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Androgen-deprivationsterapi og strålebehandling til behandling af patienter med prostatakræft

15. august 2023 opdateret af: Radiation Therapy Oncology Group

Androgen deprivationsterapi og højdosis strålebehandling med eller uden strålebehandling af hele bækkenet ved ugunstig mellemliggende eller gunstig højrisiko prostatacancer: Et fase III randomiseret forsøg

RATIONALE: Androgener kan forårsage vækst af prostatacancerceller. Androgen-deprivationsterapi kan stoppe binyrerne i at lave androgener. Strålebehandling bruger højenergi røntgenstråler til at dræbe tumorceller.

FORMÅL: Dette randomiserede fase III-studie undersøger androgen-deprivationsterapi og strålebehandling til behandling af patienter med prostatacancer.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Detaljeret beskrivelse

MÅL:

Primær

  • Demonstrer, at profylaktisk, neoadjuverende, androgen-deprivationsterapi (NADT) og strålebehandling af hele bækkenet (WPRT) vil resultere i forbedring af den samlede overlevelse (OS) for patienter med "ugunstig" mellemrisiko eller "gunstig" højrisiko prostatacancer sammenlignet med NADT og højdosis prostata (P) og sædblærer (SV) strålebehandling (RT) ved brug af intensitetsmoduleret RT (IMRT) eller ekstern stråle RT (EBRT) med en højdosisrate (HDR) eller en permanent boost af prostata (radioaktivt frø) implantat (PPI).

Sekundær

  • Demonstrer, at profylaktisk WPRT forbedrer den biokemiske kontrol.
  • Bestem den fjernmetastase (DM)-fri overlevelse.
  • Bestem den årsagsspecifikke overlevelse (CSS).
  • Sammenlign akutte og sene behandlingsbivirkninger mellem patienter, der modtager NADT og WPRT versus NADT, P og SV RT.
  • Bestem, om sundhedsrelateret livskvalitet (HRQOL), målt ved Expanded Prostate Cancer Index Composite (EPIC), forværres signifikant med stigende aggressivitet af behandlingen (dvs. arm 2, NADT + WPRT).
  • Bestem, om mere aggressiv behandling (arm 2, NADT + WPRT) er forbundet med en større stigning i træthed (PROMIS Fatigue Short Form) fra baseline til sidste uges behandling og en større stigning i cirkulerende inflammatoriske markører (IL-1, IL- 1ra, IL-6, tumornekrosefaktor (TNF)-alfa og C-reaktivt protein).
  • Demonstrer en trinvis gevinst i OS og CSS med mere aggressiv terapi, der opvejer eventuelle ulemper i de primære generiske domæner af HRQOL (dvs. mobilitet, egenomsorg, sædvanlige aktiviteter, smerte/ubehag og angst/depression).
  • Bestem, om ændringer i træthed fra baseline til de næste tre tidspunkter (ugen før RT, sidste uge af behandlingen og 3 måneder efter behandlingen) er forbundet med ændringer i cirkulerende cytokiner, humør, søvn og daglige aktiviteter på tværs af de samme tidspunkter .
  • Indsaml paraffinindlejrede vævsblokke, plasma, fuldblod og urin til planlagte og fremtidige translationelle forskningsanalyser.

OVERSIGT: Dette er en multicenterundersøgelse. Patienterne er stratificeret efter moderat- til højrisikogrupper som anført i sygdomskarakteristika i dette abstrakt, type stråleterapiboost (IMRT vs brachyterapi [Lavdosisrate (LDR) ved hjælp af PPI eller HDR]) og varighed af androgen- deprivationsterapi (kortvarig [6 måneder] versus langvarig [32 måneder]). Patienterne randomiseres til 1 ud af 2 behandlingsarme.

Alle patienter modtager neoadjuverende androgen-deprivationsterapi omfattende bicalutamid oralt (PO) én gang dagligt eller flutamid PO tre gange dagligt i 6 måneder og luteiniserende hormon-frigivende hormon (LHRH) agonist/antagonistbehandling omfattende leuprolidacetat, goserelinacetat, buserelin, eller triptorelin, eller triptorelin. degarelix subkutant (SC) eller intramuskulært (IM) hver 1. til 3. måned begyndende 2 måneder før strålebehandling og fortsætter i 6 eller 32 måneder.

Strålebehandling begynder inden for 8 uger efter påbegyndelse af LHRH agonist/antagonist injektion.

  • Arm I: Patienter gennemgår højdosis strålebehandling af prostata og sædblærer ved hjælp af intensitetsmoduleret strålebehandling (IMRT)* eller 3D-konform strålebehandling (3D-CRT)* én gang dagligt, 5 dage om ugen, i cirka 9 uger. Patienter kan også gennemgå permanent prostata implantat (PPI) brachyterapi eller højdosis brachyterapi (jod I 125 eller palladium Pd 103 kan bruges som radioisotop).
  • Arm II: Patienter gennemgår strålebehandling af hele bækkenet (WPRT)* (3D-CRT eller IMRT) én gang dagligt, 5 dage om ugen, i cirka 9 uger. Patienter kan også gennemgå brachyterapi som i arm I.

BEMÆRK: * Patienter, der gennemgår et brachyterapiimplantat, modtager 5 ugers IMRT, 3D-CRT eller WPRT.

Patienter kan gennemgå blod- og urinprøvetagning til korrelative undersøgelser. Primære tumorvævsprøver kan også indsamles.

Patienter kan udfylde Expanded Prostate Cancer Index Composite (EPIC), PROMIS-Fatigue Short Form og EuroQol (EQ-5D) livskvalitetsspørgeskemaer (QOL) ved baseline og periodisk under behandlingen. Patienter, der deltager i QOL-delen af ​​undersøgelsen, skal også acceptere periodisk blodopsamling.

Efter afslutning af studieterapien følges patienterne op hver 3. måned i 1 år, hver 6. måned i 3 år og derefter årligt.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

