Phase III Prospective Randomized Trial of Primary Lung Tumor Stereotactic Body Radiation Therapy Followed by Concurrent Mediastinal Chemoradiation for Locally-Advanced Non-Small Cell Lung Cancer
Summary
This phase III trial compares the effect of adding stereotactic body radiation therapy (SBRT) to the usual treatment (conventional image guided radiation therapy \[IGRT\] and chemotherapy followed by immunotherapy with durvalumab or targeted therapy with osimertinib) versus the usual treatment alone in treating patients with non-small cell lung cancer that has spread to nearby tissue or lymph nodes (locally advanced) and cannot be treated by surgery (inoperable). SBRT uses special equipment to position a patient and deliver radiation therapy to tumors with high precision. This method may kill tumor cells with fewer doses over a shorter period and cause less damage to normal tissue. IGRT is a type of radiation therapy that creates a picture of the tumor to help guide the radiation beam during therapy, making it more accurate and causing less damage to healthy tissue. Usual chemotherapy used in this trial consists of combinations of the following drugs: cisplatin, carboplatin, paclitaxel, nab-paclitaxel, pemetrexed, and etoposide. Cisplatin and carboplatin are in a class of medications known as platinum-containing compounds. Cisplatin works by killing, stopping, or slowing the growth of tumor cells. Carboplatin works in a way similar to the anticancer drug cisplatin but may be better tolerated than cisplatin. Carboplatin works by killing, stopping, or slowing the growth of tumor cells as well. Paclitaxel is in a class of medications called antimicrotubule agents. It works by stopping the growth and spread of tumor cells. Nab-paclitaxel is an albumin-stabilized nanoparticle formulation of paclitaxel which may have fewer side effects and work better than other forms of paclitaxel. Pemetrexed is in a class of medications called antifolate antineoplastic agents. It works by blocking the action of a certain substance in the body that may help tumor cells multiply. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and deoxyribonucleic acid (DNA) repair and may kill tumor cells. Immunotherapy with durvalumab can induce changes in the body's immune system and can interfere with the ability of tumor cells to grow and spread. Osimertinib is in a class of medications called kinase inhibitors. It works by blocking the action of a protein called EGFR that signals cancer cells to multiply. This helps slow or stop the spread of tumor cells. Adding SBRT to the usual treatment of IGRT with chemotherapy and immunotherapy may be more effective at treating patients with locally-advanced non-small cell lung cancer than giving the usual treatment alone.
Detailed description
PRIMARY OBJECTIVES: I. To compare the overall survival in patients with stage II-IIIC inoperable node-positive non-small cell lung cancer (NSCLC) after image guided, motion-managed conventional radiotherapy to the primary tumor and nodal metastases (Arm 1) or after image guided, motion-managed stereotactic body radiation therapy (SBRT) to the primary tumor followed by conventionally fractionated radiotherapy to nodal metastases (Arm 2) both given with concurrent platinum-based chemotherapy. II. To compare progression-free survival between the experimental arm (Arm 2) and control arm (Arm 1). SECONDARY OBJECTIVES: I. To compare objective response rate (as defined by Response Evaluation Criteria in Solid Tumors \[RECIST\] version \[v\] 1.1) between the experimental arm and control arm. II. To compare the rate of local control between the experimental arm and control arm. III. To compare patterns of failure (primary, locoregional, or distant) between the experimental arm and control arm. IV. To compare changes in pulmonary function (forced expiratory volume in 1 second \[FEV1\] and diffusion capacity of the lung for carbon monoxide \[DLCO\] assessed at randomization and at 6- and 12- months following completion of radiation therapy) between the experimental arm and control arm. V. To compare changes in quality of life and patient-reported outcomes assessed from pre-treatment to 3 months following radiation therapy of each treatment arm. VI. To determine acute and late toxicity profiles of each treatment arm as measured by the Common Terminology Criteria for Adverse Events (CTCAE) v5. EXPLORATORY OBJECTIVES: I. To characterize and compare longitudinal quality of life and patient-reported outcomes of each treatment arm. II. To collect biospecimens at baseline, after SBRT (for Arm 2 patients), during last 2 weeks of chemoradiation, and after first dose of consolidation therapy, to allow for future analyses. III. To collect 4-dimensional (4D) computed tomography (CT) planning scans and radiation dose to calculate regional lung ventilation and explore pre-treatment 4D-CT based ventilation to predict pulmonary toxicity. IV. To characterize clinical outcomes, toxicities and changes in pulmonary function and quality of life among patients receiving proton and photon radiotherapy. V. To develop and characterize a machine learning/artificial intelligence algorithm for radiotherapy planning and/or quality assurance. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients undergo conventional IGRT and receive usual care chemotherapy consisting of paclitaxel intravenously (IV) followed by carboplatin IV weekly (Q7D) during radiotherapy or pemetrexed IV followed by carboplatin IV every 21 days during radiotherapy or etoposide IV on days 1 to 5 and days 29 to 33 followed by cisplatin IV on days 1, 8, 29, and 36 or pemetrexed IV followed by cisplatin IV every 21 days during radiotherapy. Patients then receive consolidation durvalumab IV every 2 or 4 weeks for up to one year or osimertinib orally (PO) once daily (QD) in the absence of disease progression or unacceptable toxicity. Patients also undergo CT and/or positron emission tomography (PET)/CT during follow-up. ARM II: Patients undergo SBRT and conventional IGRT and then receive standard-of-care chemotherapy consisting of paclitaxel IV followed by carboplatin IV Q7D during radiotherapy or pemetrexed IV followed by carboplatin IV every 21 days during radiotherapy or etoposide IV on days 1 to 5 and days 29 to 33 followed by cisplatin IV on days 1, 8, 29, and 36 or pemetrexed IV followed by cisplatin IV every 21 days during radiotherapy. Patients then receive consolidation durvalumab IV every 2 or 4 weeks for up to one year or osimertinib PO QD in the absence of disease progression or unacceptable toxicity. Patients also undergo CT and/or PET/CT during follow-up. Patients are followed up every 3 months for 1 year, every 6 months during years 2 and 3, and then yearly after that for the duration of the study.
