Study of Kidney Tumors in Younger Patients

Sponsor

Children's Oncology Group (Other)

Overall Status

Recruiting

CT.gov ID

NCT00898365

Collaborator

National Cancer Institute (NCI) (NIH)

5,000

Enrollment

248

Locations

20.2

Patients Per Site

Study Details

Study Description

Brief Summary

This research trial studies kidney tumors in younger patients. Collecting and storing samples of tumor tissue, blood, and urine from patients with cancer to study in the laboratory may help doctors learn more about changes that occur in deoxyribonucleic acid (DNA) and identify biomarkers related to cancer.

Condition or Disease	Intervention/Treatment	Phase
Adult Cystic Nephroma Anaplastic Kidney Wilms Tumor Angiolipoma Cellular Congenital Mesoblastic Nephroma Classic Congenital Mesoblastic Nephroma Clear Cell Sarcoma of the Kidney Congenital Mesoblastic Nephroma Cystic Partially Differentiated Kidney Nephroblastoma Diffuse Hyperplastic Perilobar Nephroblastomatosis Extrarenal Rhabdoid Tumor Kidney Medullary Carcinoma Kidney Neoplasm Kidney Oncocytoma Kidney Wilms Tumor Metanephric Adenofibroma Metanephric Adenoma Metanephric Stromal Tumor Metanephric Tumor Mixed Congenital Mesoblastic Nephroma Ossifying Renal Tumor of Infancy Papillary Renal Cell Carcinoma Renal Cell Carcinoma Renal Cell Carcinoma Associated With Xp11.2 Translocations/TFE3 Gene Fusions Rhabdoid Tumor of the Kidney Wilms Tumor	Other: Cytology Specimen Collection Procedure Other: Laboratory Biomarker Analysis

Detailed Description

PRIMARY OBJECTIVES:

Classify patients with renal tumors by histological categorization, surgico-pathological stage, presence of metastases, age at diagnosis, tumor weight, and loss of heterozygosity for chromosomes 1p and 16q, to define eligibility for a series of therapeutic studies. (Loss of heterozygosity [LOH] testing discontinued as of April 2014)
Maintain a biological samples bank to make specimens available to scientists to evaluate additional potential biological prognostic variables and for the conduct of other research by scientists.

SECONDARY OBJECTIVES:

Monitor outcome for those patients who are not eligible for a subsequent therapeutic study including patients initially classified as Low Risk, defined as those with favorable histology Wilms tumor Stage I (> 2 years old or tumor weight > 550 g) or Stage II whose final risk classification is Low Risk and whose tumors do not have LOH 1p and 16q.
Describe whether the pulmonary tumor burden correlates with outcome in stage IV patients. (Completed as of Amendment 7)
Describe the sensitivity and specificity of abdominal computed tomography (CT) by comparison with surgical and pathologic findings for identification of local tumor spread beyond the renal capsule to adjacent muscle and organs, lymph node involvement at the renal hilum and in the retroperitoneum, preoperative tumor rupture, and metastases to the liver. (Completed as of Amendment 7)
Compare the sensitivity and specificity of pre-operative abdominal CT scan and magnetic resonance imaging (MRI) for the identification and differentiation of nephrogenic rests and Wilms' tumor in children with multiple renal lesions. (Completed as of Amendment 7)
Correlate the method of conception (natural vs assisted reproductive technology) with the development of Wilms' tumor. (Completed as of Amendment 7)
To evaluate the frequency of integrase interactor 1 (INI1) mutations in renal and extrarenal malignant rhabdoid tumor of the kidney and to determine the incidence of germline and inherited versus somatic mutations to facilitate clinical correlations on the companion study AREN0321. (INI1 testing discontinued as of April 2014) (Completed as of Amendment 7)

OUTLINE:

Tumor tissue, blood, and urine samples are collected for research studies, including immunohistochemistry. CT scans and MRIs are also performed. Loss of heterozygosity analyses (chromosome 1p and 16q) are performed by extraction of DNA. DNA polymorphisms are assayed by polymerase chain reaction using standard methodology. Leftover specimens are archived for future studies. (LOH and INI1 testing discontinued as of April 2014)

Patients are followed up periodically for 5 years.

