A randomized phase III trial of memantine and Whole-Brain radiotherapy with or without hippocampal avoidance in patients with brain metastases

NCT ID NCT02360215

NEW Sponsor: NRG Oncology Source: ClinicalTrials.gov ↗

First seen Sep 10, 2026 · Last updated Sep 10, 2026

Summary

This randomized phase III trial compares memantine hydrochloride and whole-brain radiotherapy with or without hippocampal avoidance in reducing neurocognitive decline in patients with cancer that has spread from the primary site (place where it started) to the brain. Whole brain radiotherapy (WBRT) is the most common treatment for brain metastasis. Unfortunately, the majority of patients with brain metastases experience cognitive (such as learning and memory) deterioration after WBRT. Memantine hydrochloride may enhance cognitive function by binding to and inhibiting channels of receptors located in the central nervous system. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Using radiation techniques, such as intensity modulated radiotherapy to avoid the hippocampal region during WBRT, may reduce the radiation dose to the hippocampus and help limit the radiation-induced cognitive decline. It is not yet known whether giving memantine hydrochloride and WBRT with or without hippocampal avoidance works better in reducing neurocognitive decline in patients with brain metastases.

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Study facts

What this study's own registry entry says, in plain language.

Phase

Phase 3

Large-scale testing in a bigger group. Usually the last step before a treatment can be approved.

Participants

518 people

The number who actually took part.

Started

Jul 2015

Finished

Aug 2019

Lead sponsor

Other sponsor

The registry's catch-all category, for sponsors it does not file as a company, a government agency, or a research network.

Who can take part

This study's own entry requirements. Only the study team can say for certain whether you qualify.

Ages

18 years and older

Sex

Anyone

Healthy volunteers

Not accepted

This study is not open to healthy volunteers. The entry requirements below say who it is open to.

Show the full entry requirements

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * PRIOR TO STEP 1 REGISTRATION: * Brain metastases outside a 5-mm margin around either hippocampus must be visible on contrast-enhanced magnetic resonance imaging (MRI) performed =\< 21 days prior to Step 1 registration; an allowed exception, regarding ability to image brain metastases, would be that patients who had undergone radiosurgery or surgical resection and are planning adjuvant WBRT do not have to have visible disease but do need a pre-surgery MRI or computed tomography (CT) scan demonstrating brain metastases; however, the brain metastases could not have been within 5 mm of either hippocampus * Patients must have a gadolinium contrast-enhanced three-dimensional spoiled gradient (SPGR), magnetization-prepared rapid gradient echo (MP-RAGE), or turbo field echo (TFE) axial MRI scan with standard axial and coronal gadolinium contrast-enhanced T1-weighted sequence and axial T2/FLAIR sequence acquisitions; to yield acceptable image quality, the gadolinium contrast-enhanced three-dimensional SPGR, MP-RAGE, or TFE axial MRI scan should use the smallest possible axial slice thickness not exceeding 1.5 mm; the associated coronal and sagittal contrast-enhanced T1 sequences can be up to 2.5 mm in slice thickness; this MRI must be obtained =\< 21 days prior to step 1 registration; the vendor specific MRI protocols are available for download from the Alzheimer's Disease Neuroimaging Initiative (ADNI) * Patients must provide study-specific informed consent prior to registration * PRIOR TO STEP 2 REGISTRATION: * The following baseline neurocognitive assessments must be completed prior to Step 2 registration: HVLT-R, TMT, and COWA; * Pathologically (histologically or cytologically) proven diagnosis of solid tumor malignancy within 5 years prior to Step 2 registration * History and physical examination within 28 days prior to Step 2 registration * Karnofsky performance status of \>= 70 within 28 days prior to Step 2 registration * Serum creatinine =\< 3 mg/dL (265 umol/L) and creatinine clearance \>= 30 ml/min * Blood urea nitrogen (BUN) within institutional upper limit of normal (e.g. \< 20 mg/dL) * Total bilirubin =\< 2.5 mg/dL (43 umol/L) * Patients may have had prior therapy for brain metastasis, including radiosurgery and surgical resection; patients must have completed prior therapy by at least 14 days prior to Step 2 for surgical resection and 7 days for radiosurgery * Negative serum pregnancy test (in women of childbearing potential) =\< 14 days prior to Step 2; women of childbearing potential and men who are sexually active must practice adequate contraception while on study * Patients who are primary English or French speakers are eligible Exclusion Criteria: * Prior external beam radiation therapy to the brain or whole brain radiation therapy * Planned cytotoxic chemotherapy during the WBRT only; patients may have had prior chemotherapy * Radiographic evidence of hydrocephalus or other architectural distortion of the ventricular system, including placement of external ventricular drain or ventriculoperitoneal shunt * Severe, active co-morbidity defined as follows: * Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months * Transmural myocardial infarction within the last 6 months * Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration * Chronic obstructive pulmonary disease exacerbation or other acute respiratory illness precluding study therapy at the time of registration * Severe hepatic disease defined as a diagnosis of Child-Pugh class B or C hepatic disease * Renal tubular acidosis or metabolic acidosis * Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD)4 count \< 200 cells/microliter; note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count \>= 200 cells/microliter within 30 days prior to registration; Note also that HIV testing is not required for eligibility for this protocol * Pregnant or lactating women, or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception * Prior allergic reaction to memantine (memantine hydrochloride) * Current alcohol or drug abuse (may exacerbate lethargy/dizziness with memantine) * Intractable seizures while on adequate anticonvulsant therapy-more than 1 seizure per month for the past 2 months * Patients with definitive leptomeningeal metastases * Patients with brain metastases from primary germ cell tumors, small cell carcinoma, unknown primary, or lymphoma * Contraindication to magnetic resonance (MR) imaging such as implanted metal devices or foreign bodies * Contraindication to gadolinium contrast administration during MR imaging, such as allergy or insufficient renal function * Current use of (other N-methyl D-aspartate \[NMDA\] antagonists) amantadine, ketamine, or dextromethorphan

