Illinois CancerCare - Washington	Washington	Illinois	United States	61571
172	Rush-Copley Healthcare Center	Yorkville	Illinois	United States	60560
173	IU Health North Hospital	Carmel	Indiana	United States	46032
174	Deaconess Clinic Downtown	Evansville	Indiana	United States	47713
175	Indiana University/Melvin and Bren Simon Cancer Center	Indianapolis	Indiana	United States	46202
176	Riley Hospital for Children	Indianapolis	Indiana	United States	46202
177	Saint Vincent Hospital and Health Care Center	Indianapolis	Indiana	United States	46260
178	Chancellor Center for Oncology	Newburgh	Indiana	United States	47630
179	Memorial Hospital of South Bend	South Bend	Indiana	United States	46601
180	Medical Oncology and Hematology Associates-West Des Moines	Clive	Iowa	United States	50325
181	Mercy Cancer Center-West Lakes	Clive	Iowa	United States	50325
182	Alegent Health Mercy Hospital	Council Bluffs	Iowa	United States	51503
183	Greater Regional Medical Center	Creston	Iowa	United States	50801
184	Blank Children's Hospital	Des Moines	Iowa	United States	50309
185	Iowa Methodist Medical Center	Des Moines	Iowa	United States	50309
186	Medical Oncology and Hematology Associates-Laurel	Des Moines	Iowa	United States	50314
187	Mercy Medical Center - Des Moines	Des Moines	Iowa	United States	50314
188	Iowa Lutheran Hospital	Des Moines	Iowa	United States	50316
189	University of Iowa/Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242
190	Mercy Medical Center-West Lakes	West Des Moines	Iowa	United States	50266
191	Flaget Memorial Hospital	Bardstown	Kentucky	United States	40004
192	Commonwealth Cancer Center-Corbin	Corbin	Kentucky	United States	40701
193	Saint Joseph Radiation Oncology Resource Center	Lexington	Kentucky	United States	40504
194	Saint Joseph Hospital East	Lexington	Kentucky	United States	40509
195	University of Kentucky/Markey Cancer Center	Lexington	Kentucky	United States	40536
196	Saint Joseph London	London	Kentucky	United States	40741
197	Jewish Hospital	Louisville	Kentucky	United States	40202
198	Norton Children's Hospital	Louisville	Kentucky	United States	40202
199	Saints Mary and Elizabeth Hospital	Louisville	Kentucky	United States	40215
200	UofL Health Medical Center Northeast	Louisville	Kentucky	United States	40245
201	Jewish Hospital Medical Center South	Shepherdsville	Kentucky	United States	40165
202	Children's Hospital New Orleans	New Orleans	Louisiana	United States	70118
203	Ochsner Medical Center Jefferson	New Orleans	Louisiana	United States	70121
204	Eastern Maine Medical Center	Bangor	Maine	United States	04401
205	Lafayette Family Cancer Center-EMMC	Brewer	Maine	United States	04412
206	Maine Medical Center-Bramhall Campus	Portland	Maine	United States	04102
207	Maine Children's Cancer Program	Scarborough	Maine	United States	04074
208	Maine Medical Center- Scarborough Campus	Scarborough	Maine	United States	04074
209	University of Maryland/Greenebaum Cancer Center	Baltimore	Maryland	United States	21201
210	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21215
211	Johns Hopkins University/Sidney Kimmel Cancer Center	Baltimore	Maryland	United States	21287
212	Walter Reed National Military Medical Center	Bethesda	Maryland	United States	20889-5600
213	Tufts Children's Hospital	Boston	Massachusetts	United States	02111
214	Tufts Medical Center	Boston	Massachusetts	United States	02111
215	Massachusetts General Hospital Cancer Center	Boston	Massachusetts	United States	02114
216	Dana-Farber Cancer Institute	Boston	Massachusetts	United States	02215
217	UMass Memorial Medical Center - University Campus	Worcester	Massachusetts	United States	01655
218	C S Mott Children's Hospital	Ann Arbor	Michigan	United States	48109
219	Bronson Battle Creek	Battle Creek	Michigan	United States	49017
220	Ascension Saint John Hospital	Detroit	Michigan	United States	48236
221	Michigan State University Clinical Center	East Lansing	Michigan	United States	48824-7016