2592

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • Alberta
      • Calgary, Alberta, Canada, T2N 4N2
        • Tom Baker Cancer Centre
      • Edmonton, Alberta, Canada, T6G 1Z2
        • Cross Cancer Institute
    • British Columbia
      • Kelowna, British Columbia, Canada, V1Y 5L3
        • BCCA-Cancer Centre for the Southern Interior
      • Surrey, British Columbia, Canada, V3V 1Z2
        • BCCA-Fraser Valley Cancer Centre
    • Newfoundland and Labrador
      • St. John's, Newfoundland and Labrador, Canada, A1B 3V6
        • Doctor H. Bliss Murphy Cancer Centre
    • Nova Scotia
      • Halifax, Nova Scotia, Canada, B3H 2Y9
        • QEII Health Sciences Centre/Nova Scotia Health Authority
    • Ontario
      • London, Ontario, Canada, N6A 4L6
        • London Regional Cancer Program
      • Newmarket, Ontario, Canada, L3Y 2P9
        • Stronach Regional Health Centre at Southlake
      • Toronto, Ontario, Canada, M4N 3M5
        • Odette Cancer Centre- Sunnybrook Health Sciences Centre
    • Quebec
      • Montreal, Quebec, Canada, H3T 1E2
        • Jewish General Hospital
      • Montreal, Quebec, Canada, H3H 2R9
        • The Research Institute of the McGill University Health Centre (MUHC)
      • Montreal, Quebec, Canada, H2L 4M1
        • CHUM - Hopital Notre-Dame
      • Montreal, Quebec, Canada, H2W 1S6
        • McGill University Department of Oncology
      • Montreal, Quebec, Canada, H2X 3E4
        • CHUM - Centre hospitalier de l'Université de Montréal
      • Quebec City, Quebec, Canada, G1R 2J6
        • CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
      • Sherbrooke, Quebec, Canada, J1H 5N4
        • Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
    • Saskatchewan
      • Regina, Saskatchewan, Canada, S4T 7T1
        • Allan Blair Cancer Centre
      • Saskatoon, Saskatchewan, Canada, S7N 4H4
        • Saskatoon Cancer Centre
    • Alabama
      • Mobile, Alabama, Forenede Stater, 36688
        • University of South Alabama Mitchell Cancer Institute
    • Alaska
      • Anchorage, Alaska, Forenede Stater, 98508
        • Anchorage Associates in Radiation Medicine
      • Anchorage, Alaska, Forenede Stater, 99508
        • Alaska Oncology and Hematology LLC
      • Anchorage, Alaska, Forenede Stater, 99508
        • Anchorage Oncology Centre
      • Anchorage, Alaska, Forenede Stater, 99508
        • Katmai Oncology Group
      • Anchorage, Alaska, Forenede Stater, 99508
        • Providence Alaska Medical Center
      • Fairbanks, Alaska, Forenede Stater, 99701
        • Fairbanks Memorial Hospital
    • Arizona
      • Gilbert, Arizona, Forenede Stater, 85297
        • Arizona Breast Cancer Specialists-Gilbert
      • Peoria, Arizona, Forenede Stater, 85381
        • Arizona Center for Cancer Care-Peoria
      • Phoenix, Arizona, Forenede Stater, 85004
        • Cancer Center at Saint Joseph's
      • Phoenix, Arizona, Forenede Stater, 85027
        • Arizona Oncology-Deer Valley Center
      • Phoenix, Arizona, Forenede Stater, 85013
        • Saint Joseph's Hospital and Medical Center
      • Phoenix, Arizona, Forenede Stater, 85027
        • Arizona Breast Cancer Specialists-Phoenix
      • Scottsdale, Arizona, Forenede Stater, 85258
        • Arizona Breast Cancer Specialists-Scottsdale
      • Scottsdale, Arizona, Forenede Stater, 85251
        • Arizona Breast Cancer Specialists
      • Scottsdale, Arizona, Forenede Stater, 85260
        • Arizona Oncology Services Foundation
      • Scottsdale, Arizona, Forenede Stater, 85251
        • 21st Century Oncology-Scottsdale
      • Surprise, Arizona, Forenede Stater, 85374
        • Arizona Center for Cancer Care-Surprise
      • Tucson, Arizona, Forenede Stater, 85704
        • University of Arizona Cancer Center-Orange Grove Campus
      • Tucson, Arizona, Forenede Stater, 85719
        • Banner University Medical Center - Tucson
      • Tucson, Arizona, Forenede Stater, 85719
        • University of Arizona Cancer Center-North Campus
      • Tucson, Arizona, Forenede Stater, 85704
        • Arizona Oncology Associates-West Orange Grove
    • Arkansas
      • Hot Springs, Arkansas, Forenede Stater, 71913
        • CHI Saint Vincent Cancer Center Hot Springs
      • Jonesboro, Arkansas, Forenede Stater, 72401
        • Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
      • Little Rock, Arkansas, Forenede Stater, 72205
        • University of Arkansas for Medical Sciences
    • California
      • Auburn, California, Forenede Stater, 95603
        • Sutter Cancer Centers Radiation Oncology Services-Auburn
      • Bakersfield, California, Forenede Stater, 93301
        • AIS Cancer Center at San Joaquin Community Hospital
      • Berkeley, California, Forenede Stater, 94704
        • Alta Bates Summit Medical Center-Herrick Campus
      • Burbank, California, Forenede Stater, 91505
        • Providence Saint Joseph Medical Center/Disney Family Cancer Center
      • Cameron Park, California, Forenede Stater, 95682
        • Sutter Cancer Centers Radiation Oncology Services-Cameron Park
      • Carmichael, California, Forenede Stater, 95608
        • Mercy San Juan Medical Center
      • Chico, California, Forenede Stater, 95973
        • Adventist Health Cancer Care Center Chico
      • Fresno, California, Forenede Stater, 93720
        • Saint Agnes Medical Center
      • Fresno, California, Forenede Stater, 93720
        • Fresno Cancer Center
      • Greenbrae, California, Forenede Stater, 94904
        • Marin General Hospital
      • La Jolla, California, Forenede Stater, 92093
        • UC San Diego Moores Cancer Center
      • Long Beach, California, Forenede Stater, 90822
        • Tibor Rubin VA Medical Center
      • Los Angeles, California, Forenede Stater, 90033
        • USC / Norris Comprehensive Cancer Center
      • Los Angeles, California, Forenede Stater, 90033
        • Los Angeles County-USC Medical Center
      • Los Angeles, California, Forenede Stater, 90048
        • Cedars Sinai Medical Center
      • Marysville, California, Forenede Stater, 95901
        • Fremont - Rideout Cancer Center
      • Merced, California, Forenede Stater, 95340
        • Mercy UC Davis Cancer Center
      • Modesto, California, Forenede Stater, 95355
        • Memorial Medical Center
      • Oakland, California, Forenede Stater, 94611
        • Kaiser Permanente Oakland-Broadway
      • Oakland, California, Forenede Stater, 94609
        • Alta Bates Summit Medical Center - Summit Campus
      • Palm Springs, California, Forenede Stater, 92262
        • Desert Regional Medical Center
      • Palo Alto, California, Forenede Stater, 94304
        • Stanford Cancer Institute Palo Alto
      • Palo Alto, California, Forenede Stater, 94301
        • Palo Alto Medical Foundation Health Care
      • Pomona, California, Forenede Stater, 91767
        • Pomona Valley Hospital Medical Center
      • Rancho Cordova, California, Forenede Stater, 95670
        • Kaiser Permanente-Rancho Cordova Cancer Center
      • Rohnert Park, California, Forenede Stater, 94928
        • Rohnert Park Cancer Center
      • Roseville, California, Forenede Stater, 95678
        • The Permanente Medical Group-Roseville Radiation Oncology
      • Roseville, California, Forenede Stater, 95661
        • Sutter Cancer Centers Radiation Oncology Services-Roseville
      • Sacramento, California, Forenede Stater, 95816
        • Sutter Medical Center Sacramento
      • Sacramento, California, Forenede Stater, 95817
        • University of California Davis Comprehensive Cancer Center
      • Sacramento, California, Forenede Stater, 95823
        • South Sacramento Cancer Center
      • Sacramento, California, Forenede Stater, 95816
        • Mercy Cancer Center - Sacramento
      • San Francisco, California, Forenede Stater, 94158
        • UCSF Medical Center-Mission Bay
      • San Francisco, California, Forenede Stater, 94115
        • UCSF Medical Center-Mount Zion
      • San Jose, California, Forenede Stater, 95128
        • Santa Clara Valley Medical Center
      • Santa Clara, California, Forenede Stater, 95051
        • Kaiser Permanente Medical Center - Santa Clara
      • South San Francisco, California, Forenede Stater, 94080
        • Kaiser Permanente Cancer Treatment Center
      • Stockton, California, Forenede Stater, 95204
        • Saint Joseph's Medical Center
      • Sunnyvale, California, Forenede Stater, 94086
        • Palo Alto Medical Foundation-Sunnyvale
      • Truckee, California, Forenede Stater, 96161
        • Gene Upshaw Memorial Tahoe Forest Cancer Center
      • Vacaville, California, Forenede Stater, 95687
        • Sutter Cancer Centers Radiation Oncology Services-Vacaville
    • Colorado
      • Aurora, Colorado, Forenede Stater, 80045
        • University of Colorado Hospital
      • Aurora, Colorado, Forenede Stater, 80012
        • Rocky Mountain Cancer Centers-Aurora
      • Boulder, Colorado, Forenede Stater, 80304
        • Rocky Mountain Cancer Centers-Boulder
      • Colorado Springs, Colorado, Forenede Stater, 80909
        • UCHealth Memorial Hospital Central
      • Denver, Colorado, Forenede Stater, 80210
        • Porter Adventist Hospital
      • Edwards, Colorado, Forenede Stater, 81632
        • Shaw Cancer Center
      • Greeley, Colorado, Forenede Stater, 80631
        • North Colorado Medical Center
      • Longmont, Colorado, Forenede Stater, 80501
        • Longmont United Hospital
      • Loveland, Colorado, Forenede Stater, 80539