Arms & interventions
- DrugCarboplatin
Given IV
- DrugCisplatin
Given IV
- ProcedureComputed Tomography
Undergo CT and/or PET/CT
- BiologicalDurvalumab
Given IV
- DrugEtoposide
Given IV
- RadiationImage Guided Radiation Therapy
Undergo IGRT
- DrugNab-paclitaxel
Given IV
- DrugOsimertinib
Given PO
- DrugPaclitaxel
Given IV
- DrugPemetrexed
Given IV
- ProcedurePositron Emission Tomography
Undergo PET/CT
- OtherQuestionnaire Administration
Ancillary studies
- RadiationStereotactic Body Radiation Therapy
Undergo SBRT
Outcome measures
Primary
Overall survival (OS)
Non-inferiority (NI) between arm 2 and arm 1 (reference level) will be evaluated by comparing the upper bound of the 95% confidence interval for the hazard ratio to the pre-specified NI margin. NI of arm 2 will be concluded if the upper bound of the confidence interval is equal to, or falls below, the pre-specified margin at the final analysis. When evaluating the NI of arm 2 in OS, a Cox proportional hazards (PH) model stratified by stratification factors will be used to compute the hazard ratio and associated 95% confidence interval (CI). OS rates will be estimated using the Kaplan-Meier method. If the NI of arm 2 in OS is demonstrated, the superiority of arm 1 in OS will be tested at 1-sided significance level of 0.025 using a stratified log-rank test by adjusting for stratification factors.
Time frame: Time between date of randomization and date of death due to any cause, assessed up to 8 years
Progression-free survival (PFS)
The PFS analysis will be conducted using the same methods and stratification factors as the OS analysis. The superiority of arm 2 in PFS will be tested at 1-sided significance level of 0.025 using a stratified log-rank test by adjusting for stratification factors. In the event that the NI of OS is not established, statistical inference of PFS will be considered exploratory in nature only. A Cox PH model stratified by stratification factors will be used to compute the hazard ratio and associated 95% CI.
Time frame: Time between date of randomization and first date of documented progression or death due to any cause, assessed up to 8 years
Secondary
Objective response rate (ORR)
Time frame: Up to 8 years
Time to progression
Time frame: Up to 8 years
Time to primary, locoregional, or distant failure
Time frame: Up to 8 years
Changes in pulmonary function
Time frame: From randomization to 6 months or 12 months
Patient reported outcomes-Common Terminology Criteria for Adverse Events (PRO-CTCAE)
Time frame: At 3, 12, and 24 months
Functional Assessment of Cancer Therapy Lung (FACT-L) and Trial Outcome Index (TOI)
Time frame: At 3, 12, and 24 months
European Quality of Life Five Dimension (EQ-5D) scale
Time frame: At 3, 12, and 24 months
Incidence of adverse events
Time frame: Up to 8 years
Eligibility criteria
Study locations (470)
University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
The Kirklin Clinic at Acton Road
Birmingham, Alabama, 35243
Gulf Health Hospitals Inc/Infirmary Cancer Care - Malbis
Daphne, Alabama, 36526
Thomas Hospital
Fairhope, Alabama, 36532
Mobile Infirmary Medical Center
Mobile, Alabama, 36607
Gulf Health Hospitals Inc/Infirmary Cancer Care - Saraland
Saraland, Alabama, 36571
Kingman Regional Medical Center
Kingman, Arizona, 86401
Cancer Center at Saint Joseph's
Phoenix, Arizona, 85004
Mayo Clinic Hospital in Arizona
Phoenix, Arizona, 85054
Banner University Medical Center - Tucson
Tucson, Arizona, 85719
University of Arizona Cancer Center-North Campus
Tucson, Arizona, 85719
NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
Jonesboro, Arkansas, 72401
University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
AIS Cancer Center at San Joaquin Community Hospital
Bakersfield, California, 93301
Mills-Peninsula Medical Center
Burlingame, California, 94010
Palo Alto Medical Foundation-Fremont
Fremont, California, 94538
Los Angeles General Medical Center
Los Angeles, California, 90033
USC / Norris Comprehensive Cancer Center
Los Angeles, California, 90033
Fremont - Rideout Cancer Center
Marysville, California, 95901
Memorial Medical Center
Modesto, California, 95355
Palo Alto Medical Foundation-Camino Division
Mountain View, California, 94040
Palo Alto Medical Foundation Health Care
Palo Alto, California, 94301
Sutter Cancer Centers Radiation Oncology Services-Roseville
Roseville, California, 95661
Sutter Roseville Medical Center
Roseville, California, 95661
Sutter Medical Center Sacramento
Sacramento, California, 95816
California Pacific Medical Center-Pacific Campus
San Francisco, California, 94115
Mills Health Center
San Mateo, California, 94401
Sutter Pacific Medical Foundation