222	Green Bay Oncology - Escanaba	Escanaba	Michigan	United States	49829
223	Hurley Medical Center	Flint	Michigan	United States	48503
224	Helen DeVos Children's Hospital at Spectrum Health	Grand Rapids	Michigan	United States	49503
225	Mercy Health Saint Mary's	Grand Rapids	Michigan	United States	49503
226	Spectrum Health at Butterworth Campus	Grand Rapids	Michigan	United States	49503
227	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
228	West Michigan Cancer Center	Kalamazoo	Michigan	United States	49007
229	Borgess Medical Center	Kalamazoo	Michigan	United States	49048
230	Mercy Health Mercy Campus	Muskegon	Michigan	United States	49444
231	Lakeland Hospital Niles	Niles	Michigan	United States	49120
232	Lake Huron Medical Center	Port Huron	Michigan	United States	48060
233	Spectrum Health Reed City Hospital	Reed City	Michigan	United States	49677
234	Beaumont Children's Hospital-Royal Oak	Royal Oak	Michigan	United States	48073
235	Lakeland Medical Center Saint Joseph	Saint Joseph	Michigan	United States	49085
236	Marie Yeager Cancer Center	Saint Joseph	Michigan	United States	49085
237	Munson Medical Center	Traverse City	Michigan	United States	49684
238	Metro Health Hospital	Wyoming	Michigan	United States	49519
239	Essentia Health Cancer Center	Duluth	Minnesota	United States	55805
240	Children's Hospitals and Clinics of Minnesota - Minneapolis	Minneapolis	Minnesota	United States	55404
241	University of Minnesota/Masonic Cancer Center	Minneapolis	Minnesota	United States	55455
242	Mayo Clinic in Rochester	Rochester	Minnesota	United States	55905
243	University of Mississippi Medical Center	Jackson	Mississippi	United States	39216
244	Parkland Health Center-Bonne Terre	Bonne Terre	Missouri	United States	63628
245	Saint Francis Medical Center	Cape Girardeau	Missouri	United States	63703
246	Southeast Cancer Center	Cape Girardeau	Missouri	United States	63703
247	Parkland Health Center - Farmington	Farmington	Missouri	United States	63640
248	Capital Region Southwest Campus	Jefferson City	Missouri	United States	65109
249	Children's Mercy Hospitals and Clinics	Kansas City	Missouri	United States	64108
250	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
251	Missouri Baptist Medical Center	Saint Louis	Missouri	United States	63131
252	Mercy Hospital Saint Louis	Saint Louis	Missouri	United States	63141
253	Sainte Genevieve County Memorial Hospital	Sainte Genevieve	Missouri	United States	63670
254	Missouri Baptist Sullivan Hospital	Sullivan	Missouri	United States	63080
255	Missouri Baptist Outpatient Center-Sunset Hills	Sunset Hills	Missouri	United States	63127
256	Saint Patrick Hospital - Community Hospital	Missoula	Montana	United States	59802
257	CHI Health Saint Francis	Grand Island	Nebraska	United States	68803
258	Heartland Hematology and Oncology	Kearney	Nebraska	United States	68845
259	CHI Health Good Samaritan	Kearney	Nebraska	United States	68847
260	Saint Elizabeth Regional Medical Center	Lincoln	Nebraska	United States	68510
261	Children's Hospital and Medical Center of Omaha	Omaha	Nebraska	United States	68114
262	Alegent Health Immanuel Medical Center	Omaha	Nebraska	United States	68122
263	Hematology and Oncology Consultants PC	Omaha	Nebraska	United States	68122
264	Alegent Health Bergan Mercy Medical Center	Omaha	Nebraska	United States	68124
265	Alegent Health Lakeside Hospital	Omaha	Nebraska	United States	68130
266	Creighton University Medical Center	Omaha	Nebraska	United States	68131
267	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198
268	Midlands Community Hospital	Papillion	Nebraska	United States	68046
269	Carson Tahoe Regional Medical Center	Carson City	Nevada	United States	89703
270	Cancer and Blood Specialists-Henderson	Henderson	Nevada	United States	89052
271	Comprehensive Cancer Centers of Nevada - Henderson	Henderson	Nevada	United States	89052
