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Brief Title: Higher Per Daily Treatment-Dose Radiation Therapy or Standard Per Daily Treatment Radiation Therapy in Treating Patients With Early-Stage Breast Cancer That Was Removed by Surgery
Official Title: A Phase III Trial of Accelerated Whole Breast Irradiation With Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer
Study ID: NCT01349322
Brief Summary: RATIONALE: It is not yet know whether higher per daily radiation therapy is equally as effective as standard per daily radiation therapy in treating breast cancer. PURPOSE: This randomized phase III trial studies how well an accelerated course of higher per daily radiation therapy with concomitant boost works compared to standard per daily radiation therapy with a sequential boost in treating patients with early-stage breast cancer that was removed by surgery.
Detailed Description: OBJECTIVES: Primary * To determine whether an accelerated course of hypofractionated whole-breast irradiation (WBI) including a concomitant boost to the tumor bed in 15 fractions following lumpectomy will prove to be non-inferior in local control to a regimen of standard WBI with a sequential boost following lumpectomy for early-stage breast cancer patients. Secondary * To determine whether breast-related symptoms and cosmesis from accelerated WBI that is hypofractionated (in only 3 weeks) with a concomitant boost is non-inferior to standard WBI with sequential boost. * To determine whether the risk of late cardiac toxicity in patients with left-sided breast cancer treated with hypofractionation will be non-inferior to conventional fractionated radiation therapy (RT) based upon analysis of radiation dosimetry from CT-based treatment planning and normal tissue complication probability (NTCP) calculations. * To determine whether CT-based conformal methods intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for WBI are feasible in a multi-institutional setting following lumpectomy in early-stage breast cancer patients and whether dose-volume analyses can be established to assess treatment adequacy and likelihood of toxicity. * To determine that cosmetic results and breast-related symptoms 3 years after hypofractionated breast radiation with concomitant boost will not be inferior to that obtained 3 years after WBI with sequential boost. * To determine whether future correlative studies can identify individual gene expressions and biological host factors associated with toxicity and/or local recurrence from standard and hypofractionated WBI. * If shown to be non-inferior, to then determine if accelerated course of hypofractionated WBI including a concomitant boost to the tumor bed in 15 fractions following lumpectomy will prove to be superior in local control to a regimen of standard WBI with a sequential boost following lumpectomy for early-stage breast cancer patients. * To determine whether treatment costs for hypofractionated WBI with concomitant boost are not higher than WBI with sequential boost. OUTLINE: This is a multicenter study. Patients are stratified according to age (\< 50 vs. ≥ 50 years), prior chemotherapy (yes vs. no), estrogen-receptor status (+ vs. -), and histology grade (1-2 vs. 3). Patients are randomized to 1 of 2 treatment arms. Treatment begins within 9 weeks of last surgery or chemotherapy delivery. After completion of study therapy, patients are followed at 1 month, at 6 months, and then yearly.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: FEMALE
Healthy Volunteers: No
University of Alabama at Birmingham Cancer Center, Birmingham, Alabama, United States
The Kirklin Clinic at Acton Road, Birmingham, Alabama, United States
21st Century Oncology-Scottsdale, Scottsdale, Arizona, United States
Mayo Clinic in Arizona, Scottsdale, Arizona, United States
Arizona Oncology Associates-West Orange Grove, Tucson, Arizona, United States
Banner University Medical Center - Tucson, Tucson, Arizona, United States
CHI Saint Vincent Cancer Center Hot Springs, Hot Springs, Arkansas, United States
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn, Auburn, California, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park, Cameron Park, California, United States
Mercy San Juan Medical Center, Carmichael, California, United States
Enloe Medical Center, Chico, California, United States
City of Hope Comprehensive Cancer Center, Duarte, California, United States
Epic Care-Dublin, Dublin, California, United States
21st Century Oncology - El Segundo, El Segundo, California, United States