        • McKee Medical Center
      • Parker, Colorado, Forenede Stater, 80138
        • Parker Adventist Hospital
    • Connecticut
      • Bridgeport, Connecticut, Forenede Stater, 06606
        • Hartford HealthCare - Saint Vincent's Medical Center
      • Hartford, Connecticut, Forenede Stater, 06105
        • Smilow Cancer Hospital Care Center at Saint Francis
      • Middletown, Connecticut, Forenede Stater, 06457
        • Middlesex Hospital
    • Delaware
      • Newark, Delaware, Forenede Stater, 19713
        • Helen F Graham Cancer Center
      • Newark, Delaware, Forenede Stater, 19718
        • Christiana Care Health System-Christiana Hospital
      • Rehoboth Beach, Delaware, Forenede Stater, 19971
        • Beebe Health Campus
      • Seaford, Delaware, Forenede Stater, 19973
        • TidalHealth Nanticoke / Allen Cancer Center
    • District of Columbia
      • Washington, District of Columbia, Forenede Stater, 20010
        • MedStar Washington Hospital Center
    • Florida
      • Deerfield Beach, Florida, Forenede Stater, 33064
        • Broward Health North
      • Jacksonville, Florida, Forenede Stater, 32207
        • Baptist MD Anderson Cancer Center
      • Jacksonville, Florida, Forenede Stater, 32258
        • Baptist Medical Center South
      • Jupiter, Florida, Forenede Stater, 33458
        • Jupiter Medical Center
      • Miami, Florida, Forenede Stater, 33136
        • University of Miami Miller School of Medicine-Sylvester Cancer Center
      • Orlando, Florida, Forenede Stater, 32806
        • Orlando Health Cancer Institute
      • Palatka, Florida, Forenede Stater, 32177
        • Cancer Center of Putnam
      • Plantation, Florida, Forenede Stater, 33324
        • GenesisCare USA - Plantation
      • Tampa, Florida, Forenede Stater, 33612
        • James A. Haley Veterans Affairs Hospital
      • Trinity, Florida, Forenede Stater, 34655
        • Florida Cancer Affiliates
      • Weston, Florida, Forenede Stater, 33331
        • Cleveland Clinic-Weston
    • Georgia
      • Atlanta, Georgia, Forenede Stater, 30308
        • Emory University Hospital Midtown
      • Atlanta, Georgia, Forenede Stater, 30322
        • Emory University Hospital/Winship Cancer Institute
      • Atlanta, Georgia, Forenede Stater, 30342
        • Emory Saint Joseph's Hospital
      • Atlanta, Georgia, Forenede Stater, 30303
        • Grady Health System
      • Atlanta, Georgia, Forenede Stater, 30309
        • Piedmont Hospital
      • Columbus, Georgia, Forenede Stater, 31904
        • John B Amos Cancer Center
      • Decatur, Georgia, Forenede Stater, 30033
        • Atlanta VA Medical Center
      • Fayetteville, Georgia, Forenede Stater, 30214
        • Piedmont Fayette Hospital
      • Gainesville, Georgia, Forenede Stater, 30501
        • Northeast Georgia Medical Center-Gainesville
      • Macon, Georgia, Forenede Stater, 31201
        • Central Georgia Gynecologic Oncology
      • Savannah, Georgia, Forenede Stater, 31405
        • Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
    • Hawaii
      • 'Aiea, Hawaii, Forenede Stater, 96701
        • The Cancer Center of Hawaii-Pali Momi
      • Honolulu, Hawaii, Forenede Stater, 96813
        • Queen's Medical Center
      • Honolulu, Hawaii, Forenede Stater, 96817
        • The Cancer Center of Hawaii-Liliha
    • Idaho
      • Boise, Idaho, Forenede Stater, 83706
        • Saint Alphonsus Cancer Care Center-Boise
      • Coeur d'Alene, Idaho, Forenede Stater, 83814
        • Kootenai Health - Coeur d'Alene
      • Meridian, Idaho, Forenede Stater, 83642
        • Idaho Urologic Institute-Meridian
      • Post Falls, Idaho, Forenede Stater, 83854
        • Kootenai Clinic Cancer Services - Post Falls
      • Sandpoint, Idaho, Forenede Stater, 83864
        • Kootenai Cancer Clinic
      • Twin Falls, Idaho, Forenede Stater, 83301
        • Saint Luke's Cancer Institute - Twin Falls
    • Illinois
      • Arlington Heights, Illinois, Forenede Stater, 60005
        • Northwest Community Hospital
      • Aurora, Illinois, Forenede Stater, 60504
        • Rush - Copley Medical Center
      • Chicago, Illinois, Forenede Stater, 60612
        • Rush University Medical Center
      • Chicago, Illinois, Forenede Stater, 60612
        • John H Stroger Jr Hospital of Cook County
      • Chicago, Illinois, Forenede Stater, 60657
        • UChicago Medicine Comprehensive Cancer Center - Saint Joseph Hospital
      • Chicago, Illinois, Forenede Stater, 60640
        • Weiss Memorial Hospital
      • Chicago, Illinois, Forenede Stater, 60657
        • Advocate Illinois Masonic Medical Center
      • Decatur, Illinois, Forenede Stater, 62526
        • Decatur Memorial Hospital
      • Effingham, Illinois, Forenede Stater, 62401
        • Crossroads Cancer Center
      • Maywood, Illinois, Forenede Stater, 60153
        • Loyola University Medical Center
      • Peoria, Illinois, Forenede Stater, 61637
        • OSF Saint Francis Medical Center
      • Peoria, Illinois, Forenede Stater, 61615
        • OSF Saint Francis Radiation Oncology at Peoria Cancer Center
      • Rockford, Illinois, Forenede Stater, 61114
        • SwedishAmerican Regional Cancer Center/ACT
      • Springfield, Illinois, Forenede Stater, 62781
        • Memorial Medical Center
      • Springfield, Illinois, Forenede Stater, 62702
        • Saint John's Hospital
      • Swansea, Illinois, Forenede Stater, 62226
        • Southwest Illinois Health Services LLP
      • Urbana, Illinois, Forenede Stater, 61801
        • Carle Cancer Center
    • Indiana
      • Fort Wayne, Indiana, Forenede Stater, 46805
        • Parkview Hospital Randallia
      • Fort Wayne, Indiana, Forenede Stater, 46845
        • Parkview Regional Medical Center
      • Fort Wayne, Indiana, Forenede Stater, 46804
        • Radiation Oncology Associates PC
      • Indianapolis, Indiana, Forenede Stater, 46202
        • Indiana University/Melvin and Bren Simon Cancer Center
      • Indianapolis, Indiana, Forenede Stater, 46202
        • IU Health Methodist Hospital
      • South Bend, Indiana, Forenede Stater, 46601
        • Memorial Hospital of South Bend
    • Iowa
      • Ames, Iowa, Forenede Stater, 50010
        • McFarland Clinic PC - Ames
      • Cedar Rapids, Iowa, Forenede Stater, 52403
        • Mercy Hospital
      • Cedar Rapids, Iowa, Forenede Stater, 52402
        • Saint Luke's Hospital
      • Dubuque, Iowa, Forenede Stater, 52001
        • Finley Hospital
    • Kansas
      • Garden City, Kansas, Forenede Stater, 67846
        • Central Care Cancer Center - Garden City
      • Garden City, Kansas, Forenede Stater, 67846
        • Saint Catherine Hospital
      • Kansas City, Kansas, Forenede Stater, 66160
        • University of Kansas Cancer Center
      • Lawrence, Kansas, Forenede Stater, 66044
        • Lawrence Memorial Hospital
      • Olathe, Kansas, Forenede Stater, 66061
        • Olathe Health Cancer Center
      • Overland Park, Kansas, Forenede Stater, 66210
        • University of Kansas Cancer Center-Overland Park
      • Topeka, Kansas, Forenede Stater, 66606
        • Cotton O'Neil Cancer Center / Stormont Vail Health
      • Wichita, Kansas, Forenede Stater, 67214
        • Ascension Via Christi Hospitals Wichita
    • Kentucky
      • Lexington, Kentucky, Forenede Stater, 40536
        • University of Kentucky/Markey Cancer Center
      • Owensboro, Kentucky, Forenede Stater, 42303
        • Owensboro Health Mitchell Memorial Cancer Center
    • Louisiana
      • Baton Rouge, Louisiana, Forenede Stater, 70809
        • Mary Bird Perkins Cancer Center
      • Covington, Louisiana, Forenede Stater, 70433
        • Mary Bird Perkins Cancer Center - Covington
      • Houma, Louisiana, Forenede Stater, 70360
        • Mary Bird Perkins Cancer Center - Houma
      • Metairie, Louisiana, Forenede Stater, 70006
        • East Jefferson General Hospital
      • Metairie, Louisiana, Forenede Stater, 70006
        • LSU Healthcare Network / Metairie Multi-Specialty Clinic
      • New Orleans, Louisiana, Forenede Stater, 70121
        • Ochsner Medical Center Jefferson
      • New Orleans, Louisiana, Forenede Stater, 70112
        • Tulane University Health Sciences Center
      • New Orleans, Louisiana, Forenede Stater, 70115
        • Touro Infirmary
    • Maryland
      • Annapolis, Maryland, Forenede Stater, 21401
        • Anne Arundel Medical Center
      • Baltimore, Maryland, Forenede Stater, 21204
        • Greater Baltimore Medical Center
      • Baltimore, Maryland, Forenede Stater, 21201
        • University of Maryland/Greenebaum Cancer Center
      • Baltimore, Maryland, Forenede Stater, 21229
        • Saint Agnes Hospital
      • Bel Air, Maryland, Forenede Stater, 21014
        • UM Upper Chesapeake Medical Center
      • Columbia, Maryland, Forenede Stater, 21044
        • Central Maryland Radiation Oncology in Howard County
      • Elkton, Maryland, Forenede Stater, 21921
        • University of Maryland Radiation Oncology Center at Union Hospital
      • Glen Burnie, Maryland, Forenede Stater, 21061
        • UM Baltimore Washington Medical Center/Tate Cancer Center
      • Salisbury, Maryland, Forenede Stater, 21801
        • TidalHealth Peninsula Regional
      • Towson, Maryland, Forenede Stater, 21204
        • UM Saint Joseph Medical Center
    • Massachusetts
      • Boston, Massachusetts, Forenede Stater, 02114
        • Massachusetts General Hospital Cancer Center
      • Fall River, Massachusetts, Forenede Stater, 02721