272	Comprehensive Cancer Centers of Nevada-Horizon Ridge	Henderson	Nevada	United States	89052
273	Las Vegas Cancer Center-Henderson	Henderson	Nevada	United States	89052
274	OptumCare Cancer Care at Seven Hills	Henderson	Nevada	United States	89052
275	Comprehensive Cancer Centers of Nevada-Southeast Henderson	Henderson	Nevada	United States	89074
276	Las Vegas Urology - Green Valley	Henderson	Nevada	United States	89074
277	Las Vegas Urology - Pebble	Henderson	Nevada	United States	89074
278	Urology Specialists of Nevada - Green Valley	Henderson	Nevada	United States	89074
279	Las Vegas Urology - Pecos	Las Vegas	Nevada	United States	89074
280	Desert West Surgery	Las Vegas	Nevada	United States	89102
281	OptumCare Cancer Care at Charleston	Las Vegas	Nevada	United States	89102
282	University Medical Center of Southern Nevada	Las Vegas	Nevada	United States	89102
283	Hope Cancer Care of Nevada	Las Vegas	Nevada	United States	89103
284	Cancer and Blood Specialists-Shadow	Las Vegas	Nevada	United States	89106
285	Radiation Oncology Centers of Nevada Central	Las Vegas	Nevada	United States	89106
286	Urology Specialists of Nevada - Central	Las Vegas	Nevada	United States	89106
287	Women's Cancer Center of Nevada	Las Vegas	Nevada	United States	89106
288	Sunrise Hospital and Medical Center	Las Vegas	Nevada	United States	89109
289	Las Vegas Urology - Sunset	Las Vegas	Nevada	United States	89113
290	Urology Specialists of Nevada - Southwest	Las Vegas	Nevada	United States	89113
291	Radiation Oncology Centers of Nevada Southeast	Las Vegas	Nevada	United States	89119
292	Cancer Therapy and Integrative Medicine	Las Vegas	Nevada	United States	89121
293	Ann M Wierman MD LTD	Las Vegas	Nevada	United States	89128
294	Cancer and Blood Specialists-Tenaya	Las Vegas	Nevada	United States	89128
295	Comprehensive Cancer Centers of Nevada - Northwest	Las Vegas	Nevada	United States	89128
296	Las Vegas Urology - Cathedral Rock	Las Vegas	Nevada	United States	89128
297	Las Vegas Urology - Smoke Ranch	Las Vegas	Nevada	United States	89128
298	OptumCare Cancer Care at MountainView	Las Vegas	Nevada	United States	89128
299	Urology Specialists of Nevada - Northwest	Las Vegas	Nevada	United States	89128
300	Alliance for Childhood Diseases/Cure 4 the Kids Foundation	Las Vegas	Nevada	United States	89135
301	Comprehensive Cancer Centers of Nevada - Town Center	Las Vegas	Nevada	United States	89144
302	Comprehensive Cancer Centers of Nevada-Summerlin	Las Vegas	Nevada	United States	89144
303	Summerlin Hospital Medical Center	Las Vegas	Nevada	United States	89144
304	Las Vegas Cancer Center-Medical Center	Las Vegas	Nevada	United States	89148-2405
305	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89148
306	OptumCare Cancer Care at Fort Apache	Las Vegas	Nevada	United States	89148
307	Comprehensive Cancer Centers of Nevada - Central Valley	Las Vegas	Nevada	United States	89169
308	University Cancer Center	Las Vegas	Nevada	United States	89169
309	Hope Cancer Care of Nevada-Pahrump	Pahrump	Nevada	United States	89048
310	Renown Regional Medical Center	Reno	Nevada	United States	89502
311	Saint Mary's Regional Medical Center	Reno	Nevada	United States	89503
312	Radiation Oncology Associates	Reno	Nevada	United States	89509
313	Cancer Care Specialists - Reno	Reno	Nevada	United States	89511
314	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
315	Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
316	Morristown Medical Center	Morristown	New Jersey	United States	07960
317	Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital	New Brunswick	New Jersey	United States	08903
318	Newark Beth Israel Medical Center	Newark	New Jersey	United States	07112
319	Saint Joseph's Regional Medical Center	Paterson	New Jersey	United States	07503
320	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
321	Albany Medical Center	Albany	New York	United States	12208
322	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467