UC San Diego Moores Cancer Center, La Jolla, California, United States
Los Angeles County-USC Medical Center, Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center, Los Angeles, California, United States
Cedars Sinai Medical Center, Los Angeles, California, United States
UCLA / Jonsson Comprehensive Cancer Center, Los Angeles, California, United States
Kaiser Permanente Oakland-Broadway, Oakland, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center, Rancho Cordova, California, United States
Rohnert Park Cancer Center, Rohnert Park, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville, Roseville, California, United States
The Permanente Medical Group-Roseville Radiation Oncology, Roseville, California, United States
Sutter Medical Center Sacramento, Sacramento, California, United States
University of California Davis Comprehensive Cancer Center, Sacramento, California, United States
South Sacramento Cancer Center, Sacramento, California, United States
Santa Clara Valley Medical Center, San Jose, California, United States
Kaiser Permanente Medical Center - Santa Clara, Santa Clara, California, United States
City of Hope South Pasadena, South Pasadena, California, United States
Kaiser Permanente Cancer Treatment Center, South San Francisco, California, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville, Vacaville, California, United States
University of Colorado Hospital, Aurora, Colorado, United States
Penrose-Saint Francis Healthcare, Colorado Springs, Colorado, United States
Porter Adventist Hospital, Denver, Colorado, United States
Shaw Cancer Center, Edwards, Colorado, United States
McKee Medical Center, Loveland, Colorado, United States
Hartford Hospital, Hartford, Connecticut, United States
MedStar Washington Hospital Center, Washington, District of Columbia, United States
John Fitzgerald Kennedy Medical Center, Atlantis, Florida, United States
Florida Hospital Memorial Medical Center, Daytona Beach, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach, Deerfield Beach, Florida, United States
21st Century Oncology - Fort Walton Beach, Fort Walton Beach, Florida, United States
University of Florida Health Science Center - Gainesville, Gainesville, Florida, United States
Integrated Community Oncology Network-Florida Cancer Center Beaches, Jacksonville Beach, Florida, United States
Baptist MD Anderson Cancer Center, Jacksonville, Florida, United States
Integrated Community Oncology Network-Southside Cancer Center, Jacksonville, Florida, United States
University of Florida Health Science Center - Jacksonville, Jacksonville, Florida, United States
Mayo Clinic in Florida, Jacksonville, Florida, United States
Baptist Medical Center South, Jacksonville, Florida, United States
Jackson Memorial Hospital-Holtz Children's Hospital, Miami, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, Florida, United States
21st Century Oncology-Orange Park, Orange Park, Florida, United States
AdventHealth Orlando, Orlando, Florida, United States
Orlando Health Cancer Institute, Orlando, Florida, United States
Cancer Center of Putnam, Palatka, Florida, United States
Integrated Community Oncology Network-Flager Cancer Center, Saint Augustine, Florida, United States
Moffitt Cancer Center, Tampa, Florida, United States
The Villages Regional Hospital, The Villages, Florida, United States
Grady Health System, Atlanta, Georgia, United States
Emory University Hospital Midtown, Atlanta, Georgia, United States
Piedmont Hospital, Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute, Atlanta, Georgia, United States
Emory Saint Joseph's Hospital, Atlanta, Georgia, United States
Northside Hospital, Atlanta, Georgia, United States
Northside Hospital-Forsyth, Cumming, Georgia, United States
Memorial Health University Medical Center, Savannah, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler, Savannah, Georgia, United States
Queen's Medical Center, Honolulu, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise, Boise, Idaho, United States
Rush - Copley Medical Center, Aurora, Illinois, United States
Northwestern University, Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States
Advocate Illinois Masonic Medical Center, Chicago, Illinois, United States
Decatur Memorial Hospital, Decatur, Illinois, United States
Freeport Memorial Hospital/Leonard C Ferguson Cancer Center, Freeport, Illinois, United States
Loyola University Medical Center, Maywood, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross, New Lenox, Illinois, United States
Carle Cancer Institute Normal, Normal, Illinois, United States