Santa Rosa, California, 95403
Palo Alto Medical Foundation-Sunnyvale
Sunnyvale, California, 94086
Sutter Solano Medical Center/Cancer Center
Vallejo, California, 94589
UCHealth University of Colorado Hospital
Aurora, Colorado, 80045
Rocky Mountain Cancer Centers-Penrose
Colorado Springs, Colorado, 80907
UCHealth Memorial Hospital Central
Colorado Springs, Colorado, 80909
Memorial Hospital North
Colorado Springs, Colorado, 80920
UCHealth - Cherry Creek
Denver, Colorado, 80206
Poudre Valley Hospital
Fort Collins, Colorado, 80524
Cancer Care and Hematology-Fort Collins
Fort Collins, Colorado, 80528
UCHealth Greeley Hospital
Greeley, Colorado, 80631
UCHealth Highlands Ranch Hospital
Highlands Ranch, Colorado, 80129
UCHealth Lone Tree Health Center
Lone Tree, Colorado, 80124
Medical Center of the Rockies
Loveland, Colorado, 80538
Beebe Medical Center
Lewes, Delaware, 19958
Beebe South Coastal Health Campus
Millville, Delaware, 19967
Helen F Graham Cancer Center
Newark, Delaware, 19713
Medical Oncology Hematology Consultants PA
Newark, Delaware, 19713
Christiana Care Health System-Christiana Hospital
Newark, Delaware, 19718
Beebe Health Campus
Rehoboth Beach, Delaware, 19971
Christiana Care Health System-Wilmington Hospital
Wilmington, Delaware, 19801
Bay Pines VA Healthcare System
Bay Pines, Florida, 33744
Morton Plant Hospital
Clearwater, Florida, 33756
Halifax Health Medical Center-Centers for Oncology
Daytona Beach, Florida, 32114
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood, Florida, 33021
Mayo Clinic in Florida
Jacksonville, Florida, 32224-9980
Jupiter Medical Center
Jupiter, Florida, 33458
Orlando Health Cancer Institute
Orlando, Florida, 32806
Memorial Hospital West
Pembroke Pines, Florida, 33028
Saint Joseph's Hospital/Children's Hospital-Tampa
Tampa, Florida, 33607
Winter Haven Hospital
Winter Haven, Florida, 33881
Grady Health System
Atlanta, Georgia, 30303
Emory Proton Therapy Center
Atlanta, Georgia, 30308
Emory University Hospital Midtown
Atlanta, Georgia, 30308
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, 30322
Emory Saint Joseph's Hospital
Atlanta, Georgia, 30342
Augusta University Medical Center
Augusta, Georgia, 30912
WellStar Cobb Hospital
Austell, Georgia, 30106
Hamilton Medical Center - Peeples Cancer Institute
Dalton, Georgia, 30720
Wellstar Kennestone Hospital
Marietta, Georgia, 30060
CTCA at Southeastern Regional Medical Center
Newnan, Georgia, 30265
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
Savannah, Georgia, 31405
Hawaii Cancer Care Inc - Waterfront Plaza
Honolulu, Hawaii, 96813
Queen's Cancer Cenrer - POB I
Honolulu, Hawaii, 96813
Queen's Medical Center
Honolulu, Hawaii, 96813
Straub Clinic and Hospital
Honolulu, Hawaii, 96813
University of Hawaii Cancer Center
Honolulu, Hawaii, 96813
Kuakini Medical Center
Honolulu, Hawaii, 96817
Queen's Cancer Center - Kuakini
Honolulu, Hawaii, 96817
The Cancer Center of Hawaii-Liliha
Honolulu, Hawaii, 96817
Hawaii Cancer Care - Westridge
‘Aiea, Hawaii, 96701
Pali Momi Medical Center
‘Aiea, Hawaii, 96701
Alton Memorial Hospital
Alton, Illinois, 62002
Rush-Copley Medical Center
Aurora, Illinois, 60504
Advocate Outpatient Center - Aurora
Aurora, Illinois, 60506
Advocate Good Shepherd Hospital
Barrington, Illinois, 60010
OSF Saint Joseph Medical Center
Bloomington, Illinois, 61701
Illinois CancerCare-Bloomington
Bloomington, Illinois, 61704
Illinois CancerCare-Canton
Canton, Illinois, 61520
Illinois CancerCare-Carthage
Carthage, Illinois, 62321
Centralia Oncology Clinic
Centralia, Illinois, 62801
Northwestern University
Chicago, Illinois, 60611
Advocate Illinois Masonic Medical Center
Chicago, Illinois, 60657
AMG Crystal Lake - Oncology
Crystal Lake, Illinois, 60014
Carle at The Riverfront
Danville, Illinois, 61832
Cancer Care Specialists of Illinois - Decatur
Decatur, Illinois, 62526
Decatur Memorial Hospital
Decatur, Illinois, 62526
Northwestern Medicine Cancer Center Kishwaukee
DeKalb, Illinois, 60115
Advocate Good Samaritan Hospital
Downers Grove, Illinois, 60515
Carle Physician Group-Effingham
Effingham, Illinois, 62401
Crossroads Cancer Center
Effingham, Illinois, 62401
Advocate Sherman Hospital
Elgin, Illinois, 60123
Illinois CancerCare-Eureka
Eureka, Illinois, 61530
Illinois CancerCare-Galesburg
Galesburg, Illinois, 61401
Northwestern Medicine Cancer Center Delnor
Geneva, Illinois, 60134
Advocate South Suburban Hospital
Hazel Crest, Illinois, 60429
Illinois CancerCare-Kewanee Clinic
Kewanee, Illinois, 61443
AMG Libertyville - Oncology
Libertyville, Illinois, 60048
Condell Memorial Hospital
Libertyville, Illinois, 60048
Illinois CancerCare-Macomb
Macomb, Illinois, 61455
Carle Physician Group-Mattoon/Charleston