323	Maimonides Medical Center	Brooklyn	New York	United States	11219
324	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
325	Glens Falls Hospital	Glens Falls	New York	United States	12801
326	NYU Winthrop Hospital	Mineola	New York	United States	11501
327	The Steven and Alexandra Cohen Children's Medical Center of New York	New Hyde Park	New York	United States	11040
328	Laura and Isaac Perlmutter Cancer Center at NYU Langone	New York	New York	United States	10016
329	Mount Sinai Hospital	New York	New York	United States	10029
330	NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center	New York	New York	United States	10032
331	Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
332	University of Rochester	Rochester	New York	United States	14642
333	Stony Brook University Medical Center	Stony Brook	New York	United States	11794
334	State University of New York Upstate Medical University	Syracuse	New York	United States	13210
335	New York Medical College	Valhalla	New York	United States	10595
336	Westchester Medical Center	Valhalla	New York	United States	10595
337	Mission Hospital	Asheville	North Carolina	United States	28801
338	UNC Lineberger Comprehensive Cancer Center	Chapel Hill	North Carolina	United States	27599
339	Carolinas Medical Center/Levine Cancer Institute	Charlotte	North Carolina	United States	28203
340	Novant Health Presbyterian Medical Center	Charlotte	North Carolina	United States	28204
341	Oncology Specialists of Charlotte	Charlotte	North Carolina	United States	28207
342	Southern Oncology Specialists-Charlotte	Charlotte	North Carolina	United States	28262
343	Southeastern Medical Oncology Center-Clinton	Clinton	North Carolina	United States	28328
344	Duke University Medical Center	Durham	North Carolina	United States	27710
345	Southeastern Medical Oncology Center-Goldsboro	Goldsboro	North Carolina	United States	27534
346	Wayne Memorial Hospital	Goldsboro	North Carolina	United States	27534
347	Novant Health Cancer Institute - Huntersville	Huntersville	North Carolina	United States	28078
348	Southern Oncology Specialists-Huntersville	Huntersville	North Carolina	United States	28078
349	Southeastern Medical Oncology Center-Jacksonville	Jacksonville	North Carolina	United States	28546
350	Matthews Radiation Oncology Center	Matthews	North Carolina	United States	28105
351	Novant Health Cancer Institute - Matthews	Matthews	North Carolina	United States	28105
352	Novant Health Cancer Institute - Mooresville	Mooresville	North Carolina	United States	28117
353	Novant Health Cancer Institute - Rowan	Salisbury	North Carolina	United States	28144
354	Rowan Regional Medical Center	Salisbury	North Carolina	United States	28144
355	Wake Forest University Health Sciences	Winston-Salem	North Carolina	United States	27157
356	Sanford Broadway Medical Center	Fargo	North Dakota	United States	58122
357	Children's Hospital Medical Center of Akron	Akron	Ohio	United States	44308
358	Strecker Cancer Center-Belpre	Belpre	Ohio	United States	45714
359	Adena Regional Medical Center	Chillicothe	Ohio	United States	45601
360	Good Samaritan Hospital - Cincinnati	Cincinnati	Ohio	United States	45220
361	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio	United States	45229
362	Bethesda North Hospital	Cincinnati	Ohio	United States	45242
363	TriHealth Cancer Institute-Westside	Cincinnati	Ohio	United States	45247
364	TriHealth Cancer Institute-Anderson	Cincinnati	Ohio	United States	45255
365	Case Western Reserve University	Cleveland	Ohio	United States	44106
366	Rainbow Babies and Childrens Hospital	Cleveland	Ohio	United States	44106
367	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
368	Nationwide Children's Hospital	Columbus	Ohio	United States	43205
369	Mount Carmel East Hospital	Columbus	Ohio	United States	43213
370	Columbus Oncology and Hematology Associates Inc	Columbus	Ohio	United States	43214