Advocate Lutheran General Hospital, Park Ridge, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center, Peoria, Illinois, United States
OSF Saint Francis Medical Center, Peoria, Illinois, United States
Swedish American Hospital, Rockford, Illinois, United States
SwedishAmerican Regional Cancer Center/ACT, Rockford, Illinois, United States
Saint John's Hospital, Springfield, Illinois, United States
Carle Cancer Center, Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville, Warrenville, Illinois, United States
Saint Vincent Anderson Regional Hospital/Cancer Center, Anderson, Indiana, United States
IU Health West Hospital, Avon, Indiana, United States
Goshen Center for Cancer Care, Goshen, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, United States
IU Health Methodist Hospital, Indianapolis, Indiana, United States
Community Cancer Center East, Indianapolis, Indiana, United States
Community Cancer Center North, Indianapolis, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka, Mishawaka, Indiana, United States
IU Health Ball Memorial Hospital, Muncie, Indiana, United States
Mercy Cancer Center-West Lakes, Clive, Iowa, United States
Iowa Methodist Medical Center, Des Moines, Iowa, United States
Mercy Medical Center - Des Moines, Des Moines, Iowa, United States
Finley Hospital, Dubuque, Iowa, United States
University of Kansas Cancer Center, Kansas City, Kansas, United States
Lawrence Memorial Hospital, Lawrence, Kansas, United States
University of Kansas Cancer Center-Overland Park, Overland Park, Kansas, United States
Kansas City NCI Community Oncology Research Program, Prairie Village, Kansas, United States
Cotton O'Neil Cancer Center / Stormont Vail Health, Topeka, Kansas, United States
Ascension Via Christi Hospitals Wichita, Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program, Wichita, Kansas, United States
University of Kentucky/Markey Cancer Center, Lexington, Kentucky, United States
Owensboro Health Mitchell Memorial Cancer Center, Owensboro, Kentucky, United States
Tulane University Health Sciences Center, New Orleans, Louisiana, United States
Anne Arundel Medical Center, Annapolis, Maryland, United States
University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, United States
Greater Baltimore Medical Center, Baltimore, Maryland, United States
Saint Agnes Hospital, Baltimore, Maryland, United States
Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Central Maryland Radiation Oncology in Howard County, Columbia, Maryland, United States
UM Baltimore Washington Medical Center/Tate Cancer Center, Glen Burnie, Maryland, United States
TidalHealth Peninsula Regional, Salisbury, Maryland, United States
Massachusetts General Hospital Cancer Center, Boston, Massachusetts, United States
Boston Medical Center, Boston, Massachusetts, United States
Mass General/North Shore Cancer Center, Danvers, Massachusetts, United States
Lowell General Hospital, Lowell, Massachusetts, United States
Newton-Wellesley Hospital, Newton, Massachusetts, United States
University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, United States
GenesisCare USA - Clarkston, Clarkston, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township, Clinton Township, Michigan, United States
Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, United States
Henry Ford Hospital, Detroit, Michigan, United States
Ascension Saint John Hospital, Detroit, Michigan, United States
GenesisCare USA - Farmington Hills, Farmington Hills, Michigan, United States
Weisberg Cancer Treatment Center, Farmington Hills, Michigan, United States
Beaumont Hospital - Farmington Hills, Farmington Hills, Michigan, United States
McLaren Cancer Institute-Flint, Flint, Michigan, United States
Mercy Health Saint Mary's, Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus, Grand Rapids, Michigan, United States
West Michigan Cancer Center, Kalamazoo, Michigan, United States
KCC Radiation Oncology at Monroe Cancer Center, Monroe, Michigan, United States
McLaren Cancer Institute-Northern Michigan, Petoskey, Michigan, United States
Saint Joseph Mercy Oakland, Pontiac, Michigan, United States
William Beaumont Hospital-Royal Oak, Royal Oak, Michigan, United States
Ascension Providence Hospitals - Southfield, Southfield, Michigan, United States
William Beaumont Hospital - Troy, Troy, Michigan, United States
GenesisCare USA - Troy, Troy, Michigan, United States
Saint John Macomb-Oakland Hospital, Warren, Michigan, United States
Mayo Clinic Health System in Albert Lea, Albert Lea, Minnesota, United States
Sanford Joe Lueken Cancer Center, Bemidji, Minnesota, United States