Mattoon, Illinois, 61938
Cancer Care Center of O'Fallon
O'Fallon, Illinois, 62269
HSHS Saint Elizabeth's Hospital
O'Fallon, Illinois, 62269
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453-2699
Illinois CancerCare-Ottawa Clinic
Ottawa, Illinois, 61350
Advocate High Tech Medical Park
Palos Heights, Illinois, 60463
Advocate Lutheran General Hospital
Park Ridge, Illinois, 60068
Illinois CancerCare-Pekin
Pekin, Illinois, 61554
Illinois CancerCare-Peoria
Peoria, Illinois, 61615
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
Peoria, Illinois, 61615
Methodist Medical Center of Illinois
Peoria, Illinois, 61636
OSF Saint Francis Medical Center
Peoria, Illinois, 61637
Illinois CancerCare-Peru
Peru, Illinois, 61354
Illinois CancerCare-Princeton
Princeton, Illinois, 61356
UW Health Carbone Cancer Center Rockford
Rockford, Illinois, 61114
Memorial Hospital East
Shiloh, Illinois, 62269
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
Springfield Clinic
Springfield, Illinois, 62702
Springfield Memorial Hospital
Springfield, Illinois, 62781
Carle Cancer Center
Urbana, Illinois, 61801
Northwestern Medicine Cancer Center Warrenville
Warrenville, Illinois, 60555
Illinois CancerCare - Washington
Washington, Illinois, 61571
Midwestern Regional Medical Center
Zion, Illinois, 60099
Northwest Cancer Center - Main Campus
Crown Point, Indiana, 46307
Northwest Oncology LLC
Dyer, Indiana, 46311
Northwest Cancer Center - Hobart
Hobart, Indiana, 46342
Saint Mary Medical Center
Hobart, Indiana, 46342
The Community Hospital
Munster, Indiana, 46321
Women's Diagnostic Center - Munster
Munster, Indiana, 46321
Northwest Cancer Center - Valparaiso
Valparaiso, Indiana, 46383
Mary Greeley Medical Center
Ames, Iowa, 50010
McFarland Clinic - Ames
Ames, Iowa, 50010
UI Health Care Mission Cancer and Blood - Ankeny Clinic
Ankeny, Iowa, 50023
Saint Luke's Hospital
Cedar Rapids, Iowa, 52402
Mercy Cancer Center-West Lakes
Clive, Iowa, 50325
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
Clive, Iowa, 50325
Heartland Oncology and Hematology LLP
Council Bluffs, Iowa, 51503
Methodist Jennie Edmundson Hospital
Council Bluffs, Iowa, 51503
Greater Regional Medical Center
Creston, Iowa, 50801
Iowa Methodist Medical Center
Des Moines, Iowa, 50309
UI Health Care Mission Cancer and Blood - Des Moines Clinic
Des Moines, Iowa, 50309
Mercy Medical Center - Des Moines
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Laurel Clinic
Des Moines, Iowa, 50314
UI Health Care Mission Cancer and Blood - Waukee Clinic
Waukee, Iowa, 50263
Mercy Medical Center-West Lakes
West Des Moines, Iowa, 50266
University of Kansas Cancer Center
Kansas City, Kansas, 66160
Lawrence Memorial Hospital
Lawrence, Kansas, 66044
The University of Kansas Cancer Center - Olathe
Olathe, Kansas, 66061
University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, 66210
Salina Regional Health Center
Salina, Kansas, 67401
University of Kansas Health System Saint Francis Campus
Topeka, Kansas, 66606
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, 66205
Ascension Via Christi Hospitals Wichita
Wichita, Kansas, 67214
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
Louisiana State University Health Science Center
New Orleans, Louisiana, 70112
University Medical Center New Orleans
New Orleans, Louisiana, 70112
Touro Infirmary
New Orleans, Louisiana, 70115
MaineHealth Maine Medical Center - Portland
Portland, Maine, 04102
MaineHealth Cancer Care Center of York County
Sanford, Maine, 04073
MaineHealth Maine Medical Center- Scarborough
Scarborough, Maine, 04074
MaineHealth Cancer Care and IV Therapy - South Portland
South Portland, Maine, 04106
Luminis Health Anne Arundel Medical Center
Annapolis, Maryland, 21401
Greater Baltimore Medical Center
Baltimore, Maryland, 21204
Sinai Hospital of Baltimore
Baltimore, Maryland, 21215
TidalHealth Richard A Henson Cancer Institute
Ocean Pines, Maryland, 21811
TidalHealth Peninsula Regional
Salisbury, Maryland, 21801
William E Kahlert Regional Cancer Center/Sinai Hospital
Westminster, Maryland, 21157
UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
Ann Arbor, Michigan, 48106
McLaren Cancer Institute-Bay City
Bay City, Michigan, 48706
Trinity Health IHA Medical Group Hematology Oncology - Brighton
Brighton, Michigan, 48114
Trinity Health Medical Center - Brighton
Brighton, Michigan, 48114
Henry Ford Cancer Institute-Downriver
Brownstown, Michigan, 48183
Chelsea Hospital
Chelsea, Michigan, 48118
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
Chelsea, Michigan, 48118
McLaren Cancer Institute-Clarkston
Clarkston, Michigan, 48346
Michigan Healthcare Professionals Clarkston
Clarkston, Michigan, 48346