371	Riverside Methodist Hospital	Columbus	Ohio	United States	43214
372	Grant Medical Center	Columbus	Ohio	United States	43215
373	The Mark H Zangmeister Center	Columbus	Ohio	United States	43219
374	Mount Carmel Health Center West	Columbus	Ohio	United States	43222
375	Doctors Hospital	Columbus	Ohio	United States	43228
376	Dayton Children's Hospital	Dayton	Ohio	United States	45404
377	Delaware Health Center-Grady Cancer Center	Delaware	Ohio	United States	43015
378	Grady Memorial Hospital	Delaware	Ohio	United States	43015
379	Columbus Oncology and Hematology Associates	Dublin	Ohio	United States	43016
380	Dublin Methodist Hospital	Dublin	Ohio	United States	43016
381	Mount Carmel Grove City Hospital	Grove City	Ohio	United States	43123
382	Saint Rita's Medical Center	Lima	Ohio	United States	45801
383	OhioHealth Mansfield Hospital	Mansfield	Ohio	United States	44903
384	Marietta Memorial Hospital	Marietta	Ohio	United States	45750
385	OhioHealth Marion General Hospital	Marion	Ohio	United States	43302
386	Knox Community Hospital	Mount Vernon	Ohio	United States	43050
387	Licking Memorial Hospital	Newark	Ohio	United States	43055
388	Mercy Health Perrysburg Cancer Center	Perrysburg	Ohio	United States	43551
389	Southern Ohio Medical Center	Portsmouth	Ohio	United States	45662
390	ProMedica Flower Hospital	Sylvania	Ohio	United States	43560
391	ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital	Toledo	Ohio	United States	43606
392	Saint Vincent Mercy Medical Center	Toledo	Ohio	United States	43608
393	Mercy Health - Saint Anne Hospital	Toledo	Ohio	United States	43623
394	Saint Ann's Hospital	Westerville	Ohio	United States	43081
395	Genesis Healthcare System Cancer Care Center	Zanesville	Ohio	United States	43701
396	Cancer Centers of Southwest Oklahoma Research	Lawton	Oklahoma	United States	73505
397	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
398	Saint Charles Health System	Bend	Oregon	United States	97701
399	Clackamas Radiation Oncology Center	Clackamas	Oregon	United States	97015
400	Providence Cancer Institute Clackamas Clinic	Clackamas	Oregon	United States	97015
401	Bay Area Hospital	Coos Bay	Oregon	United States	97420
402	Rogue Valley Medical Center	Medford	Oregon	United States	97504
403	Providence Newberg Medical Center	Newberg	Oregon	United States	97132
404	Providence Portland Medical Center	Portland	Oregon	United States	97213
405	Providence Saint Vincent Medical Center	Portland	Oregon	United States	97225
406	Legacy Emanuel Children's Hospital	Portland	Oregon	United States	97227
407	Oregon Health and Science University	Portland	Oregon	United States	97239
408	Jefferson Abington Hospital	Abington	Pennsylvania	United States	19001
409	Lehigh Valley Hospital-Cedar Crest	Allentown	Pennsylvania	United States	18103
410	Lehigh Valley Hospital - Muhlenberg	Bethlehem	Pennsylvania	United States	18017
411	Geisinger Medical Center	Danville	Pennsylvania	United States	17822
412	Penn State Children's Hospital	Hershey	Pennsylvania	United States	17033
413	Children's Hospital of Philadelphia	Philadelphia	Pennsylvania	United States	19104
414	Saint Christopher's Hospital for Children	Philadelphia	Pennsylvania	United States	19134
415	UPMC-Magee Womens Hospital	Pittsburgh	Pennsylvania	United States	15213
416	Children's Hospital of Pittsburgh of UPMC	Pittsburgh	Pennsylvania	United States	15224
417	University of Pittsburgh Cancer Institute (UPCI)	Pittsburgh	Pennsylvania	United States	15232
418	UPMC-Passavant Hospital	Pittsburgh	Pennsylvania	United States	15237
419	Asplundh Cancer Pavilion	Willow Grove	Pennsylvania	United States	19090
420	Rhode Island Hospital	Providence	Rhode Island	United States	02903
421	Prisma Health Cancer Institute - Spartanburg	Boiling Springs	South Carolina	United States	29316
422	Medical University of South Carolina	Charleston	South Carolina	United States	29425
423	Prisma Health Richland Hospital	Columbia	South Carolina	United States	29203