        • Saint Anne's Hospital
      • Hyannis, Massachusetts, Forenede Stater, 02601
        • Cape Cod Hospital
      • Lowell, Massachusetts, Forenede Stater, 01854
        • Lowell General Hospital
      • Plymouth, Massachusetts, Forenede Stater, 02360
        • Beth Israel Deaconess Hospital-Plymouth
    • Michigan
      • Adrian, Michigan, Forenede Stater, 49221
        • Bixby Medical Center
      • Ann Arbor, Michigan, Forenede Stater, 48109
        • University of Michigan Comprehensive Cancer Center
      • Ann Arbor, Michigan, Forenede Stater, 48106
        • Saint Joseph Mercy Hospital
      • Ann Arbor, Michigan, Forenede Stater, 48105
        • Veteran's Administration Medical Center - Ann Arbor
      • Battle Creek, Michigan, Forenede Stater, 49017
        • Bronson Battle Creek
      • Bay City, Michigan, Forenede Stater, 48706
        • McLaren Cancer Institute-Bay City
      • Brownstown, Michigan, Forenede Stater, 48183
        • Henry Ford Cancer Institute-Downriver
      • Clarkston, Michigan, Forenede Stater, 48346
        • McLaren Cancer Institute-Clarkston
      • Clarkston, Michigan, Forenede Stater, 48346
        • GenesisCare USA - Clarkston
      • Clinton Township, Michigan, Forenede Stater, 48038
        • Henry Ford Macomb Hospital-Clinton Township
      • Dearborn, Michigan, Forenede Stater, 48124
        • Beaumont Hospital - Dearborn
      • Detroit, Michigan, Forenede Stater, 48202
        • Henry Ford Hospital
      • Detroit, Michigan, Forenede Stater, 48201
        • Wayne State University/Karmanos Cancer Institute
      • Detroit, Michigan, Forenede Stater, 48236
        • Ascension Saint John Hospital
      • Farmington Hills, Michigan, Forenede Stater, 48334
        • Weisberg Cancer Treatment Center
      • Farmington Hills, Michigan, Forenede Stater, 48336
        • Beaumont Hospital - Farmington Hills
      • Farmington Hills, Michigan, Forenede Stater, 48334
        • GenesisCare USA - Farmington Hills
      • Flint, Michigan, Forenede Stater, 48532
        • McLaren Cancer Institute-Flint
      • Grand Rapids, Michigan, Forenede Stater, 49503
        • Spectrum Health at Butterworth Campus
      • Grand Rapids, Michigan, Forenede Stater, 49503
        • Mercy Health Saint Mary's
      • Kalamazoo, Michigan, Forenede Stater, 49007
        • West Michigan Cancer Center
      • Lansing, Michigan, Forenede Stater, 48912
        • Sparrow Hospital
      • Lansing, Michigan, Forenede Stater, 48910
        • Karmanos Cancer Institute at McLaren Greater Lansing
      • Lapeer, Michigan, Forenede Stater, 48446
        • McLaren Cancer Institute-Lapeer Region
      • Livonia, Michigan, Forenede Stater, 48154
        • Saint Mary Mercy Hospital
      • Mount Clemens, Michigan, Forenede Stater, 48043
        • McLaren Cancer Institute-Macomb
      • Mount Pleasant, Michigan, Forenede Stater, 48858
        • McLaren Cancer Institute-Central Michigan
      • Muskegon, Michigan, Forenede Stater, 49444
        • Mercy Health Mercy Campus
      • Owosso, Michigan, Forenede Stater, 48867
        • McLaren Cancer Institute-Owosso
      • Petoskey, Michigan, Forenede Stater, 49770
        • McLaren Cancer Institute-Northern Michigan
      • Pontiac, Michigan, Forenede Stater, 48341
        • Saint Joseph Mercy Oakland
      • Pontiac, Michigan, Forenede Stater, 48341
        • 21st Century Oncology-Pontiac
      • Port Huron, Michigan, Forenede Stater, 48060
        • McLaren-Port Huron
      • Royal Oak, Michigan, Forenede Stater, 48073
        • William Beaumont Hospital-Royal Oak
      • Saginaw, Michigan, Forenede Stater, 48601
        • Ascension Saint Mary's Hospital
      • Saint Joseph, Michigan, Forenede Stater, 49085
        • Lakeland Medical Center Saint Joseph
      • Troy, Michigan, Forenede Stater, 48085
        • William Beaumont Hospital - Troy
      • Troy, Michigan, Forenede Stater, 48098
        • GenesisCare USA - Troy
      • Warren, Michigan, Forenede Stater, 48093
        • Saint John Macomb-Oakland Hospital
      • West Bloomfield, Michigan, Forenede Stater, 48322
        • Henry Ford West Bloomfield Hospital
      • Wyoming, Michigan, Forenede Stater, 49519
        • Metro Health Hospital
    • Minnesota
      • Albert Lea, Minnesota, Forenede Stater, 56007
        • Mayo Clinic Health System in Albert Lea
      • Bemidji, Minnesota, Forenede Stater, 56601
        • Sanford Joe Lueken Cancer Center
      • Duluth, Minnesota, Forenede Stater, 55805
        • Saint Luke's Hospital of Duluth
      • Mankato, Minnesota, Forenede Stater, 56001
        • Mayo Clinic Health Systems-Mankato
      • Minneapolis, Minnesota, Forenede Stater, 55415
        • Hennepin County Medical Center
      • Monticello, Minnesota, Forenede Stater, 55362
        • Monticello Cancer Center
      • Saint Cloud, Minnesota, Forenede Stater, 56303
        • Coborn Cancer Center at Saint Cloud Hospital
      • Saint Louis Park, Minnesota, Forenede Stater, 55416
        • Park Nicollet Clinic - Saint Louis Park
      • Saint Paul, Minnesota, Forenede Stater, 55101
        • Regions Hospital
      • Willmar, Minnesota, Forenede Stater, 56201
        • Rice Memorial Hospital
    • Mississippi
      • Jackson, Mississippi, Forenede Stater, 39216
        • University of Mississippi Medical Center
      • Pascagoula, Mississippi, Forenede Stater, 39581
        • Singing River Hospital
    • Missouri
      • Cape Girardeau, Missouri, Forenede Stater, 63703
        • Saint Francis Medical Center
      • Cape Girardeau, Missouri, Forenede Stater, 63703
        • Southeast Cancer Center
      • Creve Coeur, Missouri, Forenede Stater, 63141
        • Siteman Cancer Center at West County Hospital
      • Joplin, Missouri, Forenede Stater, 64804
        • Freeman Health System
      • Kansas City, Missouri, Forenede Stater, 64128
        • Kansas City Veterans Affairs Medical Center
      • Kansas City, Missouri, Forenede Stater, 64154
        • University of Kansas Cancer Center - North
      • Kansas City, Missouri, Forenede Stater, 64116
        • North Kansas City Hospital
      • Kansas City, Missouri, Forenede Stater, 64131
        • The University of Kansas Cancer Center-South
      • Lee's Summit, Missouri, Forenede Stater, 64064
        • University of Kansas Cancer Center - Lee's Summit
      • Rolla, Missouri, Forenede Stater, 65401
        • Delbert Day Cancer Institute at PCRMC
      • Saint Joseph, Missouri, Forenede Stater, 64506
        • Heartland Regional Medical Center
      • Saint Louis, Missouri, Forenede Stater, 63110
        • Washington University School of Medicine
      • Saint Louis, Missouri, Forenede Stater, 63131
        • Missouri Baptist Medical Center
      • Saint Louis, Missouri, Forenede Stater, 63141
        • Mercy Hospital Saint Louis
      • Saint Louis, Missouri, Forenede Stater, 63129
        • Siteman Cancer Center-South County
      • Saint Louis, Missouri, Forenede Stater, 63125
        • Veteran's Affairs Medical Center - Saint Louis
      • Saint Peters, Missouri, Forenede Stater, 63376
        • Siteman Cancer Center at Saint Peters Hospital
      • Springfield, Missouri, Forenede Stater, 65807
        • CoxHealth South Hospital
    • Montana
      • Billings, Montana, Forenede Stater, 59101
        • Billings Clinic Cancer Center
      • Great Falls, Montana, Forenede Stater, 59405
        • Benefis Healthcare- Sletten Cancer Institute
    • Nebraska
      • Omaha, Nebraska, Forenede Stater, 68198
        • University of Nebraska Medical Center
      • Omaha, Nebraska, Forenede Stater, 68124
        • Alegent Health Bergan Mercy Medical Center
    • Nevada
      • Reno, Nevada, Forenede Stater, 89502
        • Renown Regional Medical Center
    • New Hampshire
      • Exeter, New Hampshire, Forenede Stater, 03833
        • Exeter Hospital
      • Lebanon, New Hampshire, Forenede Stater, 03756
        • Dartmouth Hitchcock Medical Center
    • New Jersey
      • Egg Harbor Township, New Jersey, Forenede Stater, 08234
        • AtlantiCare Surgery Center
      • Mount Holly, New Jersey, Forenede Stater, 08060
        • Virtua Memorial
      • Mullica Hill, New Jersey, Forenede Stater, 08062
        • Inspira Medical Center Mullica Hill
      • Plainsboro, New Jersey, Forenede Stater, 08536
        • Penn Medicine Princeton Health
      • Sewell, New Jersey, Forenede Stater, 08080
        • Sidney Kimmel Cancer Center Washington Township
      • Somerville, New Jersey, Forenede Stater, 08876
        • Robert Wood Johnson University Hospital Somerset
      • Sparta, New Jersey, Forenede Stater, 07871
        • Sparta Cancer Treatment Center
      • Vineland, New Jersey, Forenede Stater, 08360
        • Inspira Medical Center Vineland
      • Voorhees, New Jersey, Forenede Stater, 08043
        • Virtua Voorhees
    • New Mexico
      • Las Cruces, New Mexico, Forenede Stater, 88011
        • Memorial Medical Center - Las Cruces
    • New York
      • Bay Shore, New York, Forenede Stater, 11706
        • South Shore University Hospital
      • Bronx, New York, Forenede Stater, 10468
        • James J Peters VA Medical Center
      • Brooklyn, New York, Forenede Stater, 11215
        • New York-Presbyterian/Brooklyn Methodist Hospital
      • Canandaigua, New York, Forenede Stater, 14424
        • Sands Cancer Center
      • Cooperstown, New York, Forenede Stater, 13326
        • Mary Imogene Bassett Hospital
      • Elmira, New York, Forenede Stater, 14905
        • Arnot Ogden Medical Center/Falck Cancer Center