Miller-Dwan Hospital, Duluth, Minnesota, United States
Mayo Clinic Health Systems-Mankato, Mankato, Minnesota, United States
Mayo Clinic in Rochester, Rochester, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital, Saint Cloud, Minnesota, United States
Singing River Hospital, Pascagoula, Mississippi, United States
Saint Francis Medical Center, Cape Girardeau, Missouri, United States
Saint Luke's Hospital, Chesterfield, Missouri, United States
Siteman Cancer Center at West County Hospital, Creve Coeur, Missouri, United States
The University of Kansas Cancer Center-South, Kansas City, Missouri, United States
University of Kansas Cancer Center - North, Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit, Lee's Summit, Missouri, United States
Liberty Radiation Oncology Center, Liberty, Missouri, United States
Washington University School of Medicine, Saint Louis, Missouri, United States
Siteman Cancer Center-South County, Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital, Saint Peters, Missouri, United States
Billings Clinic Cancer Center, Billings, Montana, United States
Benefis Healthcare- Sletten Cancer Institute, Great Falls, Montana, United States
Kalispell Regional Medical Center, Kalispell, Montana, United States
Nebraska Methodist Hospital, Omaha, Nebraska, United States
University of Nebraska Medical Center, Omaha, Nebraska, United States
Radiation Oncology Centers of Nevada Central, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, United States
Renown Regional Medical Center, Reno, Nevada, United States
Saint Mary's Regional Medical Center, Reno, Nevada, United States
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
Memorial Sloan Kettering Basking Ridge, Basking Ridge, New Jersey, United States
Ocean Medical Center, Brick, New Jersey, United States
Monmouth Medical Center, Long Branch, New Jersey, United States
Morristown Medical Center, Morristown, New Jersey, United States
Virtua Memorial, Mount Holly, New Jersey, United States
Jersey Shore Medical Center, Neptune, New Jersey, United States
Saint Peter's University Hospital, New Brunswick, New Jersey, United States
Capital Health Medical Center-Hopewell, Pennington, New Jersey, United States
Riverview Medical Center/Booker Cancer Center, Red Bank, New Jersey, United States
Sparta Cancer Treatment Center, Sparta, New Jersey, United States
Overlook Hospital, Summit, New Jersey, United States
Community Medical Center, Toms River, New Jersey, United States
Virtua Voorhees, Voorhees, New Jersey, United States
University of New Mexico Cancer Center, Albuquerque, New Mexico, United States
Memorial Medical Center - Las Cruces, Las Cruces, New Mexico, United States
New York Oncology Hematology PC - Albany, Albany, New York, United States
Saint Peter's Health Partners, Albany, New York, United States
Montefiore Medical Center - Moses Campus, Bronx, New York, United States
Roswell Park Cancer Institute, Buffalo, New York, United States
Sands Cancer Center, Canandaigua, New York, United States
Memorial Sloan Kettering Commack, Commack, New York, United States
Mary Imogene Bassett Hospital, Cooperstown, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse, East Syracuse, New York, United States
Cayuga Medical Center, Ithaca, New York, United States
Northwell Health NCORP, Lake Success, New York, United States
Northwell Health/Center for Advanced Medicine, Lake Success, New York, United States
Long Island Jewish Medical Center, New Hyde Park, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York, United States
Memorial Sloan Kettering Cancer Center, New York, New York, United States
Hudson Valley Oncology Associates, Poughkeepsie, New York, United States
Wilmot Cancer Institute Radiation Oncology at Greece, Rochester, New York, United States
Highland Hospital, Rochester, New York, United States
Rochester General Hospital, Rochester, New York, United States
University of Rochester, Rochester, New York, United States
Memorial Sloan Kettering Sleepy Hollow, Sleepy Hollow, New York, United States
Staten Island University Hospital, Staten Island, New York, United States
Stony Brook University Medical Center, Stony Brook, New York, United States
Memorial Sloan Kettering Nassau, Uniondale, New York, United States
Dickstein Cancer Treatment Center, White Plains, New York, United States
Duke University Medical Center, Durham, North Carolina, United States
East Carolina University, Greenville, North Carolina, United States
The Coleman Radiation Center-Carteret General Hospital, Morehead City, North Carolina, United States