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Conditions

The condition(s) this trial relates to.

brain cancer Cognitive Dysfunction metastatic malignant neoplasm in the brain neoplasm

As listed by the trial registrant

The condition terms exactly as the trial's registrant entered them.

Cognitive impairment Metastatic malignant neoplasm in the brain Solid neoplasm

Contacts and locations

Locations

21st Century Oncology MHP - Clarkston

Clarkston, Michigan, 48346, United States
21st Century Oncology MHP - Farmington

Farmington Hills, Michigan, 48334, United States
21st Century Oncology MHP - Troy

Troy, Michigan, 48098, United States
Abbott-Northwestern Hospital

Minneapolis, Minnesota, 55407, United States
Abington Memorial Hospital

Abington, Pennsylvania, 19001, United States
Allan Blair Cancer Centre

Regina, Saskatchewan, S4T 7T1, Canada
Aria Health-Torresdale Campus

Philadelphia, Pennsylvania, 19114, United States
Ascension Columbia Saint Mary's Water Tower Medical Commons

Milwaukee, Wisconsin, 53211, United States
Ascension Via Christi Hospitals Wichita

Wichita, Kansas, 67214, United States
Aspirus Regional Cancer Center

Wausau, Wisconsin, 54401, United States
Aspirus UW Cancer Center

Wisconsin Rapids, Wisconsin, 54494, United States
Aurora BayCare Medical Center

Green Bay, Wisconsin, 54311, United States
Aurora Cancer Care-Grafton

Grafton, Wisconsin, 53024, United States
Aurora Cancer Care-Kenosha South

Kenosha, Wisconsin, 53142, United States
Aurora Medical Center in Summit

Summit, Wisconsin, 53066, United States
Aurora Saint Luke's Medical Center

Milwaukee, Wisconsin, 53215, United States
Aurora Sinai Medical Center

Milwaukee, Wisconsin, 53233, United States
Aurora West Allis Medical Center

West Allis, Wisconsin, 53227, United States
Banner MD Anderson Cancer Center

Gilbert, Arizona, 85234, United States
Banner University Medical Center - Tucson

Tucson, Arizona, 85719, United States
Benefis Healthcare- Sletten Cancer Institute

Great Falls, Montana, 59405, United States
Billings Clinic Cancer Center

Billings, Montana, 59101, United States
Boca Raton Regional Hospital

Boca Raton, Florida, 33486, United States
Bryn Mawr Hospital

Bryn Mawr, Pennsylvania, 19010, United States
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)