Study Design

Study Type:

Observational

Anticipated Enrollment :

5000 participants

Observational Model:

Case-Only

Time Perspective:

Prospective

Official Title:

Renal Tumors Classification, Biology, and Banking Study

Actual Study Start Date :

Feb 27, 2006

Anticipated Primary Completion Date :

Jan 1, 2100

Arms and Interventions

Arm	Intervention/Treatment
Ancillary-correlative (renal tumor classification, biology) Tumor tissue, blood, and urine samples are collected for research studies, including immunohistochemistry. CT scans and MRIs are also performed. Loss of heterozygosity analyses (chromosome 1p and 16q) are performed by extraction of DNA. DNA polymorphisms are assayed by polymerase chain reaction using standard methodology. Leftover specimens are archived for future studies. (LOH and INI1 testing discontinued as of April 2014)	Other: Cytology Specimen Collection Procedure Correlative studies Other Names: Cytologic Sampling Other: Laboratory Biomarker Analysis Correlative studies

Arm

Intervention/Treatment

Ancillary-correlative (renal tumor classification, biology)

Other: Cytology Specimen Collection Procedure

Correlative studies

Other Names:

Cytologic Sampling

Other: Laboratory Biomarker Analysis

Correlative studies

Outcome Measures

Primary Outcome Measures

Event-free survival [Up to 5 years from study enrollment]
Time from diagnosis to the earliest occurrence of disease progression (if enrolling with measurable disease), first relapse (if enrolling without measurable disease), secondary malignancy, or death. Analysis plans are specific to individual COG-approved projects and biology protocols.
Overall survival [Up to 5 years from study enrollment]
Time from diagnosis to death. Analysis plans are specific to individual COG-approved projects and biology protocols.

Secondary Outcome Measures

Loss of heterozygosity (LOH testing discontinued as of April 2014) [Baseline]
Evaluation of LOH (1p and 16q) status was performed in select patients with newly diagnosed favorable histology Wilms Tumor during the time that AREN0532 and AREN0533 were open to enrollment, in order to direct patients to the appropriate therapeutic protocol and study arm as well as validate the markers' prognostic value.