CarolinaEast Medical Center, New Bern, North Carolina, United States
FirstHealth of the Carolinas-Moore Regional Hospital, Pinehurst, North Carolina, United States
Iredell Memorial Hospital, Statesville, North Carolina, United States
NHRMC Radiation Oncology - Supply, Supply, North Carolina, United States
New Hanover Regional Medical Center/Zimmer Cancer Center, Wilmington, North Carolina, United States
NHRMC Radiation Oncology - 16th Street, Wilmington, North Carolina, United States
Sanford Bismarck Medical Center, Bismarck, North Dakota, United States
Sanford Roger Maris Cancer Center, Fargo, North Dakota, United States
Altru Cancer Center, Grand Forks, North Dakota, United States
Summa Health System - Akron Campus, Akron, Ohio, United States
Cleveland Clinic Akron General, Akron, Ohio, United States
Summa Health System - Barberton Campus, Barberton, Ohio, United States
UHHS-Chagrin Highlands Medical Center, Beachwood, Ohio, United States
Geauga Hospital, Chardon, Ohio, United States
Adena Regional Medical Center, Chillicothe, Ohio, United States
The Christ Hospital, Cincinnati, Ohio, United States
University of Cincinnati Cancer Center-UC Medical Center, Cincinnati, Ohio, United States
Case Western Reserve University, Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital, Cleveland, Ohio, United States
Cleveland Clinic Foundation, Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
Cleveland Clinic Cancer Center Independence, Independence, Ohio, United States
Hillcrest Hospital Cancer Center, Mayfield Heights, Ohio, United States
Summa Health Medina Medical Center, Medina, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus, Mentor, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital, Middleburg Heights, Ohio, United States
University Hospitals Parma Medical Center, Parma, Ohio, United States
University Hospitals Portage Medical Center, Ravenna, Ohio, United States
North Coast Cancer Care, Sandusky, Ohio, United States
Cleveland Clinic Cancer Center Strongsville, Strongsville, Ohio, United States
UHHS-Westlake Medical Center, Westlake, Ohio, United States
Cleveland Clinic Wooster Family Health and Surgery Center, Wooster, Ohio, United States
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
Natalie Warren Bryant Cancer Center at Saint Francis, Tulsa, Oklahoma, United States
Clackamas Radiation Oncology Center, Clackamas, Oregon, United States
Willamette Valley Cancer Center, Eugene, Oregon, United States
Three Rivers Community Hospital, Grants Pass, Oregon, United States
Providence Medford Medical Center, Medford, Oregon, United States
Rogue Valley Medical Center, Medford, Oregon, United States
Providence Portland Medical Center, Portland, Oregon, United States
Jefferson Abington Hospital, Abington, Pennsylvania, United States
UPMC-Heritage Valley Health System Beaver, Beaver, Pennsylvania, United States
Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, United States
Geisinger Medical Center, Danville, Pennsylvania, United States
Delaware County Memorial Hospital, Drexel Hill, Pennsylvania, United States
Northeast Radiation Oncology Center, Dunmore, Pennsylvania, United States
Pocono Medical Center, East Stroudsburg, Pennsylvania, United States
UPMC Hillman Cancer Center Erie, Erie, Pennsylvania, United States
Fox Chase Cancer Center Buckingham, Furlong, Pennsylvania, United States
Adams Cancer Center, Gettysburg, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion, Greensburg, Pennsylvania, United States
Cherry Tree Cancer Center, Hanover, Pennsylvania, United States
Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center, Johnstown, Pennsylvania, United States
Lancaster General Hospital, Lancaster, Pennsylvania, United States
Saint Mary Medical and Regional Cancer Center, Langhorne, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport, McKeesport, Pennsylvania, United States
Holy Redeemer Hospital and Medical Center, Meadowbrook, Pennsylvania, United States
Riddle Memorial Hospital, Media, Pennsylvania, United States
Intercommunity Cancer Center, Monroeville, Pennsylvania, United States
UPMC-Coraopolis/Heritage Valley Radiation Oncology, Moon, Pennsylvania, United States
Allegheny Valley Hospital, Natrona Heights, Pennsylvania, United States
UPMC Jameson, New Castle, Pennsylvania, United States
Paoli Memorial Hospital, Paoli, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania, United States
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
UPMC-Magee Womens Hospital, Pittsburgh, Pennsylvania, United States
UPMC-Saint Margaret, Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital, Pittsburgh, Pennsylvania, United States