Québec, Quebec, G1R 2J6, Canada
CHUM - Centre Hospitalier de l'Universite de Montreal

Montreal, Quebec, H2X 3E4, Canada
CHUM - Hopital Notre-Dame

Montreal, Quebec, H2L 4M1, Canada
California Pacific Medical Center-Pacific Campus

San Francisco, California, 94115, United States
Carle Cancer Center

Urbana, Illinois, 61801, United States
Case Western Reserve University

Cleveland, Ohio, 44106, United States
Central Maryland Radiation Oncology in Howard County

Columbia, Maryland, 21044, United States
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont

Sherbrooke, Quebec, J1H 5N4, Canada
Christiana Care Health System-Christiana Hospital

Newark, Delaware, 19718, United States
Christiana Care Health System-Concord Health Center

Chadds Ford, Pennsylvania, 19317, United States
City of Hope Comprehensive Cancer Center

Duarte, California, 91010, United States
Cleveland Clinic Akron General

Akron, Ohio, 44307, United States
Cleveland Clinic Cancer Center Independence

Independence, Ohio, 44131, United States
Cleveland Clinic Cancer Center Strongsville

Strongsville, Ohio, 44136, United States
Cleveland Clinic Cancer Center/Fairview Hospital

Cleveland, Ohio, 44111, United States
Cleveland Clinic Foundation

Cleveland, Ohio, 44195, United States
Cleveland Clinic-Weston

Weston, Florida, 33331, United States
Community Cancer Center East

Indianapolis, Indiana, 46219, United States
Community Cancer Center North

Indianapolis, Indiana, 46256, United States
Community Cancer Center South

Indianapolis, Indiana, 46227, United States
Community Medical Hospital

Missoula, Montana, 59804, United States
Community Memorial Hospital

Menomonee Falls, Wisconsin, 53051, United States
Condell Memorial Hospital

Libertyville, Illinois, 60048, United States
CoxHealth South Hospital

Springfield, Missouri, 65807, United States
Crossroads Cancer Center

Effingham, Illinois, 62401, United States
Crozer Regional Cancer Center at Brinton Lake

Glen Mills, Pennsylvania, 19342, United States
Crozer-Keystone Regional Cancer Center at Broomall

Broomall, Pennsylvania, 19008, United States
Dartmouth Hitchcock Medical Center

Lebanon, New Hampshire, 03756, United States
Decatur Memorial Hospital

Decatur, Illinois, 62526, United States
Diagnostic and Treatment Center

Weston, Wisconsin, 54476, United States
Edward Hines Jr VA Hospital

Hines, Illinois, 60141, United States
Emory Saint Joseph's Hospital

Atlanta, Georgia, 30342, United States
Emory University Hospital Midtown

Atlanta, Georgia, 30308, United States
Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, 30322, United States
Fox Chase Cancer Center

Philadelphia, Pennsylvania, 19111, United States
Geisinger Medical Center

Danville, Pennsylvania, 17822, United States
Geisinger Wyoming Valley/Henry Cancer Center

Wilkes-Barre, Pennsylvania, 18711, United States
Genesys Hurley Cancer Institute

Flint, Michigan, 48503, United States
Grady Health System

Atlanta, Georgia, 30303, United States
Greenville Health System Cancer Institute-Eastside

Greenville, South Carolina, 29615, United States
Greenville Health System Cancer Institute-Faris

Greenville, South Carolina, 29605, United States
Greenville Health System Cancer Institute-Spartanburg

Spartanburg, South Carolina, 29307, United States
Gundersen Lutheran Medical Center

La Crosse, Wisconsin, 54601, United States
Helen F Graham Cancer Center

Newark, Delaware, 19713, United States
Henry Ford Cancer Institute-Downriver

Brownstown, Michigan, 48183, United States
Henry Ford Hospital

Detroit, Michigan, 48202, United States
Henry Ford Macomb Hospital-Clinton Township

Clinton Township, Michigan, 48038, United States
Henry Ford West Bloomfield Hospital

West Bloomfield, Michigan, 48322, United States
Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah, 84112, United States
John H Stroger Jr Hospital of Cook County

Chicago, Illinois, 60612, United States
Kaiser Permanente Cancer Treatment Center

South San Francisco, California, 94080, United States
Kaiser Permanente Los Angeles Medical Center