      • Lake Success, New York, Forenede Stater, 11042
        • Northwell Health/Center for Advanced Medicine
      • New Hyde Park, New York, Forenede Stater, 11040
        • Long Island Jewish Medical Center
      • New York, New York, Forenede Stater, 10032
        • NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
      • Rochester, New York, Forenede Stater, 14642
        • University of Rochester
      • Rochester, New York, Forenede Stater, 14620
        • Highland Hospital
      • Rochester, New York, Forenede Stater, 14606
        • Wilmot Cancer Institute Radiation Oncology at Greece
      • Stony Brook, New York, Forenede Stater, 11794
        • Stony Brook University Medical Center
    • North Carolina
      • Chapel Hill, North Carolina, Forenede Stater, 27599
        • UNC Lineberger Comprehensive Cancer Center
      • Durham, North Carolina, Forenede Stater, 27710
        • Duke University Medical Center
      • Durham, North Carolina, Forenede Stater, 27705
        • Durham VA Medical Center
      • Morehead City, North Carolina, Forenede Stater, 28557
        • The Coleman Radiation Center-Carteret General Hospital
      • Pinehurst, North Carolina, Forenede Stater, 28374
        • FirstHealth of the Carolinas-Moore Regional Hospital
      • Raleigh, North Carolina, Forenede Stater, 27607
        • UNC REX Cancer Center
      • Supply, North Carolina, Forenede Stater, 28462
        • NHRMC Radiation Oncology - Supply
      • Wilmington, North Carolina, Forenede Stater, 28401
        • NHRMC Radiation Oncology - 16th Street
      • Winston-Salem, North Carolina, Forenede Stater, 27157
        • Wake Forest University Health Sciences
      • Winston-Salem, North Carolina, Forenede Stater, 27103
        • Novant Health Forsyth Medical Center
    • North Dakota
      • Fargo, North Dakota, Forenede Stater, 58122
        • Sanford Broadway Medical Center
    • Ohio
      • Akron, Ohio, Forenede Stater, 44307
        • Cleveland Clinic Akron General
      • Akron, Ohio, Forenede Stater, 44304
        • Summa Health System - Akron Campus
      • Barberton, Ohio, Forenede Stater, 44203
        • Summa Health System - Barberton Campus
      • Beachwood, Ohio, Forenede Stater, 44122
        • UHHS-Chagrin Highlands Medical Center
      • Canton, Ohio, Forenede Stater, 44708
        • Cleveland Clinic Mercy Hospital
      • Chardon, Ohio, Forenede Stater, 44024
        • Geauga Hospital
      • Chillicothe, Ohio, Forenede Stater, 45601
        • Adena Regional Medical Center
      • Cleveland, Ohio, Forenede Stater, 44106
        • Case Western Reserve University
      • Cleveland, Ohio, Forenede Stater, 44195
        • Cleveland Clinic Foundation
      • Cleveland, Ohio, Forenede Stater, 44111
        • Cleveland Clinic Cancer Center/Fairview Hospital
      • Columbus, Ohio, Forenede Stater, 43210
        • Ohio State University Comprehensive Cancer Center
      • Columbus, Ohio, Forenede Stater, 43219
        • The Mark H Zangmeister Center
      • Columbus, Ohio, Forenede Stater, 43222
        • Mount Carmel Health Center West
      • Elyria, Ohio, Forenede Stater, 44035
        • Mercy Cancer Center-Elyria
      • Independence, Ohio, Forenede Stater, 44131
        • Cleveland Clinic Cancer Center Independence
      • Mansfield, Ohio, Forenede Stater, 44906
        • Cleveland Clinic Cancer Center Mansfield
      • Maumee, Ohio, Forenede Stater, 43537
        • Toledo Clinic Cancer Centers-Maumee
      • Mayfield Heights, Ohio, Forenede Stater, 44124
        • Hillcrest Hospital Cancer Center
      • Medina, Ohio, Forenede Stater, 44256
        • Summa Health Medina Medical Center
      • Mentor, Ohio, Forenede Stater, 44060
        • UH Seidman Cancer Center at Lake Health Mentor Campus
      • Middleburg Heights, Ohio, Forenede Stater, 44130
        • UH Seidman Cancer Center at Southwest General Hospital
      • Oregon, Ohio, Forenede Stater, 43616
        • Saint Charles Hospital
      • Parma, Ohio, Forenede Stater, 44129
        • University Hospitals Parma Medical Center
      • Portsmouth, Ohio, Forenede Stater, 45662
        • Southern Ohio Medical Center
      • Ravenna, Ohio, Forenede Stater, 44266
        • University Hospitals Portage Medical Center
      • Salem, Ohio, Forenede Stater, 44460
        • UH Seidman Cancer Center at Salem Regional Medical Center
      • Sandusky, Ohio, Forenede Stater, 44870
        • North Coast Cancer Care
      • Sandusky, Ohio, Forenede Stater, 44870
        • UH Seidman Cancer Center at Firelands Regional Medical Center
      • Strongsville, Ohio, Forenede Stater, 44136
        • Cleveland Clinic Cancer Center Strongsville
      • Sylvania, Ohio, Forenede Stater, 43560
        • ProMedica Flower Hospital
      • Toledo, Ohio, Forenede Stater, 43623
        • Mercy Health - Saint Anne Hospital
      • Toledo, Ohio, Forenede Stater, 43614
        • University of Toledo
      • Westlake, Ohio, Forenede Stater, 44145
        • UHHS-Westlake Medical Center
      • Wooster, Ohio, Forenede Stater, 44691
        • Cleveland Clinic Wooster Family Health and Surgery Center
      • Wooster, Ohio, Forenede Stater, 44691
        • Cancer Treatment Center
      • Wright-Patterson Air Force Base, Ohio, Forenede Stater, 45433
        • Wright-Patterson Medical Center
      • Zanesville, Ohio, Forenede Stater, 43701
        • Genesis Healthcare System Cancer Care Center
    • Oklahoma
      • Oklahoma City, Oklahoma, Forenede Stater, 73104
        • University of Oklahoma Health Sciences Center
      • Tulsa, Oklahoma, Forenede Stater, 74104
        • Saint John Medical Center
    • Oregon
      • Clackamas, Oregon, Forenede Stater, 97015
        • Clackamas Radiation Oncology Center
      • Grants Pass, Oregon, Forenede Stater, 97527
        • Three Rivers Community Hospital
      • Medford, Oregon, Forenede Stater, 97504
        • Providence Medford Medical Center
      • Medford, Oregon, Forenede Stater, 97504
        • Rogue Valley Medical Center
      • Portland, Oregon, Forenede Stater, 97213
        • Providence Portland Medical Center
      • Portland, Oregon, Forenede Stater, 97225
        • Providence Saint Vincent Medical Center
      • Portland, Oregon, Forenede Stater, 97227
        • Kaiser Permanente Northwest
    • Pennsylvania
      • Abington, Pennsylvania, Forenede Stater, 19001
        • Jefferson Abington Hospital
      • Allentown, Pennsylvania, Forenede Stater, 18103
        • Lehigh Valley Hospital-Cedar Crest
      • Danville, Pennsylvania, Forenede Stater, 17822
        • Geisinger Medical Center
      • Dunmore, Pennsylvania, Forenede Stater, 18512
        • Northeast Radiation Oncology Center
      • Ephrata, Pennsylvania, Forenede Stater, 17522
        • Ephrata Cancer Center
      • Furlong, Pennsylvania, Forenede Stater, 18925
        • Fox Chase Cancer Center Buckingham
      • Gettysburg, Pennsylvania, Forenede Stater, 17325
        • Adams Cancer Center
      • Hanover, Pennsylvania, Forenede Stater, 17331
        • Cherry Tree Cancer Center
      • Hershey, Pennsylvania, Forenede Stater, 17033-0850
        • Penn State Milton S Hershey Medical Center
      • Lebanon, Pennsylvania, Forenede Stater, 17042
        • Sechler Family Cancer Center
      • Milford, Pennsylvania, Forenede Stater, 18337
        • Upper Delaware Valley Cancer Center
      • Philadelphia, Pennsylvania, Forenede Stater, 19111
        • Fox Chase Cancer Center
      • Pittsburgh, Pennsylvania, Forenede Stater, 15240
        • VA Pittsburgh Healthcare System
      • West Reading, Pennsylvania, Forenede Stater, 19611
        • Reading Hospital
      • Wilkes-Barre, Pennsylvania, Forenede Stater, 18711
        • Geisinger Wyoming Valley/Henry Cancer Center
      • Willow Grove, Pennsylvania, Forenede Stater, 19090
        • Asplundh Cancer Pavilion
      • York, Pennsylvania, Forenede Stater, 17403
        • WellSpan Health-York Hospital
    • South Carolina
      • Anderson, South Carolina, Forenede Stater, 29621
        • AnMed Health Cancer Center
      • Boiling Springs, South Carolina, Forenede Stater, 29316
        • Prisma Health Cancer Institute - Spartanburg
      • Charleston, South Carolina, Forenede Stater, 29425
        • Medical University of South Carolina
      • Georgetown, South Carolina, Forenede Stater, 29440
        • Tidelands Georgetown Memorial Hospital
      • Greenville, South Carolina, Forenede Stater, 29605
        • Prisma Health Cancer Institute - Faris
      • Greenville, South Carolina, Forenede Stater, 29607
        • Saint Francis Cancer Center
      • Greenville, South Carolina, Forenede Stater, 29615
        • Prisma Health Cancer Institute - Eastside
      • Greenwood, South Carolina, Forenede Stater, 29646
        • Self Regional Healthcare
      • Greer, South Carolina, Forenede Stater, 29650
        • Prisma Health Cancer Institute - Greer
      • Greer, South Carolina, Forenede Stater, 29651
        • Gibbs Cancer Center-Pelham
      • Hilton Head Island, South Carolina, Forenede Stater, 29926
        • The Radiation Oncology Center-Hilton Head/Bluffton
      • Seneca, South Carolina, Forenede Stater, 29672
        • Prisma Health Cancer Institute - Seneca
      • Spartanburg, South Carolina, Forenede Stater, 29303
        • Spartanburg Medical Center
    • South Dakota
      • Sioux Falls, South Dakota, Forenede Stater, 57117-5134
        • Sanford USD Medical Center - Sioux Falls
    • Tennessee
      • Chattanooga, Tennessee, Forenede Stater, 37403