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A to 29 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Patients with the first occurrence of any tumor of the kidney identified on CT scan or MRI are eligible for this study; histologic diagnosis is not required prior to enrollment but is required for all patients once on study
Eligible tumors include (but are not limited to):
Nephroblastic tumors
Nephroblastoma (Wilms' tumor) (favorable histology, anaplasia [diffuse, focal])
Nephrogenic rests and nephroblastomatosis
Cystic nephroma and cystic partially differentiated nephroblastoma
Metanephric tumors (metanephric adenoma, metanephric adenofibroma, metanephric stromal tumor)
Mesoblastic nephroma (cellular, classic, mixed)
Clear cell sarcoma
Rhabdoid tumor (any malignant rhabdoid tumor occurring outside the central nervous system [CNS])
Renal epithelioid tumors of childhood (papillary renal cell carcinoma, medullary renal cell carcinoma, renal tumors associated with Xp11.2 translocations, oncocytic renal neoplasms after neuroblastoma)
Angiolipoma
Ossifying renal tumor of infancy
Patients with the first occurrence of the following tumors are also eligible:
Extrarenal nephroblastoma or extrarenal neprogenic rests
Malignant rhabdoid tumor occurring anywhere outside the central nervous system
Required specimens, reports, forms, and copies of imaging studies must be available or will become available for submission and the institution must intend on submitting them as described in the protocol procedures
For ALL patients, (with exception of bilateral, bilaterally predisposed, multicentric, or unilateral tumor in solitary kidney planning to enroll without biopsy***), the following submissions are required:
A complete set of recut hematoxylin and eosin (H & E) slides (including from sampled lymph nodes, if patient had upfront nephrectomy)
- Tissue must be from diagnosis, prior to any renal tumor directed chemotherapy or radiation (only exception is for presumed favorable histology Wilms tumor [FHWT] patients discovered to have diffuse anaplastic Wilms tumor [DAWT] at delayed nephrectomy and plan to enroll at delayed nephrectomy)
Representative formalin-fixed paraffin-embedded tissue block or if a block is unavailable, 10 unstained slides from a representative block of tumor, if available.
Tissue must be from diagnosis, prior to any renal tumor directed chemotherapy or radiation (only exception is for presumed FHWT patients discovered to have DAWT at delayed nephrectomy and plan to enroll at delayed nephrectomy)
Institutional pathology report, Specimen Transmittal Form, and Pre-Treatment Pathology Checklist
Copies of images and institutional reports of CT and/or MRI abdomen and pelvis, and Pre Treatment Imaging Checklist
Copies of images and institutional report of chest CT for all malignant tumors
Institutional surgical report(s) and Pre-Treatment Surgical Checklist
CRFs: Staging Checklist and Metastatic Disease Form (if metastatic disease is noted on imaging)
Patients with bilateral, bilaterally predisposed, multicentric, or unilateral tumor in solitary kidney planning to enroll without biopsy via imaging only - these patients will not have central review or have a risk assignment issued, but may contribute to specimen banking for future research. However, if biopsy is done, tissue must be submitted as for other renal tumors, and initial risk assignment will require pathology and surgical rapid central reviews. The Specimen Transmittal Form and Pre Treatment Pathology Checklist are also needed.
Please note: if the above required items are not received within 120 days of study enrollment, the patient will be considered off study
All patients and/or their parents or legal guardians must sign a written informed consent
All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Children's Hospital of Alabama	Birmingham	Alabama	United States	35233
2	University of Alabama at Birmingham Cancer Center	Birmingham	Alabama	United States	35233
3	USA Health Strada Patient Care Center	Mobile	Alabama	United States	36604
4	Providence Alaska Medical Center	Anchorage	Alaska	United States	99508
5	Phoenix Childrens Hospital	Phoenix	Arizona	United States	85016
6	Banner University Medical Center - Tucson	Tucson	Arizona	United States	85719
7	Arkansas Children's Hospital	Little Rock	Arkansas	United States	72202-3591
8	University of Arkansas for Medical Sciences	Little Rock	Arkansas	United States	72205
9	Kaiser Permanente Downey Medical Center	Downey	California	United States	90242
10	City of Hope Comprehensive Cancer Center	Duarte	California	United States	91010
11	Loma Linda University Medical Center	Loma Linda	California	United States	92354