Los Angeles, California, 90027, United States
Kaiser Permanente Medical Center - Santa Clara

Santa Clara, California, 95051, United States
Kaiser Permanente Oakland-Broadway

Oakland, California, 94611, United States
Kaiser Permanente-Rancho Cordova Cancer Center

Rancho Cordova, California, 95670, United States
Lahey Hospital and Medical Center

Burlington, Massachusetts, 01805, United States
Lakeland Medical Center Saint Joseph

Saint Joseph, Michigan, 49085, United States
Langlade Hospital and Cancer Center

Antigo, Wisconsin, 54409, United States
Lankenau Medical Center

Wynnewood, Pennsylvania, 19096, United States
Lawrence Memorial Hospital

Lawrence, Kansas, 66044, United States
Legacy Good Samaritan Hospital and Medical Center

Portland, Oregon, 97210, United States
Legacy Mount Hood Medical Center

Gresham, Oregon, 97030, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

Savannah, Georgia, 31405, United States
Lewis and Faye Manderson Cancer Center

Tuscaloosa, Alabama, 35401, United States
Los Angeles County-USC Medical Center

Los Angeles, California, 90033, United States
Lowell General Hospital

Lowell, Massachusetts, 01854, United States
Loyola University Medical Center

Maywood, Illinois, 60153, United States
M D Anderson Cancer Center

Houston, Texas, 77030, United States
Marshfield Clinic Stevens Point Center

Stevens Point, Wisconsin, 54482, United States
Mayo Clinic

Rochester, Minnesota, 55905, United States
Mayo Clinic Health System in Albert Lea

Albert Lea, Minnesota, 56007, United States
Mayo Clinic Health System-Eau Claire Clinic

Eau Claire, Wisconsin, 54701, United States
Mayo Clinic Health System-Franciscan Healthcare

La Crosse, Wisconsin, 54601, United States
Mayo Clinic Health Systems-Mankato

Mankato, Minnesota, 56001, United States
Mayo Clinic Radiation Therapy-Northfield

Northfield, Minnesota, 55057, United States
McGill University Department of Oncology

Montreal, Quebec, H2W 1S6, Canada
McLaren Cancer Institute-Bay City

Bay City, Michigan, 48706, United States
McLaren Cancer Institute-Central Michigan

Mount Pleasant, Michigan, 48858, United States
McLaren Cancer Institute-Clarkston

Clarkston, Michigan, 48346, United States
McLaren Cancer Institute-Flint

Flint, Michigan, 48532, United States
McLaren Cancer Institute-Lapeer Region

Lapeer, Michigan, 48446, United States
McLaren Cancer Institute-Macomb

Mount Clemens, Michigan, 48043, United States
McLaren Cancer Institute-Northern Michigan

Petoskey, Michigan, 49770, United States
McLaren Cancer Institute-Owosso

Owosso, Michigan, 48867, United States
McLaren-Port Huron

Port Huron, Michigan, 48060, United States
MedStar Union Memorial Hospital

Baltimore, Maryland, 21218, United States
Medical College of Wisconsin

Milwaukee, Wisconsin, 53226, United States
Memorial Health University Medical Center

Savannah, Georgia, 31404, United States
Memorial Medical Center

Springfield, Illinois, 62781, United States
Mercy Cancer Center - Sacramento

Sacramento, California, 95816, United States
Mercy Health Mercy Campus

Muskegon, Michigan, 49444, United States
Mercy Hospital Saint Louis

St Louis, Missouri, 63141, United States
Mercy San Juan Medical Center

Carmichael, California, 95608, United States
Methodist Medical Center of Illinois

Peoria, Illinois, 61636, United States
Missouri Baptist Medical Center

St Louis, Missouri, 63131, United States
Montefiore Medical Center - Moses Campus

The Bronx, New York, 10467, United States
NHRMC Radiation Oncology - 16th Street

Wilmington, North Carolina, 28401, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, 10032, United States
New York-Presbyterian/Brooklyn Methodist Hospital

Brooklyn, New York, 11215, United States
Norris Cotton Cancer Center-North

Saint Johnsbury, Vermont, 05819, United States
North Kansas City Hospital

Kansas City, Missouri, 64116, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital

Yakima, Washington, 98902, United States
Northeast Radiation Oncology Center

Dunmore, Pennsylvania, 18512, United States
Northwestern Medicine Cancer Center Delnor