        • Erlanger Medical Center
      • Kingsport, Tennessee, Forenede Stater, 37660
        • Wellmont Holston Valley Hospital and Medical Center
      • Nashville, Tennessee, Forenede Stater, 37232
        • Vanderbilt University/Ingram Cancer Center
    • Texas
      • Abilene, Texas, Forenede Stater, 79606
        • Texas Cancer Center
      • Beaumont, Texas, Forenede Stater, 77702
        • Texas Oncology PA Beaumont
      • Dallas, Texas, Forenede Stater, 75390
        • UT Southwestern/Simmons Cancer Center-Dallas
      • Denison, Texas, Forenede Stater, 75020
        • Texas Oncology - Denison Cancer Center
      • Fort Sam Houston, Texas, Forenede Stater, 78234
        • Brooke Army Medical Center
      • Fort Worth, Texas, Forenede Stater, 76104
        • Texas Oncology - Fort Worth Cancer Center
      • Galveston, Texas, Forenede Stater, 77555-0565
        • University of Texas Medical Branch
      • Houston, Texas, Forenede Stater, 77030
        • Ben Taub General Hospital
      • Houston, Texas, Forenede Stater, 77024
        • Memorial Hermann Memorial City Medical Center
      • League City, Texas, Forenede Stater, 77573
        • UTMB Cancer Center at Victory Lakes
      • McAllen, Texas, Forenede Stater, 78503
        • Texas Oncology-McAllen
      • McKinney, Texas, Forenede Stater, 75071
        • Texas Oncology-McKinney
      • Odessa, Texas, Forenede Stater, 79761
        • West Texas Cancer Center
      • Plano, Texas, Forenede Stater, 75093
        • Texas Oncology-Plano West
      • San Antonio, Texas, Forenede Stater, 78229
        • University of Texas Health Science Center at San Antonio
      • Sugar Land, Texas, Forenede Stater, 77479
        • Texas Oncology Cancer Center Sugar Land
      • Webster, Texas, Forenede Stater, 77598
        • Deke Slayton Cancer Center
    • Utah
      • American Fork, Utah, Forenede Stater, 84003
        • American Fork Hospital / Huntsman Intermountain Cancer Center
      • Cedar City, Utah, Forenede Stater, 84720
        • Sandra L Maxwell Cancer Center
      • Murray, Utah, Forenede Stater, 84107
        • Intermountain Medical Center
      • Ogden, Utah, Forenede Stater, 84403
        • McKay-Dee Hospital Center
      • Ogden, Utah, Forenede Stater, 84405
        • Ogden Regional Medical Center
      • Provo, Utah, Forenede Stater, 84604
        • Utah Valley Regional Medical Center
      • Saint George, Utah, Forenede Stater, 84770
        • Dixie Medical Center Regional Cancer Center
      • Salt Lake City, Utah, Forenede Stater, 84112
        • Huntsman Cancer Institute/University of Utah
      • Salt Lake City, Utah, Forenede Stater, 84106
        • Utah Cancer Specialists-Salt Lake City
    • Vermont
      • Bennington, Vermont, Forenede Stater, 05201
        • Southwestern Vermont Medical Center
      • Berlin, Vermont, Forenede Stater, 05602
        • Central Vermont Medical Center/National Life Cancer Treatment
      • Burlington, Vermont, Forenede Stater, 05401
        • University of Vermont Medical Center
      • Saint Johnsbury, Vermont, Forenede Stater, 05819
        • Norris Cotton Cancer Center-North
    • Virginia
      • Charlottesville, Virginia, Forenede Stater, 22908
        • University of Virginia Cancer Center
      • Fishersville, Virginia, Forenede Stater, 22939
        • Augusta Health Center for Cancer and Blood Disorders
      • Hampton, Virginia, Forenede Stater, 23666
        • Sentara Cancer Institute at Sentara CarePlex Hospital
      • Harrisonburg, Virginia, Forenede Stater, 22801
        • Sentara Rockingham Memorial Hospital Hahn Cancer Center
      • Norfolk, Virginia, Forenede Stater, 23507
        • Sentara Norfolk General Hospital
      • Norfolk, Virginia, Forenede Stater, 23505
        • Bon Secours DePaul Medical Center
      • Portsmouth, Virginia, Forenede Stater, 23708-2197
        • Naval Medical Center - Portsmouth
      • Richmond, Virginia, Forenede Stater, 23249
        • Hunter Holmes McGuire Veterans Administration Medical Center
      • Roanoke, Virginia, Forenede Stater, 24014
        • Oncology and Hematology Associates of Southwest Virginia
      • Suffolk, Virginia, Forenede Stater, 23434
        • Sentara Obici Hospital
      • Virginia Beach, Virginia, Forenede Stater, 23454
        • Sentara Virginia Beach General Hospital
    • Washington
      • Federal Way, Washington, Forenede Stater, 98003
        • Saint Francis Hospital
      • Seattle, Washington, Forenede Stater, 98101
        • Virginia Mason Medical Center
      • Tacoma, Washington, Forenede Stater, 98431
        • Madigan Army Medical Center
      • Vancouver, Washington, Forenede Stater, 98664
        • PeaceHealth Southwest Medical Center
      • Yakima, Washington, Forenede Stater, 98902
        • North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
    • West Virginia
      • Bridgeport, West Virginia, Forenede Stater, 26330
        • United Hospital Center
      • Morgantown, West Virginia, Forenede Stater, 26506
        • West Virginia University Healthcare
    • Wisconsin
      • Antigo, Wisconsin, Forenede Stater, 54409
        • Langlade Hospital and Cancer Center
      • Appleton, Wisconsin, Forenede Stater, 54911
        • ThedaCare Regional Cancer Center
      • Appleton, Wisconsin, Forenede Stater, 54911
        • ThedaCare Regional Medical Center - Appleton
      • Brookfield, Wisconsin, Forenede Stater, 53045
        • Ascension Southeast Wisconsin Hospital - Elmbrook Campus
      • Eau Claire, Wisconsin, Forenede Stater, 54701
        • Marshfield Medical Center-EC Cancer Center
      • Eau Claire, Wisconsin, Forenede Stater, 54703
        • Mayo Clinic Health System Eau Claire Hospital-Luther Campus
      • Franklin, Wisconsin, Forenede Stater, 53132
        • Ascension Saint Francis - Reiman Cancer Center
      • Green Bay, Wisconsin, Forenede Stater, 54311
        • Aurora BayCare Medical Center
      • Green Bay, Wisconsin, Forenede Stater, 54301
        • Saint Vincent Hospital Cancer Center Green Bay
      • Green Bay, Wisconsin, Forenede Stater, 54303
        • Saint Vincent Hospital Cancer Center at Saint Mary's
      • Johnson Creek, Wisconsin, Forenede Stater, 53038
        • UW Cancer Center Johnson Creek
      • La Crosse, Wisconsin, Forenede Stater, 54601
        • Gundersen Lutheran Medical Center
      • La Crosse, Wisconsin, Forenede Stater, 54601
        • Mayo Clinic Health System-Franciscan Healthcare
      • Madison, Wisconsin, Forenede Stater, 53792
        • University of Wisconsin Hospital and Clinics
      • Marinette, Wisconsin, Forenede Stater, 54143
        • Aurora Bay Area Medical Group-Marinette
      • Marinette, Wisconsin, Forenede Stater, 54143
        • Bay Area Medical Center
      • Marshfield, Wisconsin, Forenede Stater, 54449
        • Marshfield Medical Center-Marshfield
      • Menomonee Falls, Wisconsin, Forenede Stater, 53051
        • Froedtert Menomonee Falls Hospital
      • Mequon, Wisconsin, Forenede Stater, 53097
        • Ascension Columbia Saint Mary's Hospital Ozaukee
      • Milwaukee, Wisconsin, Forenede Stater, 53226
        • Medical College of Wisconsin
      • Milwaukee, Wisconsin, Forenede Stater, 53215
        • Aurora Saint Luke's Medical Center
      • Milwaukee, Wisconsin, Forenede Stater, 53210
        • Ascension Southeast Wisconsin Hospital - Saint Joseph Campus
      • Milwaukee, Wisconsin, Forenede Stater, 53211
        • Ascension Columbia Saint Mary's Hospital - Milwaukee
      • Milwaukee, Wisconsin, Forenede Stater, 53295
        • Zablocki Veterans Administration Medical Center
      • Minocqua, Wisconsin, Forenede Stater, 54548
        • Marshfield Clinic-Minocqua Center
      • Oshkosh, Wisconsin, Forenede Stater, 54904
        • Vince Lombardi Cancer Clinic - Oshkosh
      • Racine, Wisconsin, Forenede Stater, 53405
        • Ascension All Saints Hospital
      • Rice Lake, Wisconsin, Forenede Stater, 54868
        • Marshfield Medical Center-Rice Lake
      • Sheboygan, Wisconsin, Forenede Stater, 53081
        • Vince Lombardi Cancer Clinic-Sheboygan
      • Sheboygan, Wisconsin, Forenede Stater, 53081
        • HSHS Saint Nicholas Hospital
      • Stevens Point, Wisconsin, Forenede Stater, 54482
        • Marshfield Clinic Stevens Point Center
      • Sturgeon Bay, Wisconsin, Forenede Stater, 54235-1495
        • Saint Vincent Hospital Cancer Center at Sturgeon Bay
      • Summit, Wisconsin, Forenede Stater, 53066
        • Aurora Medical Center in Summit
      • Two Rivers, Wisconsin, Forenede Stater, 54241
        • Vince Lombardi Cancer Clinic-Two Rivers
      • Wausau, Wisconsin, Forenede Stater, 54401
        • Aspirus Regional Cancer Center
      • West Allis, Wisconsin, Forenede Stater, 53227
        • Aurora West Allis Medical Center
      • West Bend, Wisconsin, Forenede Stater, 53095
        • Froedtert West Bend Hospital/Kraemer Cancer Center
      • Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
        • Aspirus Cancer Care - Wisconsin Rapids
    • Wyoming
      • Cody, Wyoming, Forenede Stater, 82414
        • Billings Clinic-Cody
      • Chai Wan, Hong Kong
        • Pamela Youde Nethersole Eastern Hospital
      • Petach Tikva, Israel, 49100
        • Rabin Medical Center
      • Tel Hashomer, Israel, 52621
        • Chaim Sheba Medical Center
      • Aarau, Schweiz, 5001
        • Kantonsspital Aarau
      • Singapore, Singapore, 169610
        • National Cancer Centre Singapore
      • Singapore, Singapore, 119074
        • National University Hospital Singapore