12	Miller Children's and Women's Hospital Long Beach	Long Beach	California	United States	90806
13	Children's Hospital Los Angeles	Los Angeles	California	United States	90027
14	Cedars Sinai Medical Center	Los Angeles	California	United States	90048
15	Mattel Children's Hospital UCLA	Los Angeles	California	United States	90095
16	Valley Children's Hospital	Madera	California	United States	93636
17	Children's Hospital and Research Center at Oakland	Oakland	California	United States	94609-1809
18	Kaiser Permanente-Oakland	Oakland	California	United States	94611
19	Children's Hospital of Orange County	Orange	California	United States	92868
20	Lucile Packard Children's Hospital Stanford University	Palo Alto	California	United States	94304
21	Sutter Medical Center Sacramento	Sacramento	California	United States	95816
22	University of California Davis Comprehensive Cancer Center	Sacramento	California	United States	95817
23	Rady Children's Hospital - San Diego	San Diego	California	United States	92123
24	Naval Medical Center -San Diego	San Diego	California	United States	92134
25	UCSF Medical Center-Parnassus	San Francisco	California	United States	94143
26	UCSF Medical Center-Mission Bay	San Francisco	California	United States	94158
27	Santa Barbara Cottage Hospital	Santa Barbara	California	United States	93102
28	Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center	Torrance	California	United States	90502
29	Children's Hospital Colorado	Aurora	Colorado	United States	80045
30	Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center	Denver	Colorado	United States	80218
31	Connecticut Children's Medical Center	Hartford	Connecticut	United States	06106
32	Yale University	New Haven	Connecticut	United States	06520
33	Alfred I duPont Hospital for Children	Wilmington	Delaware	United States	19803
34	MedStar Georgetown University Hospital	Washington	District of Columbia	United States	20007
35	Children's National Medical Center	Washington	District of Columbia	United States	20010
36	Broward Health Medical Center	Fort Lauderdale	Florida	United States	33316
37	Lee Memorial Health System	Fort Myers	Florida	United States	33901
38	Golisano Children's Hospital of Southwest Florida	Fort Myers	Florida	United States	33908
39	University of Florida Health Science Center - Gainesville	Gainesville	Florida	United States	32610
40	Memorial Regional Hospital/Joe DiMaggio Children's Hospital	Hollywood	Florida	United States	33021
41	Nemours Children's Clinic-Jacksonville	Jacksonville	Florida	United States	32207
42	University of Miami Miller School of Medicine-Sylvester Cancer Center	Miami	Florida	United States	33136
43	Nicklaus Children's Hospital	Miami	Florida	United States	33155
44	Miami Cancer Institute	Miami	Florida	United States	33176
45	AdventHealth Orlando	Orlando	Florida	United States	32803
46	Arnold Palmer Hospital for Children	Orlando	Florida	United States	32806
47	Nemours Children's Clinic - Orlando	Orlando	Florida	United States	32806
48	UF Cancer Center at Orlando Health	Orlando	Florida	United States	32806
49	Nemours Children's Hospital	Orlando	Florida	United States	32827
50	Nemours Children's Clinic - Pensacola	Pensacola	Florida	United States	32504
51	Johns Hopkins All Children's Hospital	Saint Petersburg	Florida	United States	33701
52	Tampa General Hospital	Tampa	Florida	United States	33606
53	Saint Joseph's Hospital/Children's Hospital-Tampa	Tampa	Florida	United States	33607
54	Saint Mary's Hospital	West Palm Beach	Florida	United States	33407
55	Children's Healthcare of Atlanta - Egleston	Atlanta	Georgia	United States	30322
56	Augusta University Medical Center	Augusta	Georgia	United States	30912
57	Medical Center of Central Georgia	Macon	Georgia	United States	31201
58	Memorial Health University Medical Center	Savannah	Georgia	United States	31404
59	University of Hawaii Cancer Center	Honolulu	Hawaii	United States	96813
60	Kapiolani Medical Center for Women and Children	Honolulu	Hawaii	United States	96826
61	Tripler Army Medical Center	Honolulu	Hawaii	United States	96859
62	Saint Luke's Mountain States Tumor Institute	Boise	Idaho	United States	83712
63	Lurie Children's Hospital-Chicago	Chicago	Illinois	United States	60611
64	University of Illinois	Chicago	Illinois	United States	60612
65	University of Chicago Comprehensive Cancer Center	Chicago	Illinois	United States	60637
66	Loyola University Medical Center	Maywood	Illinois	United States	60153
67	Advocate Children's Hospital-Oak Lawn	Oak Lawn	Illinois	United States	60453
68	Advocate Children's Hospital-Park Ridge	Park Ridge	Illinois	United States	60068
69	Advocate Lutheran General Hospital	Park Ridge	Illinois	United States	60068