UPMC Jefferson Regional Radiation Oncology, Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital, Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center, Pittsburgh, Pennsylvania, United States
Penn State Health Saint Joseph Medical Center, Reading, Pennsylvania, United States
Grand View Hospital, Sellersville, Pennsylvania, United States
Mount Nittany Medical Center, State College, Pennsylvania, United States
Crozer-Chester Medical Center, Upland, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology, Washington, Pennsylvania, United States
Reading Hospital, West Reading, Pennsylvania, United States
Lankenau Medical Center, Wynnewood, Pennsylvania, United States
WellSpan Health-York Hospital, York, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg, Boiling Springs, South Carolina, United States
Medical University of South Carolina, Charleston, South Carolina, United States
Greenville Health System Cancer Institute-Andrews, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer, Greer, South Carolina, United States
Gibbs Cancer Center-Pelham, Greer, South Carolina, United States
The Radiation Oncology Center-Hilton Head/Bluffton, Hilton Head Island, South Carolina, United States
Prisma Health Cancer Institute - Seneca, Seneca, South Carolina, United States
Spartanburg Medical Center, Spartanburg, South Carolina, United States
Lexington Medical Center, West Columbia, South Carolina, United States
Rapid City Regional Hospital, Rapid City, South Dakota, United States
Avera Cancer Institute, Sioux Falls, South Dakota, United States
Texas Oncology-Arlington South, Arlington, Texas, United States
Texas Oncology-Austin Midtown, Austin, Texas, United States
Texas Oncology - South Austin Cancer Center, Austin, Texas, United States
Texas Oncology Bedford, Bedford, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas, Dallas, Texas, United States
Texas Oncology - Denison Cancer Center, Denison, Texas, United States
Texas Oncology-Denton South, Denton, Texas, United States
Brooke Army Medical Center, Fort Sam Houston, Texas, United States
Texas Oncology - Fort Worth Cancer Center, Fort Worth, Texas, United States
Memorial Hermann Memorial City Medical Center, Houston, Texas, United States
Baylor Medical Center at Irving, Irving, Texas, United States
Texas Oncology - Lewisville, Lewisville, Texas, United States
West Texas Cancer Center, Odessa, Texas, United States
Texas Oncology-Plano West, Plano, Texas, United States
Texas Oncology-Seton Williamson, Round Rock, Texas, United States
Texas Oncology - Round Rock Cancer Center, Round Rock, Texas, United States
Cancer Care Centers of South Texas- Northeast, San Antonio, Texas, United States
University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
Texas Oncology Cancer Center Sugar Land, Sugar Land, Texas, United States
Texas Oncology-Wichita Falls Texoma Cancer Center, Wichita Falls, Texas, United States
Logan Regional Hospital, Logan, Utah, United States
Intermountain Medical Center, Murray, Utah, United States
McKay-Dee Hospital Center, Ogden, Utah, United States
Dixie Medical Center Regional Cancer Center, Saint George, Utah, United States
Utah Cancer Specialists-Salt Lake City, Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah, Salt Lake City, Utah, United States
Norris Cotton Cancer Center-North, Saint Johnsbury, Vermont, United States
Inova Alexandria Hospital, Alexandria, Virginia, United States
University of Virginia Cancer Center, Charlottesville, Virginia, United States
Inova Fairfax Hospital, Falls Church, Virginia, United States
Augusta Health Center for Cancer and Blood Disorders, Fishersville, Virginia, United States
Sentara Cancer Institute at Sentara CarePlex Hospital, Hampton, Virginia, United States
Sentara Rockingham Memorial Hospital Hahn Cancer Center, Harrisonburg, Virginia, United States
Sentara Norfolk General Hospital, Norfolk, Virginia, United States
Naval Medical Center - Portsmouth, Portsmouth, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center, Richmond, Virginia, United States
Sentara Virginia Beach General Hospital, Virginia Beach, Virginia, United States
Harrison Medical Center, Bremerton, Washington, United States
Saint Francis Hospital, Federal Way, Washington, United States
Tri-Cities Cancer Center, Kennewick, Washington, United States
Skagit Valley Hospital, Mount Vernon, Washington, United States
Virginia Mason Medical Center, Seattle, Washington, United States
Seattle Cancer Care Alliance, Seattle, Washington, United States
Olympic Medical Cancer Care Center, Sequim, Washington, United States