Henry Ford Macomb Hospital-Clinton Township
Clinton Township, Michigan, 48038
Henry Ford Medical Center-Fairlane
Dearborn, Michigan, 48126
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
Henry Ford Hospital
Detroit, Michigan, 48202
Michigan Healthcare Professionals Farmington
Farmington Hills, Michigan, 48334
Weisberg Cancer Treatment Center
Farmington Hills, Michigan, 48334
Corewell Health Farmington Hills Hospital
Farmington Hills, Michigan, 48336
McLaren Cancer Institute-Flint
Flint, Michigan, 48532
Trinity Health Grand Rapids Hospital
Grand Rapids, Michigan, 49503
Allegiance Health
Jackson, Michigan, 49201
Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
Beacon Kalamazoo
Kalamazoo, Michigan, 49048
Karmanos Cancer Institute at McLaren Greater Lansing
Lansing, Michigan, 48910
University of Michigan Health - Sparrow Lansing
Lansing, Michigan, 48912
McLaren Cancer Institute-Lapeer Region
Lapeer, Michigan, 48446
Trinity Health Saint Mary Mercy Livonia Hospital
Livonia, Michigan, 48154
Michigan Healthcare Professionals Macomb
Macomb, Michigan, 48044
Michigan Healthcare Professionals Madison Heights
Madison Heights, Michigan, 48071
McLaren Cancer Institute-Macomb
Mount Clemens, Michigan, 48043
McLaren Cancer Institute-Central Michigan
Mount Pleasant, Michigan, 48858
Henry Ford Medical Center-Columbus
Novi, Michigan, 48377
McLaren Cancer Institute-Northern Michigan
Petoskey, Michigan, 49770
Michigan Healthcare Professionals Pontiac
Pontiac, Michigan, 48341
Trinity Health Saint Joseph Mercy Oakland Hospital
Pontiac, Michigan, 48341
McLaren-Port Huron
Port Huron, Michigan, 48060
Corewell Health William Beaumont University Hospital
Royal Oak, Michigan, 48073
Munson Medical Center
Traverse City, Michigan, 49684
Corewell Health Beaumont Troy Hospital
Troy, Michigan, 48085
Michigan Healthcare Professionals Troy
Troy, Michigan, 48098
Henry Ford Health Warren Hospital
Warren, Michigan, 48093
Henry Ford West Bloomfield Hospital
West Bloomfield, Michigan, 48322
University of Michigan Health - West
Wyoming, Michigan, 49519
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
Ypsilanti, Michigan, 48197
Sanford Joe Lueken Cancer Center
Bemidji, Minnesota, 56601
Essentia Health Saint Joseph's Medical Center
Brainerd, Minnesota, 56401
Essentia Health - Deer River Clinic
Deer River, Minnesota, 56636
Essentia Health Cancer Center
Duluth, Minnesota, 55805
Essentia Health Saint Mary's Medical Center
Duluth, Minnesota, 55805
Miller-Dwan Hospital
Duluth, Minnesota, 55805
Essentia Health Hibbing Clinic
Hibbing, Minnesota, 55746
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
Coborn Cancer Center at Saint Cloud Hospital
Saint Cloud, Minnesota, 56303
Essentia Health Sandstone
Sandstone, Minnesota, 55072
Essentia Health Virginia Clinic
Virginia, Minnesota, 55792
Baptist Memorial Hospital and Cancer Center-Desoto
Southhaven, Mississippi, 38671
Saint Francis Medical Center
Cape Girardeau, Missouri, 63703
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, 63376
MU Health - University Hospital/Ellis Fischel Cancer Center
Columbia, Missouri, 65212
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, 63141
Parkland Health Center - Farmington
Farmington, Missouri, 63640
Freeman Health System
Joplin, Missouri, 64804
University of Kansas Cancer Center - Briarcliff
Kansas City, Missouri, 64116
University of Kansas Cancer Center - North
Kansas City, Missouri, 64154
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, 64064
Sainte Genevieve County Memorial Hospital
Sainte Genevieve, Missouri, 63670
Mercy Hospital Springfield
Springfield, Missouri, 65804
Washington University School of Medicine
St Louis, Missouri, 63110
Mercy Hospital South
St Louis, Missouri, 63128
Siteman Cancer Center-South County
St Louis, Missouri, 63129
Missouri Baptist Medical Center
St Louis, Missouri, 63131
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, 63136
Mercy Hospital Saint Louis
St Louis, Missouri, 63141
Missouri Baptist Sullivan Hospital
Sullivan, Missouri, 63080
BJC Outpatient Center at Sunset Hills
Sunset Hills, Missouri, 63127
Billings Clinic Cancer Center
Billings, Montana, 59101
Bozeman Health Deaconess Hospital
Bozeman, Montana, 59715
Benefis Sletten Cancer Institute
Great Falls, Montana, 59405
Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
Omaha, Nebraska, 68114
Nebraska Methodist Hospital
Omaha, Nebraska, 68114
Oncology Associates PC
Omaha, Nebraska, 68114
Renown Regional Medical Center
Reno, Nevada, 89502
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
Memorial Sloan Kettering Basking Ridge
Basking Ridge, New Jersey, 07920
Cooper Hospital University Medical Center
Camden, New Jersey, 08103
Jefferson Cherry Hill Hospital