70	Saint Jude Midwest Affiliate	Peoria	Illinois	United States	61637
71	Southern Illinois University School of Medicine	Springfield	Illinois	United States	62702
72	Riley Hospital for Children	Indianapolis	Indiana	United States	46202
73	Saint Vincent Hospital and Health Care Center	Indianapolis	Indiana	United States	46260
74	Blank Children's Hospital	Des Moines	Iowa	United States	50309
75	University of Iowa/Holden Comprehensive Cancer Center	Iowa City	Iowa	United States	52242
76	University of Kansas Cancer Center	Kansas City	Kansas	United States	66160
77	University of Kentucky/Markey Cancer Center	Lexington	Kentucky	United States	40536
78	Norton Children's Hospital	Louisville	Kentucky	United States	40202
79	Tulane University Health Sciences Center	New Orleans	Louisiana	United States	70112
80	Children's Hospital New Orleans	New Orleans	Louisiana	United States	70118
81	Ochsner Medical Center Jefferson	New Orleans	Louisiana	United States	70121
82	Eastern Maine Medical Center	Bangor	Maine	United States	04401
83	Maine Children's Cancer Program	Scarborough	Maine	United States	04074
84	University of Maryland/Greenebaum Cancer Center	Baltimore	Maryland	United States	21201
85	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21215
86	Johns Hopkins University/Sidney Kimmel Cancer Center	Baltimore	Maryland	United States	21287
87	Walter Reed National Military Medical Center	Bethesda	Maryland	United States	20889-5600
88	Floating Hospital for Children at Tufts Medical Center	Boston	Massachusetts	United States	02111
89	Massachusetts General Hospital Cancer Center	Boston	Massachusetts	United States	02114
90	Dana-Farber Cancer Institute	Boston	Massachusetts	United States	02215
91	Baystate Medical Center	Springfield	Massachusetts	United States	01199
92	UMass Memorial Medical Center - University Campus	Worcester	Massachusetts	United States	01655
93	C S Mott Children's Hospital	Ann Arbor	Michigan	United States	48109
94	Wayne State University/Karmanos Cancer Institute	Detroit	Michigan	United States	48201
95	Ascension Saint John Hospital	Detroit	Michigan	United States	48236
96	Michigan State University Clinical Center	East Lansing	Michigan	United States	48824-7016
97	Hurley Medical Center	Flint	Michigan	United States	48503
98	Helen DeVos Children's Hospital at Spectrum Health	Grand Rapids	Michigan	United States	49503
99	Bronson Methodist Hospital	Kalamazoo	Michigan	United States	49007
100	Kalamazoo Center for Medical Studies	Kalamazoo	Michigan	United States	49008
101	Beaumont Children's Hospital-Royal Oak	Royal Oak	Michigan	United States	48073
102	William Beaumont Hospital-Royal Oak	Royal Oak	Michigan	United States	48073
103	Children's Hospitals and Clinics of Minnesota - Minneapolis	Minneapolis	Minnesota	United States	55404
104	University of Minnesota/Masonic Cancer Center	Minneapolis	Minnesota	United States	55455
105	Mayo Clinic in Rochester	Rochester	Minnesota	United States	55905
106	University of Mississippi Medical Center	Jackson	Mississippi	United States	39216
107	Columbia Regional	Columbia	Missouri	United States	65201
108	Children's Mercy Hospitals and Clinics	Kansas City	Missouri	United States	64108
109	Cardinal Glennon Children's Medical Center	Saint Louis	Missouri	United States	63104
110	Washington University School of Medicine	Saint Louis	Missouri	United States	63110
111	Mercy Hospital Saint Louis	Saint Louis	Missouri	United States	63141
112	Children's Hospital and Medical Center of Omaha	Omaha	Nebraska	United States	68114
113	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198
114	University Medical Center of Southern Nevada	Las Vegas	Nevada	United States	89102
115	Sunrise Hospital and Medical Center	Las Vegas	Nevada	United States	89109
116	Alliance for Childhood Diseases/Cure 4 the Kids Foundation	Las Vegas	Nevada	United States	89135
117	Summerlin Hospital Medical Center	Las Vegas	Nevada	United States	89144
118	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
119	Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
120	Saint Barnabas Medical Center	Livingston	New Jersey	United States	07039
121	Morristown Medical Center	Morristown	New Jersey	United States	07960
122	Saint Peter's University Hospital	New Brunswick	New Jersey	United States	08901
123	Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital	New Brunswick	New Jersey	United States	08903
124	Newark Beth Israel Medical Center	Newark	New Jersey	United States	07112
125	Saint Joseph's Regional Medical Center	Paterson	New Jersey	United States	07503
126	Overlook Hospital	Summit	New Jersey	United States	07902
127	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87102
128	Albany Medical Center	Albany	New York	United States	12208