424	Gibbs Cancer Center-Gaffney	Gaffney	South Carolina	United States	29341
425	Saint Francis Hospital	Greenville	South Carolina	United States	29601
426	BI-LO Charities Children's Cancer Center	Greenville	South Carolina	United States	29605
427	Prisma Health Cancer Institute - Butternut	Greenville	South Carolina	United States	29605
428	Prisma Health Cancer Institute - Faris	Greenville	South Carolina	United States	29605
429	Prisma Health Greenville Memorial Hospital	Greenville	South Carolina	United States	29605
430	Saint Francis Cancer Center	Greenville	South Carolina	United States	29607
431	Prisma Health Cancer Institute - Eastside	Greenville	South Carolina	United States	29615
432	Prisma Health Cancer Institute - Greer	Greer	South Carolina	United States	29650
433	Gibbs Cancer Center-Pelham	Greer	South Carolina	United States	29651
434	Prisma Health Cancer Institute - Seneca	Seneca	South Carolina	United States	29672
435	North Grove Medical Park	Spartanburg	South Carolina	United States	29303
436	Spartanburg Medical Center	Spartanburg	South Carolina	United States	29303
437	Spartanburg Medical Center - Mary Black Campus	Spartanburg	South Carolina	United States	29307
438	MGC Hematology Oncology-Union	Union	South Carolina	United States	29379
439	Sanford USD Medical Center - Sioux Falls	Sioux Falls	South Dakota	United States	57117-5134
440	T C Thompson Children's Hospital	Chattanooga	Tennessee	United States	37403
441	Memorial Hospital	Chattanooga	Tennessee	United States	37404
442	Pulmonary Medicine Center of Chattanooga-Hixson	Hixson	Tennessee	United States	37343
443	East Tennessee Childrens Hospital	Knoxville	Tennessee	United States	37916
444	Saint Jude Children's Research Hospital	Memphis	Tennessee	United States	38105
445	The Children's Hospital at TriStar Centennial	Nashville	Tennessee	United States	37203
446	Vanderbilt University/Ingram Cancer Center	Nashville	Tennessee	United States	37232
447	Memorial GYN Plus	Ooltewah	Tennessee	United States	37363
448	The Don and Sybil Harrington Cancer Center	Amarillo	Texas	United States	79106
449	Dell Children's Medical Center of Central Texas	Austin	Texas	United States	78723
450	Saint Joseph Regional Cancer Center	Bryan	Texas	United States	77802
451	Driscoll Children's Hospital	Corpus Christi	Texas	United States	78411
452	Medical City Dallas Hospital	Dallas	Texas	United States	75230
453	Parkland Memorial Hospital	Dallas	Texas	United States	75235
454	UT Southwestern/Simmons Cancer Center-Dallas	Dallas	Texas	United States	75390
455	El Paso Children's Hospital	El Paso	Texas	United States	79905
456	Texas Tech University Health Sciences Center-El Paso	El Paso	Texas	United States	79905
457	Cook Children's Medical Center	Fort Worth	Texas	United States	76104
458	Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center	Houston	Texas	United States	77030
459	M D Anderson Cancer Center	Houston	Texas	United States	77030
460	Covenant Children's Hospital	Lubbock	Texas	United States	79410
461	UMC Cancer Center / UMC Health System	Lubbock	Texas	United States	79415
462	Texas Tech University Health Sciences Center-Lubbock	Lubbock	Texas	United States	79430
463	Children's Hospital of San Antonio	San Antonio	Texas	United States	78207
464	Methodist Children's Hospital of South Texas	San Antonio	Texas	United States	78229
465	University Hospital	San Antonio	Texas	United States	78229
466	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78229
467	Scott and White Memorial Hospital	Temple	Texas	United States	76508
468	Primary Children's Hospital	Salt Lake City	Utah	United States	84113
469	Central Vermont Medical Center/National Life Cancer Treatment	Berlin	Vermont	United States	05602
470	University of Vermont Medical Center	Burlington	Vermont	United States	05401
471	University of Vermont and State Agricultural College	Burlington	Vermont	United States	05405
472	Children's Hospital of The King's Daughters	Norfolk	Virginia	United States	23507