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

16 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

SYGDOMS KARAKTERISTIKA:

  • Patologisk (histologisk eller cytologisk) dokumenteret diagnose af prostataadenokarcinom inden for 180 dage efter registrering med moderat til høj risiko for recidiv som bestemt af en af ​​følgende kombinationer:

    • Gleason-score 7-10 + T1c-T2b (palpering) + prostataspecifikt antigen (PSA) < 50 ng/mL (inkluderer mellem- og højrisikopatienter)
    • Gleason score 6 + T2c-T4 (palpering) + PSA < 50 ng/mL ELLER
    • Gleason score 6 + >= 50 % (positive) biopsier + PSA < 50 ng/ml
    • Gleason-score 6 + T1c-T2b (palpation) + PSA > 20 ng/ml Patienter, der tidligere er diagnosticeret med lavrisikoprostatacancer, der er under aktiv overvågning, og som genbiopsieres og viser sig at have ugunstig mellemrisikosygdom eller gunstig højrisikosygdom i henhold til protokollen kriterier er berettiget til tilmelding inden for 180 dage efter den gentagne biopsiprocedure.
  • Anamnese og/eller fysisk undersøgelse (som minimum omfatter digital rektal undersøgelse af prostata og undersøgelse af skelet og mave) inden for 90 dage før registrering
  • Klinisk negative lymfeknuder som fastslået ved billeddannelse (bækken- og/eller abdominal CT eller MR), (men ikke ved nodalprøvetagning eller dissektion) inden for 90 dage før registrering

    • Patienter med lymfeknuder, der er tvetydige eller tvivlsomme ved billeddiagnostik, er kvalificerede, hvis knuderne er ≤ 1,5 cm
    • Patientstatus efter en negativ lymfeknudedissektion er ikke berettiget
  • Ingen tegn på knoglemetastaser (M0) på knoglescanning inden for 120 dage før registrering (Na F PET/CT er en acceptabel erstatning)

    • Tvetydige knoglescanningsfund er tilladt, hvis almindelige film (eller CT eller MR) er negative for metastase
  • Baseline serum PSA-værdi udført med et FDA-godkendt assay (f.eks. Abbott, Hybritech) inden for 120 dage før registrering
  • Studieindgangs-PSA bør ikke opnås inden for følgende tidsrammer:

    • Ti dages periode efter prostatabiopsi
    • Efter påbegyndelse af hormonbehandling
    • Inden for 30 dage efter seponering af finasterid
    • Inden for 90 dage efter seponering af dutasterid

PATIENT KARAKTERISTIKA:

  • Zubrod præstationsstatus 0-1
  • Absolut neutrofiltal (ANC) ≥ 1.500/mm³
  • Blodpladeantal ≥ 100.000/mm³
  • Hæmoglobin (Hgb) ≥ 8,0 g/dL (transfusion eller anden intervention for at opnå Hgb ≥ 8,0 g/dL er acceptabel)
  • Ingen tidligere invasiv (undtagen ikke-melanom hudkræft) malignitet, medmindre sygdomsfri i mindst 3 år (1.095 dage) og ikke i bækkenet

    • F.eks. er carcinom in situ i mundhulen tilladt; dog er patienter med tidligere blærekræft ikke tilladt
    • Ingen tidligere hæmatologisk (f.eks. leukæmi, lymfom eller myelom) malignitet
    • Ingen tidligere radikal kirurgi (prostatektomi) eller kryokirurgi for prostatacancer
    • Ingen tidligere bækkenbestråling, prostata brachyterapi eller bilateral orkiektomi
    • Ingen tidligere hormonbehandling, såsom LHRH-agonister (f.eks. leuprolid, goserelin, buserelin, triptorelin) eller LHRH-antagonist (f.eks. degarelix), anti-androgener (f.eks. flutamid, bicalutamid, cyproteronacetat), østrogener (f.eks. DES) eller kirurgisk kastration (orkiektomi)
  • Forudgående farmakologisk androgenablation for prostatacancer er kun tilladt, hvis starten af ​​androgenablation (både LHRH-agonist og oral anti-androgen) er ≤ 45 dage før registreringsdatoen.
  • Ingen alvorlig, aktiv komorbiditet, defineret som nogen af ​​følgende:

    • Ustabil angina og/eller kongestiv hjerteinsufficiens, der kræver indlæggelse inden for de sidste 6 måneder
    • Transmuralt myokardieinfarkt inden for de sidste 6 måneder
    • Akut bakteriel eller svampeinfektion, der kræver intravenøs antibiotika på registreringstidspunktet
    • Kronisk obstruktiv lungesygdom eksacerbation eller anden luftvejssygdom, der kræver hospitalsindlæggelse eller udelukker studieterapi på registreringstidspunktet
    • Leverinsufficiens, der resulterer i klinisk gulsot og/eller koagulationsdefekter eller alvorlig leverdysfunktion
    • Erhvervet immundefektsyndrom (AIDS) baseret på den nuværende definition af Centers for Disease Control (CDC)

      • Protokolspecifikke krav kan også udelukke immunkompromitterede patienter
      • HIV-test er ikke påkrævet for at komme ind i denne protokol
  • Ingen patienter, der er seksuelt aktive og ikke vil/i stand til at bruge medicinsk acceptable præventionsformer
  • Ingen tidligere allergisk reaktion på hormonerne involveret i denne protokol

FORUDSÆTNING SAMTYDLIG TERAPI:

  • Se Sygdomskarakteristika
  • Ingen forudgående radikal kirurgi (prostatektomi) eller kryokirurgi for prostatacancer
  • Ingen tidligere bækkenbestråling, prostata brachyterapi eller bilateral orkiektomi
  • Ingen forudgående hormonbehandling, såsom luteiniserende hormon-frigivende hormon (LHRH) agonister (f.eks. leuprolid, goserelin, buserelin, triptorelin) eller LHRH-antagonist (f.eks. degarelix), anti-androgener (f.eks. flutamid, bicalutronamid, acetat), østrogener (f.eks. diethylstilbestrol (DES)) eller kirurgisk kastration (orkiektomi)
  • Ingen forudgående farmakologisk androgenablation for prostatacancer, medmindre starten af ​​androgenablation er ≤ 45 dage før registreringsdatoen
  • Ingen finasterid inden for 30 dage før registrering
  • Intet dutasterid eller dutasterid/tamsulosin (Jalyn) inden for 90 dage før registrering
  • Ingen forudgående eller samtidig cytotoksisk kemoterapi til prostatacancer

    • Forudgående kemoterapi for en anden cancer er tilladt
  • Ingen forudgående strålebehandling, inklusive brachyterapi, til kræftområdet i undersøgelsen, der ville resultere i overlapning af stråleterapifelter

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Arm I
Patienter gennemgår højdosis strålebehandling af prostata og sædblærer ved hjælp af intensitetsmoduleret strålebehandling (IMRT)* eller 3D-konform strålebehandling (3D-CRT)* én gang dagligt, 5 dage om ugen, i cirka 9 uger. Patienter kan også gennemgå permanent prostata implantat (PPI) brachyterapi eller højdosis brachyterapi (I 125 eller Pd 103 kan bruges som radioisotop).
Gennemgå RT ved hjælp af IMRT eller 3D-CRT
Eksperimentel: Arm II
Patienter gennemgår strålebehandling af hele bækkenet (WPRT)* (3D-CRT eller IMRT) en gang dagligt, 5 dage om ugen, i cirka 9 uger. Patienter kan også gennemgå brachyterapi som i arm I.
Gennemgå helbækkenstrålebehandling (WPRT)

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Tidsramme
Samlet overlevelse
Tidsramme: Fra dato for randomisering til dato for død.
Fra dato for randomisering til dato for død.

Sekundære resultatmål

Resultatmål
Tidsramme
Årsagsspecifik overlevelse
Tidsramme: Fra dato for randomisering til dato for død på grund af prostatakræft.
Fra dato for randomisering til dato for død på grund af prostatakræft.
Fjernmetastasefri overlevelse
Tidsramme: Fra datoen for randomisering til datoen for første dokumenterede fjernmetastase eller datoen for første kliniske og/eller radiografiske forekomst af spredt sygdom.
Fra datoen for randomisering til datoen for første dokumenterede fjernmetastase eller datoen for første kliniske og/eller radiografiske forekomst af spredt sygdom.
Biokemisk svigt ifølge Phoenix-definitionen (PSA ≥ 2 ng/mL over PSA-nadir)
Tidsramme: Fra datoen for randomisering til datoen for første biokemiske fejl ved phoenix definition inden for 5 år efter randomisering.
Fra datoen for randomisering til datoen for første biokemiske fejl ved phoenix definition inden for 5 år efter randomisering.
Forekomst af "akutte" uønskede hændelser vurderet af de fælles toksicitetskriterier for bivirkninger (CTCAE) nuværende version
Tidsramme: Fra protokolbehandlingens startdato til datoen for første forekomst af den værste sværhedsgrad af bivirkningen
Fra protokolbehandlingens startdato til datoen for første forekomst af den værste sværhedsgrad af bivirkningen
Tid til "sen" grad 3+ bivirkninger som vurderet af CTCAE nuværende version
Tidsramme: Fra protokolbehandlingens startdato til datoen for den første sene grad 3+ bivirkning, der forekommer mere end 30 dage efter afslutningen af ​​strålebehandlingen.
Fra protokolbehandlingens startdato til datoen for den første sene grad 3+ bivirkning, der forekommer mere end 30 dage efter afslutningen af ​​strålebehandlingen.
Prostatacancer-specifik HRQOL-ændring målt ved EPIC-26 (tarm- eller urindomæne)
Tidsramme: Dato for, hvornår baseline EPIC-26 blev afsluttet til 6 måneder efter strålebehandling, 1 år efter strålebehandling og 5 år efter strålebehandling.
Dato for, hvornår baseline EPIC-26 blev afsluttet til 6 måneder efter strålebehandling, 1 år efter strålebehandling og 5 år efter strålebehandling.
Træthedsstatus målt ved Patient-Reported Outcome Measurement Information System (PROMIS) træthedsdomæneændringsscore
Tidsramme: Fra den dato, hvor baseline PROMIS er afsluttet til den sidste uge af behandlingen.
Fra den dato, hvor baseline PROMIS er afsluttet til den sidste uge af behandlingen.
Vurdering og sammenligning af kvalitetsjusterede leveår (QALYs)
Tidsramme: Fra baseline QALYs vurdering til den sidste uge af strålebehandling (RT), 3 måneder efter RT, 6 måneder efter RT, 1 år efter RT og 5 år efter RT.
Fra baseline QALYs vurdering til den sidste uge af strålebehandling (RT), 3 måneder efter RT, 6 måneder efter RT, 1 år efter RT og 5 år efter RT.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Efterforskere

  • Ledende efterforsker: Mack Roach, MD, University of California, San Francisco

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

1. juli 2011

Primær færdiggørelse (Anslået)

1. juli 2027

Studieafslutning (Anslået)

1. juli 2031

Datoer for studieregistrering

Først indsendt

7. juni 2011

Først indsendt, der opfyldte QC-kriterier

7. juni 2011

Først opslået (Anslået)

8. juni 2011

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

16. august 2023

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

15. august 2023

Sidst verificeret

1. august 2023

Mere information

Begreber relateret til denne undersøgelse

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med strålebehandling

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