129	Montefiore Medical Center - Moses Campus	Bronx	New York	United States	10467
130	Brooklyn Hospital Center	Brooklyn	New York	United States	11201
131	Roswell Park Cancer Institute	Buffalo	New York	United States	14263
132	NYU Winthrop Hospital	Mineola	New York	United States	11501
133	The Steven and Alexandra Cohen Children's Medical Center of New York	New Hyde Park	New York	United States	11040
134	Laura and Isaac Perlmutter Cancer Center at NYU Langone	New York	New York	United States	10016
135	Mount Sinai Hospital	New York	New York	United States	10029
136	NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center	New York	New York	United States	10032
137	Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
138	NYP/Weill Cornell Medical Center	New York	New York	United States	10065
139	University of Rochester	Rochester	New York	United States	14642
140	Stony Brook University Medical Center	Stony Brook	New York	United States	11794
141	State University of New York Upstate Medical University	Syracuse	New York	United States	13210
142	New York Medical College	Valhalla	New York	United States	10595
143	Mission Hospital	Asheville	North Carolina	United States	28801
144	UNC Lineberger Comprehensive Cancer Center	Chapel Hill	North Carolina	United States	27599
145	Carolinas Medical Center/Levine Cancer Institute	Charlotte	North Carolina	United States	28203
146	Novant Health Presbyterian Medical Center	Charlotte	North Carolina	United States	28204
147	Duke University Medical Center	Durham	North Carolina	United States	27710
148	East Carolina University	Greenville	North Carolina	United States	27834
149	Wake Forest University Health Sciences	Winston-Salem	North Carolina	United States	27157
150	Sanford Broadway Medical Center	Fargo	North Dakota	United States	58122
151	Children's Hospital Medical Center of Akron	Akron	Ohio	United States	44308
152	Cincinnati Children's Hospital Medical Center	Cincinnati	Ohio	United States	45229
153	Rainbow Babies and Childrens Hospital	Cleveland	Ohio	United States	44106
154	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
155	Nationwide Children's Hospital	Columbus	Ohio	United States	43205
156	Dayton Children's Hospital	Dayton	Ohio	United States	45404
157	ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital	Toledo	Ohio	United States	43606
158	Mercy Children's Hospital	Toledo	Ohio	United States	43608
159	University of Oklahoma Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
160	Natalie Warren Bryant Cancer Center at Saint Francis	Tulsa	Oklahoma	United States	74136
161	Legacy Emanuel Children's Hospital	Portland	Oregon	United States	97227
162	Legacy Emanuel Hospital and Health Center	Portland	Oregon	United States	97227
163	Oregon Health and Science University	Portland	Oregon	United States	97239
164	Lehigh Valley Hospital-Cedar Crest	Allentown	Pennsylvania	United States	18103
165	Lehigh Valley Hospital - Muhlenberg	Bethlehem	Pennsylvania	United States	18017
166	Geisinger Medical Center	Danville	Pennsylvania	United States	17822
167	Penn State Children's Hospital	Hershey	Pennsylvania	United States	17033
168	Children's Hospital of Philadelphia	Philadelphia	Pennsylvania	United States	19104
169	Saint Christopher's Hospital for Children	Philadelphia	Pennsylvania	United States	19134
170	Children's Hospital of Pittsburgh of UPMC	Pittsburgh	Pennsylvania	United States	15224
171	Rhode Island Hospital	Providence	Rhode Island	United States	02903
172	Medical University of South Carolina	Charleston	South Carolina	United States	29425
173	Prisma Health Richland Hospital	Columbia	South Carolina	United States	29203
174	BI-LO Charities Children's Cancer Center	Greenville	South Carolina	United States	29605
175	Greenville Cancer Treatment Center	Greenville	South Carolina	United States	29605
176	Sanford USD Medical Center - Sioux Falls	Sioux Falls	South Dakota	United States	57117-5134
177	T C Thompson Children's Hospital	Chattanooga	Tennessee	United States	37403
178	East Tennessee Childrens Hospital	Knoxville	Tennessee	United States	37916
179	Saint Jude Children's Research Hospital	Memphis	Tennessee	United States	38105
180	The Children's Hospital at TriStar Centennial	Nashville	Tennessee	United States	37203
181	Vanderbilt University/Ingram Cancer Center	Nashville	Tennessee	United States	37232
182	Texas Tech University Health Sciences Center-Amarillo	Amarillo	Texas	United States	79106
183	Dell Children's Medical Center of Central Texas	Austin	Texas	United States	78723
184	Driscoll Children's Hospital	Corpus Christi	Texas	United States	78411
185	Medical City Dallas Hospital	Dallas	Texas	United States	75230
186	UT Southwestern/Simmons Cancer Center-Dallas	Dallas	Texas	United States	75390