Cherry Hill, New Jersey, 08002
The Cancer Institute of New Jersey Hamilton
Hamilton, New Jersey, 08690
Jersey City Medical Center
Jersey City, New Jersey, 07302
Monmouth Medical Center Southern Campus
Lakewood, New Jersey, 08701
Saint Barnabas Medical Center
Livingston, New Jersey, 07039
Monmouth Medical Center
Long Branch, New Jersey, 07740
Memorial Sloan Kettering Monmouth
Middletown, New Jersey, 07748
Memorial Sloan Kettering Bergen
Montvale, New Jersey, 07645
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, 08903
Rutgers New Jersey Medical School
Newark, New Jersey, 07101
Sidney Kimmel Cancer Center Washington Township
Sewell, New Jersey, 08080
Robert Wood Johnson University Hospital Somerset
Somerville, New Jersey, 08876
Community Medical Center
Toms River, New Jersey, 08755
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87106
Presbyterian Kaseman Hospital
Albuquerque, New Mexico, 87110
Memorial Medical Center-Las Cruces
Las Cruces, New Mexico, 88011
Presbyterian Rust Medical Center/Jorgensen Cancer Center
Rio Rancho, New Mexico, 87124
Wilmot Cancer Center at Batavia
Batavia, New York, 14020
Northwell Health Imbert Cancer Center
Bay Shore, New York, 11706
Sands Cancer Center
Canandiaqua, New York, 14424
Memorial Sloan Kettering Commack
Commack, New York, 11725
Memorial Sloan Kettering Westchester
East White Plains, New York, 10604
Glens Falls Hospital
Glens Falls, New York, 12801
Northwell Health Cancer Institute at Huntington
Greenlawn, New York, 11740
Northwell Health/Center for Advanced Medicine
Lake Success, New York, 11042
New York Proton Center
New York, New York, 10035
Manhattan Eye Ear and Throat Hospital
New York, New York, 10065
Memorial Sloan Kettering Cancer Center
New York, New York, 10065
Lenox Hill Hospital
New York, New York, 10075
Wilmot Cancer Institute Radiation Oncology at Greece
Rochester, New York, 14606
Highland Hospital
Rochester, New York, 14620
University of Rochester
Rochester, New York, 14642
Staten Island University Hospital
Staten Island, New York, 10305
Stony Brook University Medical Center
Stony Brook, New York, 11794
State University of New York Upstate Medical University
Syracuse, New York, 13210
Montefiore Medical Center-Einstein Campus
The Bronx, New York, 10461
Montefiore Medical Center-Weiler Hospital
The Bronx, New York, 10461
Montefiore Medical Center - Moses Campus
The Bronx, New York, 10467
Memorial Sloan Kettering Nassau
Uniondale, New York, 11553
Westchester Medical Center
Valhalla, New York, 10595
Wilmot Cancer Institute at Webster
Webster, New York, 14580
Atrium Health Stanly/LCI-Albemarle
Albemarle, North Carolina, 28002
Duke Cancer Center Cary
Cary, North Carolina, 27518
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
Novant Health Presbyterian Medical Center
Charlotte, North Carolina, 28204
Atrium Health Pineville/LCI-Pineville
Charlotte, North Carolina, 28210
Atrium Health University City/LCI-University
Charlotte, North Carolina, 28262
Levine Cancer Institute-Ballantyne
Charlotte, North Carolina, 28277
Wake Forest University at Clemmons
Clemmons, North Carolina, 27012
Atrium Health Cabarrus/LCI-Concord
Concord, North Carolina, 28025
Duke University Medical Center
Durham, North Carolina, 27710
Levine Cancer Institute - Rutherford
Forest City, North Carolina, 28043
CaroMont Regional Medical Center
Gastonia, North Carolina, 28054
Novant Health Breast Surgery - Greensboro
Greensboro, North Carolina, 27403
Hayworth Cancer Center
High Point, North Carolina, 27262
Novant Health Cancer Institute - Huntersville
Huntersville, North Carolina, 28078
Novant Health Presbyterian Medical Center Huntersville
Huntersville, North Carolina, 28078
Novant Health Cancer Institute - Kernersville
Kernersville, North Carolina, 27284
Levine Cancer Institute - Union West
Matthews, North Carolina, 28104
Matthews Radiation Oncology Center
Matthews, North Carolina, 28105
Novant Health Cancer Institute - Matthews
Matthews, North Carolina, 28105
Atrium Health Union/LCI-Union
Monroe, North Carolina, 28112
Novant Health Cancer Institute - Mooresville
Mooresville, North Carolina, 28117
Novant Health Cancer Institute - Mount Airy
Mount Airy, North Carolina, 27030
Novant Health Cancer Institute - Wilkesboro
North Wilkesboro, North Carolina, 28659
Duke Cancer Center Raleigh
Raleigh, North Carolina, 27609
Novant Health Cancer Institute - Rowan
Salisbury, North Carolina, 28144
Rowan Regional Medical Center
Salisbury, North Carolina, 28144
Atrium Health Cleveland/LCI-Cleveland
Shelby, North Carolina, 28150
Wake Forest Baptist Health - Hematology Oncology - Statesville
Statesville, North Carolina, 28677
Novant Health Cancer Institute - Statesville
Stateville, North Carolina, 28625