Cancer Care Northwest - Spokane South, Spokane, Washington, United States
Cancer Care Northwest-North Spokane, Spokane, Washington, United States
Wenatchee Valley Hospital and Clinics, Wenatchee, Washington, United States
Edwards Comprehensive Cancer Center, Huntington, West Virginia, United States
West Virginia University Healthcare, Morgantown, West Virginia, United States
Wheeling Hospital/Schiffler Cancer Center, Wheeling, West Virginia, United States
Langlade Hospital and Cancer Center, Antigo, Wisconsin, United States
ThedaCare Regional Medical Center - Appleton, Appleton, Wisconsin, United States
Beloit Memorial Hospital, Beloit, Wisconsin, United States
Mayo Clinic Health System Eau Claire Hospital-Luther Campus, Eau Claire, Wisconsin, United States
Saint Agnes Hospital/Agnesian Cancer Center, Fond Du Lac, Wisconsin, United States
Bellin Memorial Hospital, Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay, Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's, Green Bay, Wisconsin, United States
Aurora BayCare Medical Center, Green Bay, Wisconsin, United States
UW Cancer Center Johnson Creek, Johnson Creek, Wisconsin, United States
Gundersen Lutheran Medical Center, La Crosse, Wisconsin, United States
Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin, United States
University of Wisconsin Hospital and Clinics, Madison, Wisconsin, United States
Bay Area Medical Center, Marinette, Wisconsin, United States
Froedtert Menomonee Falls Hospital, Menomonee Falls, Wisconsin, United States
Ascension Columbia Saint Mary's Hospital Ozaukee, Mequon, Wisconsin, United States
Ascension Columbia Saint Mary's Hospital - Milwaukee, Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center, Milwaukee, Wisconsin, United States
Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Ascension All Saints Hospital, Racine, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan, Sheboygan, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Sturgeon Bay, Sturgeon Bay, Wisconsin, United States
Aurora Medical Center in Summit, Summit, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers, Two Rivers, Wisconsin, United States
ProHealth Waukesha Memorial Hospital, Waukesha, Wisconsin, United States
Aspirus Regional Cancer Center, Wausau, Wisconsin, United States
Aurora West Allis Medical Center, West Allis, Wisconsin, United States
Cross Cancer Institute, Edmonton, Alberta, Canada
BCCA-Vancouver Cancer Centre, Vancouver, British Columbia, Canada
CancerCare Manitoba, Winnipeg, Manitoba, Canada
Atlantic Health Sciences Corporation-Saint John Regional Hospital, Saint John, New Brunswick, Canada
Grand River Regional Cancer Centre at Grand River Hospital, Kitchener, Ontario, Canada
London Regional Cancer Program, London, Ontario, Canada
Stronach Regional Health Centre at Southlake, Newmarket, Ontario, Canada
Ottawa Hospital and Cancer Center-General Campus, Ottawa, Ontario, Canada
Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
Irving Greenberg Family Cancer Centre, Ottawa, Ontario, Canada
Windsor Regional Cancer Centre, Windsor, Ontario, Canada
Hopital de la Cite-de-la-Sante, Laval, Quebec, Canada
CIUSSSEMTL-Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
CHUM - Hopital Notre-Dame, Montreal, Quebec, Canada
McGill University Department of Oncology, Montreal, Quebec, Canada
CHUM - Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
The Research Institute of the McGill University Health Centre (MUHC), Montreal, Quebec, Canada
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ), Quebec City, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont, Sherbrooke, Quebec, Canada
Allan Blair Cancer Centre, Regina, Saskatchewan, Canada
Pamela Youde Nethersole Eastern Hospital, Chai Wan, , Hong Kong
Rabin Medical Center, Petach Tikva, , Israel
Chaim Sheba Medical Center, Tel Hashomer, , Israel
Shizuoka Cancer Center, Shizuoka City, Suntou, Japan
National Cancer Center-Korea, Goyang-si, Gyeonggi-do, Korea, Republic of
Yonsei University Health System-Severance Hospital, Seoul, , Korea, Republic of
National University Hospital Singapore, Singapore, , Singapore
National Cancer Centre Singapore, Singapore, , Singapore
Kantonsspital Aarau, Aarau, , Switzerland
Name: Frank A. Vicini, MD, FACR
Affiliation: St. Joseph Mercy Oakland
Role: PRINCIPAL_INVESTIGATOR
Name: Gary M. Freedman, MD
Affiliation: University of Pennsylvania
Role: STUDY_CHAIR
Name: Julia R. White, MD
Affiliation: Ohio State University
Role: STUDY_CHAIR
Name: Douglas W. Arthur, MD
Affiliation: Virginia Commonwealth University
Role: STUDY_CHAIR