187	Brooke Army Medical Center	Fort Sam Houston	Texas	United States	78234
188	Cook Children's Medical Center	Fort Worth	Texas	United States	76104
189	Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center	Houston	Texas	United States	77030
190	M D Anderson Cancer Center	Houston	Texas	United States	77030
191	Covenant Children's Hospital	Lubbock	Texas	United States	79410
192	UMC Cancer Center / UMC Health System	Lubbock	Texas	United States	79415
193	Children's Hospital of San Antonio	San Antonio	Texas	United States	78207
194	Methodist Children's Hospital of South Texas	San Antonio	Texas	United States	78229
195	University of Texas Health Science Center at San Antonio	San Antonio	Texas	United States	78229
196	Scott and White Memorial Hospital	Temple	Texas	United States	76508
197	Primary Children's Hospital	Salt Lake City	Utah	United States	84113
198	University of Vermont and State Agricultural College	Burlington	Vermont	United States	05405
199	University of Virginia Cancer Center	Charlottesville	Virginia	United States	22908
200	Inova Fairfax Hospital	Falls Church	Virginia	United States	22042
201	Children's Hospital of The King's Daughters	Norfolk	Virginia	United States	23507
202	Naval Medical Center - Portsmouth	Portsmouth	Virginia	United States	23708-2197
203	Virginia Commonwealth University/Massey Cancer Center	Richmond	Virginia	United States	23298
204	Carilion Children's	Roanoke	Virginia	United States	24014
205	Seattle Children's Hospital	Seattle	Washington	United States	98105
206	Providence Sacred Heart Medical Center and Children's Hospital	Spokane	Washington	United States	99204
207	Mary Bridge Children's Hospital and Health Center	Tacoma	Washington	United States	98405
208	Madigan Army Medical Center	Tacoma	Washington	United States	98431
209	West Virginia University Charleston Division	Charleston	West Virginia	United States	25304
210	Cabell-Huntington Hospital	Huntington	West Virginia	United States	25701
211	Saint Vincent Hospital Cancer Center Green Bay	Green Bay	Wisconsin	United States	54301
212	University of Wisconsin Hospital and Clinics	Madison	Wisconsin	United States	53792
213	Marshfield Medical Center-Marshfield	Marshfield	Wisconsin	United States	54449
214	Children's Hospital of Wisconsin	Milwaukee	Wisconsin	United States	53226
215	John Hunter Children's Hospital	Hunter Regional Mail Centre	New South Wales	Australia	2310
216	Sydney Children's Hospital	Randwick	New South Wales	Australia	2031
217	The Children's Hospital at Westmead	Westmead	New South Wales	Australia	2145
218	Royal Brisbane and Women's Hospital	Herston	Queensland	Australia	4029
219	Royal Children's Hospital-Brisbane	Herston	Queensland	Australia	4029
220	Queensland Children's Hospital	South Brisbane	Queensland	Australia	4101
221	Women's and Children's Hospital-Adelaide	North Adelaide	South Australia	Australia	5006
222	Monash Medical Center-Clayton Campus	Clayton	Victoria	Australia	3168
223	Royal Children's Hospital	Parkville	Victoria	Australia	3052
224	Princess Margaret Hospital for Children	Perth	Western Australia	Australia	6008
225	Perth Children's Hospital	Perth	Western Australia	Australia	6009
226	Alberta Children's Hospital	Calgary	Alberta	Canada	T3B 6A8
227	University of Alberta Hospital	Edmonton	Alberta	Canada	T6G 2B7
228	British Columbia Children's Hospital	Vancouver	British Columbia	Canada	V6H 3V4
229	CancerCare Manitoba	Winnipeg	Manitoba	Canada	R3E 0V9
230	Janeway Child Health Centre	Saint John's	Newfoundland and Labrador	Canada	A1B 3V6
231	IWK Health Centre	Halifax	Nova Scotia	Canada	B3K 6R8
232	McMaster Children's Hospital at Hamilton Health Sciences	Hamilton	Ontario	Canada	L8N 3Z5
233	Kingston Health Sciences Centre	Kingston	Ontario	Canada	K7L 2V7
234	Children's Hospital	London	Ontario	Canada	N6A 5W9
235	Children's Hospital of Eastern Ontario	Ottawa	Ontario	Canada	K1H 8L1
236	Hospital for Sick Children	Toronto	Ontario	Canada	M5G 1X8
237	The Montreal Children's Hospital of the MUHC	Montreal	Quebec	Canada	H3H 1P3
238	Centre Hospitalier Universitaire Sainte-Justine	Montreal	Quebec	Canada	H3T 1C5
239	Allan Blair Cancer Centre	Regina	Saskatchewan	Canada	S4T 7T1
240	Saskatoon Cancer Centre	Saskatoon	Saskatchewan	Canada	S7N 4H4
241	Centre Hospitalier Universitaire de Quebec	Quebec		Canada	G1V 4G2
242	Schneider Children's Medical Center of Israel	Petah Tikua		Israel	49202
243	Starship Children's Hospital	Grafton	Auckland	New Zealand	1145
244	Christchurch Hospital	Christchurch		New Zealand	8011
245	Wellington Children's Hospital	Wellington		New Zealand	6002
246	San Jorge Children's Hospital	San Juan		Puerto Rico	00912
247	University Pediatric Hospital	San Juan		Puerto Rico	00926
248	Swiss Pediatric Oncology Group - Bern	Bern		Switzerland	3010