Novant Cancer Institute Radiation Oncology - Supply
Supply, North Carolina, 28462
Novant Health Cancer Institute - Thomasville
Thomasville, North Carolina, 27360
Wake Forest Baptist Health - Wilkes Medical Center
Wilkesboro, North Carolina, 28659
Novant Health Cancer Institute Radiation Oncology - Wilmington
Wilmington, North Carolina, 28401
Novant Health New Hanover Regional Medical Center
Wilmington, North Carolina, 28401
Novant Health Forsyth Medical Center
Winston-Salem, North Carolina, 27103
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
Sanford Bismarck Medical Center
Bismarck, North Dakota, 58501
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
Sanford Roger Maris Cancer Center
Fargo, North Dakota, 58122
Altru Cancer Center
Grand Forks, North Dakota, 58201
Cleveland Clinic Akron General
Akron, Ohio, 44307
UH Seidman Cancer Center at UH Avon Health Center
Avon, Ohio, 44011
UHHS-Chagrin Highlands Medical Center
Beachwood, Ohio, 44122
Cleveland Clinic Mercy Hospital
Canton, Ohio, 44708
Aultman Health Foundation
Canton, Ohio, 44710
Miami Valley Hospital South
Centerville, Ohio, 45459
University of Cincinnati Cancer Center-UC Medical Center
Cincinnati, Ohio, 45219
Case Western Reserve University
Cleveland, Ohio, 44106
Riverside Methodist Hospital
Columbus, Ohio, 43214
Grant Medical Center
Columbus, Ohio, 43215
Doctors Hospital
Columbus, Ohio, 43228
Miami Valley Hospital
Dayton, Ohio, 45409
Premier Blood and Cancer Center
Dayton, Ohio, 45409
Dayton Physician LLC - Englewood
Dayton, Ohio, 45415
Miami Valley Hospital North
Dayton, Ohio, 45415
Delaware Health Center-Grady Cancer Center
Delaware, Ohio, 43015
Grady Memorial Hospital
Delaware, Ohio, 43015
Dublin Methodist Hospital
Dublin, Ohio, 43016
Atrium Medical Center-Middletown Regional Hospital
Franklin, Ohio, 45005-1066
Miami Valley Cancer Care and Infusion
Greenville, Ohio, 45331
OhioHealth Mansfield Hospital
Mansfield, Ohio, 44903
OhioHealth Marion General Hospital
Marion, Ohio, 43302
UH Seidman Cancer Center at Lake Health Mentor Campus
Mentor, Ohio, 44060
Mercy Health - Perrysburg Hospital
Perrysburg, Ohio, 43551
Upper Valley Medical Center
Troy, Ohio, 45373
University of Cincinnati Cancer Center-West Chester
West Chester, Ohio, 45069
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
Legacy Mount Hood Medical Center
Gresham, Oregon, 97030
Legacy Good Samaritan Hospital and Medical Center
Portland, Oregon, 97210
Legacy Meridian Park Hospital
Tualatin, Oregon, 97062
Christiana Care Health System-Concord Health Center
Chadds Ford, Pennsylvania, 19317
Chambersburg Hospital
Chambersburg, Pennsylvania, 17201
Geisinger Medical Center
Danville, Pennsylvania, 17822
Ephrata Cancer Center
Ephrata, Pennsylvania, 17522
Adams Cancer Center
Gettysburg, Pennsylvania, 17325
Penn State Milton S Hershey Medical Center
Hershey, Pennsylvania, 17033-0850
Lancaster General Ann B Barshinger Cancer Institute
Lancaster, Pennsylvania, 17601
Sechler Family Cancer Center
Lebanon, Pennsylvania, 17042
Geisinger Medical Oncology-Lewisburg
Lewisburg, Pennsylvania, 17837
University of Pennsylvania/Abramson Cancer Center
Philadelphia, Pennsylvania, 19104
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, 19107
Fox Chase Cancer Center
Philadelphia, Pennsylvania, 19111
Temple University Hospital
Philadelphia, Pennsylvania, 19140
Reading Hospital
West Reading, Pennsylvania, 19611
Geisinger Wyoming Valley/Henry Cancer Center
Wilkes-Barre, Pennsylvania, 18711
Asplundh Cancer Pavilion
Willow Grove, Pennsylvania, 19090
Lankenau Medical Center
Wynnewood, Pennsylvania, 19096
WellSpan Health-York Cancer Center
York, Pennsylvania, 17403
WellSpan Health-York Hospital
York, Pennsylvania, 17403
Saint Joseph's/Candler - Bluffton Campus
Bluffton, South Carolina, 29910
Gibbs Cancer Center-Gaffney
Gaffney, South Carolina, 29341
Saint Francis Hospital
Greenville, South Carolina, 29601
Saint Francis Cancer Center
Greenville, South Carolina, 29607
Gibbs Cancer Center-Pelham
Greer, South Carolina, 29651
Lancaster Radiation Therapy Center
Lancaster, South Carolina, 29720
Rock Hill Radiation Therapy Center
Rock Hill, South Carolina, 29730
Levine Cancer Institute-Rock Hill
Rock Hill, South Carolina, 29732
Spartanburg Medical Center
Spartanburg, South Carolina, 29303
SMC Center for Hematology Oncology Union
Union, South Carolina, 29379
Lexington Medical Center
West Columbia, South Carolina, 29169
Sanford Cancer Center Oncology Clinic
Sioux Falls, South Dakota, 57104
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
Baptist Memorial Hospital and Cancer Center-Collierville
Collierville, Tennessee, 38017
University of Tennessee - Knoxville
Knoxville, Tennessee, 37920