473	Naval Medical Center - Portsmouth	Portsmouth	Virginia	United States	23708-2197
474	Virginia Commonwealth University/Massey Cancer Center	Richmond	Virginia	United States	23298
475	Providence Regional Cancer System-Aberdeen	Aberdeen	Washington	United States	98520
476	Overlake Medical Center	Bellevue	Washington	United States	98004
477	PeaceHealth Saint Joseph Medical Center	Bellingham	Washington	United States	98225
478	Harrison HealthPartners Hematology and Oncology-Bremerton	Bremerton	Washington	United States	98310
479	Harrison Medical Center	Bremerton	Washington	United States	98310
480	Highline Medical Center-Main Campus	Burien	Washington	United States	98166
481	Providence Regional Cancer System-Centralia	Centralia	Washington	United States	98531
482	Swedish Cancer Institute-Edmonds	Edmonds	Washington	United States	98026
483	Saint Elizabeth Hospital	Enumclaw	Washington	United States	98022
484	Providence Regional Cancer Partnership	Everett	Washington	United States	98201
485	Saint Francis Hospital	Federal Way	Washington	United States	98003
486	Swedish Cancer Institute-Issaquah	Issaquah	Washington	United States	98029
487	Kadlec Clinic Hematology and Oncology	Kennewick	Washington	United States	99336
488	Providence Regional Cancer System-Lacey	Lacey	Washington	United States	98503
489	Saint Clare Hospital	Lakewood	Washington	United States	98499
490	PeaceHealth Saint John Medical Center	Longview	Washington	United States	98632
491	Harrison HealthPartners Hematology and Oncology-Poulsbo	Poulsbo	Washington	United States	98370
492	Pacific Gynecology Specialists	Seattle	Washington	United States	98104
493	Seattle Children's Hospital	Seattle	Washington	United States	98105
494	Swedish Medical Center-Ballard Campus	Seattle	Washington	United States	98107
495	Kaiser Permanente Washington	Seattle	Washington	United States	98112
496	Swedish Medical Center-First Hill	Seattle	Washington	United States	98122-4307
497	Swedish Medical Center-Cherry Hill	Seattle	Washington	United States	98122-5711
498	Providence Regional Cancer System-Shelton	Shelton	Washington	United States	98584
499	MultiCare Deaconess Cancer and Blood Specialty Center - Valley	Spokane Valley	Washington	United States	99216
500	MultiCare Deaconess Cancer and Blood Specialty Center - Downtown	Spokane	Washington	United States	99204
501	Providence Sacred Heart Medical Center and Children's Hospital	Spokane	Washington	United States	99204
502	MultiCare Deaconess Cancer and Blood Specialty Center - North	Spokane	Washington	United States	99218
503	Franciscan Research Center-Northwest Medical Plaza	Tacoma	Washington	United States	98405
504	Mary Bridge Children's Hospital and Health Center	Tacoma	Washington	United States	98405
505	Northwest Medical Specialties PLLC	Tacoma	Washington	United States	98405
506	Madigan Army Medical Center	Tacoma	Washington	United States	98431
507	PeaceHealth Southwest Medical Center	Vancouver	Washington	United States	98664
508	Providence Saint Mary Regional Cancer Center	Walla Walla	Washington	United States	99362
509	North Star Lodge Cancer Center at Yakima Valley Memorial Hospital	Yakima	Washington	United States	98902
510	Providence Regional Cancer System-Yelm	Yelm	Washington	United States	98597
511	United Hospital Center	Bridgeport	West Virginia	United States	26330
512	West Virginia University Charleston Division	Charleston	West Virginia	United States	25304
513	WVUH-Berkely Medical Center	Martinsburg	West Virginia	United States	25401
514	West Virginia University Healthcare	Morgantown	West Virginia	United States	26506
515	Camden Clark Medical Center	Parkersburg	West Virginia	United States	26101
516	Green Bay Oncology at Saint Vincent Hospital	Green Bay	Wisconsin	United States	54301-3526
517	Saint Vincent Hospital Cancer Center Green Bay	Green Bay	Wisconsin	United States	54301
518	Saint Vincent Hospital Cancer Center at Saint Mary's	Green Bay	Wisconsin	United States	54303
519	UW Cancer Center Johnson Creek	Johnson Creek	Wisconsin	United States	53038
520	University of Wisconsin Carbone Cancer Center	Madison	Wisconsin	United States	53792
521	Holy Family Memorial Hospital	Manitowoc	Wisconsin	United States	54221
522	Saint Vincent Hospital Cancer Center at Marinette	Marinette	Wisconsin	United States	54143
523	Marshfield Medical Center-Marshfield	Marshfield	Wisconsin	United States	54449
524	Children's Hospital of Wisconsin	Milwaukee	Wisconsin	United States	53226
525	Saint Vincent Hospital Cancer Center at Oconto Falls	Oconto Falls	Wisconsin	United States	54154
526	HSHS Saint Nicholas Hospital	Sheboygan	Wisconsin	United States	53081
527	Saint Vincent Hospital Cancer Center at Sturgeon Bay	Sturgeon Bay	Wisconsin	United States	54235-1495
528	John Hunter Children's Hospital	Hunter Regional Mail Centre	New South Wales	Australia	2310
529	Sydney Children's Hospital	Randwick	New South Wales	Australia	2031
530	The Children's Hospital at Westmead	Westmead	New South Wales	Australia	2145
531	Queensland Children's Hospital	South Brisbane	Queensland	Australia	4101
532	Monash Medical Center-Clayton Campus	Clayton	Victoria	Australia	3168
533	Royal Children's Hospital	Parkville	Victoria	Australia	3052
534	Princess Margaret Hospital for Children	Perth	Western Australia	Australia	6008
535	Perth Children's Hospital	Perth	Western Australia	Australia	6009
536	Alberta Children's Hospital	Calgary	Alberta	Canada	T3B 6A8
537	University of Alberta Hospital	Edmonton	Alberta	Canada	T6G 2B7
538	British Columbia Children's Hospital	Vancouver	British Columbia	Canada	V6H 3V4
539	CancerCare Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
540	Janeway Child Health Centre	Saint John's	Newfoundland and Labrador	Canada	A1B 3V6
541	IWK Health Centre	Halifax	Nova Scotia	Canada	B3K 6R8
542	McMaster Children's Hospital at Hamilton Health Sciences	Hamilton	Ontario	Canada	L8N 3Z5
543	Kingston Health Sciences Centre	Kingston	Ontario	Canada	K7L 2V7
544	Children's Hospital	London	Ontario	Canada	N6A 5W9
545	Children's Hospital of Eastern Ontario	Ottawa	Ontario	Canada	K1H 8L1
546	Odette Cancer Centre- Sunnybrook Health Sciences Centre	Toronto	Ontario	Canada	M4N 3M5
547	Hospital for Sick Children	Toronto	Ontario	Canada	M5G 1X8
548	University Health Network-Princess Margaret Hospital	Toronto	Ontario	Canada	M5G 2M9
549	The Montreal Children's Hospital of the MUHC	Montreal	Quebec	Canada	H3H 1P3
550	Centre Hospitalier Universitaire Sainte-Justine	Montreal	Quebec	Canada	H3T 1C5
551	Centre Hospitalier Universitaire de Quebec	Quebec		Canada	G1V 4G2
552	Tohoku University School of Medicine	Sendai	Aoba-ku	Japan	980-8574
553	Niigata Cancer Centre	Niigata	Chuo-ku	Japan	951-8566
554	Kyushu Univeristy	Higashi-ku	Fukuoka	Japan	812-8581
555	Hyogo Prefectural Kobe Children's Hospital	Kobe	Hyogo	Japan	650-0047
556	University of Tsukuba Hospital	Tsukuba	Ibaraki	Japan	305-8576
557	Kanagawa Children's Medical Center	Yokohama	Kanagawa	Japan	232-8555
558	Saitama Children's Medical Center	Chuo-ku	Saitama	Japan	330-8777
559	Keio University	Shinjuku-ku	Tokyo	Japan	160-8582
560	Hiroshima University Hospital	Hiroshima City		Japan	734-8551
561	Kyoto Perfectural University of Medicine	Kyoto		Japan	602-8566
562	Hyogo College of Medicine	Nishinomiya, Hyogo		Japan	663-8501
563	Osaka City General Hospital	Osaka City		Japan	534-0021
564	Saitama Medical University International Medical Center	Saitama		Japan	350-1298
565	Kokuritsu Seiiku Medical Research Center Hospital	Tokyo		Japan	157-8535
566	Starship Children's Hospital	Grafton	Auckland	New Zealand	1145
567	Christchurch Hospital	Christchurch		New Zealand	8011
568	HIMA San Pablo Oncologic Hospital	Caguas		Puerto Rico	00726
569	San Jorge Children's Hospital	San Juan		Puerto Rico	00912
570	King Faisal Specialist Hospital and Research Centre	Riyadh		Saudi Arabia	11211