Baptist Memorial Hospital and Cancer Center-Memphis
Memphis, Tennessee, 38120
MD Anderson in The Woodlands
Conroe, Texas, 77384
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
Ben Taub General Hospital
Houston, Texas, 77030
M D Anderson Cancer Center
Houston, Texas, 77030
MD Anderson West Houston
Houston, Texas, 77079
MD Anderson League City
League City, Texas, 77573
MD Anderson in Sugar Land
Sugar Land, Texas, 77478
Central Vermont Medical Center/National Life Cancer Treatment
Berlin Corners, Vermont, 05602
University of Vermont Medical Center
Burlington, Vermont, 05401
University of Vermont and State Agricultural College
Burlington, Vermont, 05405
Dartmouth Cancer Center - North
Saint Johnsbury, Vermont, 05819
Virginia Mason Medical Center
Seattle, Washington, 98101
Legacy Cancer Institute Medical Oncology and Day Treatment
Vancouver, Washington, 98684
Legacy Salmon Creek Hospital
Vancouver, Washington, 98686
Edwards Comprehensive Cancer Center
Huntington, West Virginia, 25701
West Virginia University Healthcare
Morgantown, West Virginia, 26506
Langlade Hospital and Cancer Center
Antigo, Wisconsin, 54409
Duluth Clinic Ashland
Ashland, Wisconsin, 54806
Northwest Wisconsin Cancer Center
Ashland, Wisconsin, 54806
Aurora Cancer Care-Southern Lakes VLCC
Burlington, Wisconsin, 53105
HSHS Sacred Heart Hospital
Eau Claire, Wisconsin, 54701
Marshfield Medical Center-EC Cancer Center
Eau Claire, Wisconsin, 54701
Aurora Health Care Germantown Health Center
Germantown, Wisconsin, 53022
Aurora Cancer Care-Grafton
Grafton, Wisconsin, 53024
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
Aurora BayCare Medical Center
Green Bay, Wisconsin, 54311
Essentia Health-Hayward Clinic
Hayward, Wisconsin, 54843
University of Wisconsin Carbone Cancer Center - Johnson Creek
Johnson Creek, Wisconsin, 53038
Aurora Cancer Care-Kenosha South
Kenosha, Wisconsin, 53142
William S Middleton VA Medical Center
Madison, Wisconsin, 53705
University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
Madison, Wisconsin, 53718
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
Aurora Bay Area Medical Group-Marinette
Marinette, Wisconsin, 54143
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
Froedtert Menomonee Falls Hospital
Menomonee Falls, Wisconsin, 53051
Aurora Cancer Care-Milwaukee
Milwaukee, Wisconsin, 53209
Aurora Saint Luke's Medical Center
Milwaukee, Wisconsin, 53215
Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Aurora Sinai Medical Center
Milwaukee, Wisconsin, 53233
Zablocki Veterans Administration Medical Center
Milwaukee, Wisconsin, 53295
Marshfield Medical Center - Minocqua
Minocqua, Wisconsin, 54548
ProHealth D N Greenwald Center
Mukwonago, Wisconsin, 53149
Drexel Town Square Health Center
Oak Creek, Wisconsin, 53154
ProHealth Oconomowoc Memorial Hospital
Oconomowoc, Wisconsin, 53066
Vince Lombardi Cancer Clinic - Oshkosh
Oshkosh, Wisconsin, 54904
Aurora Cancer Care-Racine
Racine, Wisconsin, 53406
Aspirus Cancer Care - James Beck Cancer Center
Rhinelander, Wisconsin, 54501
Marshfield Medical Center-Rice Lake
Rice Lake, Wisconsin, 54868
Saint Vincent Hospital Cancer Center at Sheboygan
Sheboygan, Wisconsin, 53081
Vince Lombardi Cancer Clinic-Sheboygan
Sheboygan, Wisconsin, 53081
Essentia Health-Spooner Clinic
Spooner, Wisconsin, 54801
Aspirus Cancer Care - Stevens Point
Stevens Point, Wisconsin, 54481
Marshfield Medical Center-River Region at Stevens Point
Stevens Point, Wisconsin, 54482
Saint Vincent Hospital Cancer Center at Sturgeon Bay
Sturgeon Bay, Wisconsin, 54235-1495
Aurora Medical Center in Summit
Summit, Wisconsin, 53066
Essentia Health Saint Mary's Hospital - Superior
Superior, Wisconsin, 54880
UW Cancer Center at ProHealth Care
Waukesha, Wisconsin, 53188
Aspirus Regional Cancer Center
Wausau, Wisconsin, 54401
Aurora Cancer Care-Milwaukee West
Wauwatosa, Wisconsin, 53226
Aurora West Allis Medical Center
West Allis, Wisconsin, 53227
Froedtert West Bend Hospital/Kraemer Cancer Center
West Bend, Wisconsin, 53095
Marshfield Medical Center - Weston
Weston, Wisconsin, 54476
Aspirus Cancer Care - Wisconsin Rapids
Wisconsin Rapids, Wisconsin, 54494
References
- Heinzerling JH, Mileham KF, Robinson MM, Symanowski JT, Induru RR, Brouse GM, Corso CD, Prabhu RS, Haggstrom DE, Moeller BJ, Bobo WE, Fasola CE, Thakkar VV, Pal SE, Gregory JM, Norek SL, Begic XJ, Kesarwala AH, Burri SH, Simone CB 2nd. Primary lung tumour stereotactic body radiotherapy followed by concurrent mediastinal chemoradiotherapy and adjuvant immunotherapy for locally advanced non-small-cell lung cancer: a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2025 Jan;26(1):85-97. doi: 10.1016/S1470-2045(24)00573-4. Epub 2024 Nov 29.(PubMed)