Geneva, Illinois, 60134, United States
Northwestern Medicine Cancer Center Warrenville

Warrenville, Illinois, 60555, United States
Northwestern University

Chicago, Illinois, 60611, United States
OSF Saint Francis Medical Center

Peoria, Illinois, 61637, United States
Ogden Regional Medical Center

Ogden, Utah, 84405, United States
Ohio State University Comprehensive Cancer Center

Columbus, Ohio, 43210, United States
Park Nicollet Clinic - Saint Louis Park

Saint Louis Park, Minnesota, 55416, United States
Parkview Hospital Randallia

Fort Wayne, Indiana, 46805, United States
Penrose-Saint Francis Healthcare

Colorado Springs, Colorado, 80907, United States
Piedmont Hospital

Atlanta, Georgia, 30309, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center

Burbank, California, 91505, United States
Reading Hospital

West Reading, Pennsylvania, 19611, United States
Renown Regional Medical Center

Reno, Nevada, 89502, United States
Riddle Memorial Hospital

Media, Pennsylvania, 19063, United States
Rocky Mountain Cancer Centers-Boulder

Boulder, Colorado, 80304, United States
Rohnert Park Cancer Center

Rohnert Park, California, 94928, United States
SIH Cancer Institute

Carterville, Illinois, 62918, United States
Saint Alphonsus Cancer Care Center-Boise

Boise, Idaho, 83706, United States
Saint Francis Medical Center

Cape Girardeau, Missouri, 63703, United States
Saint Joseph Mercy Chelsea

Chelsea, Michigan, 48118, United States
Saint Joseph Mercy Hospital

Ann Arbor, Michigan, 48106, United States
Saint Joseph Mercy Oakland

Pontiac, Michigan, 48341, United States
Saint Luke's Hospital

Cedar Rapids, Iowa, 52402, United States
Saint Luke's Mountain States Tumor Institute

Boise, Idaho, 83712, United States
Saint Luke's Mountain States Tumor Institute - Meridian

Meridian, Idaho, 83642, United States
Saint Luke's Mountain States Tumor Institute - Nampa

Nampa, Idaho, 83686, United States
Saint Luke's Mountain States Tumor Institute-Twin Falls

Twin Falls, Idaho, 83301, United States
Saint Mary Mercy Hospital

Livonia, Michigan, 48154, United States
Saint Vincent's Medical Center

Bridgeport, Connecticut, 06606, United States
Sanford Bismarck Medical Center

Bismarck, North Dakota, 58501, United States
Sanford Roger Maris Cancer Center

Fargo, North Dakota, 58122, United States
Sanford USD Medical Center - Sioux Falls

Sioux Falls, South Dakota, 57117-5134, United States
Saskatoon Cancer Centre

Saskatoon, Saskatchewan, S7N 4H4, Canada
Self Regional Healthcare

Greenwood, South Carolina, 29646, United States
Siteman Cancer Center at Saint Peters Hospital

City of Saint Peters, Missouri, 63376, United States
Siteman Cancer Center at West County Hospital

Creve Coeur, Missouri, 63141, United States
Siteman Cancer Center-South County

St Louis, Missouri, 63129, United States
Spectrum Health at Butterworth Campus

Grand Rapids, Michigan, 49503, United States
Stanford Cancer Center South Bay

San Jose, California, 95124, United States
Stanford Cancer Institute Palo Alto

Palo Alto, California, 94304, United States
Summa Akron City Hospital/Cooper Cancer Center

Akron, Ohio, 44304, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville

Roseville, California, 95661, United States
Sutter Medical Center Sacramento

Sacramento, California, 95816, United States
Sutter Solano Medical Center/Cancer Center

Vallejo, California, 94589, United States
Swedish Medical Center

Englewood, Colorado, 80113, United States
Temple University Hospital

Philadelphia, Pennsylvania, 19140, United States
The Permanente Medical Group-Roseville Radiation Oncology

Roseville, California, 95678, United States
The Radiation Oncology Center-Hilton Head/Bluffton

Hilton Head Island, South Carolina, 29926, United States
The Research Institute of the McGill University Health Centre (MUHC)

Montreal, Quebec, H3H 2R9, Canada
Thomas Jefferson University Hospital

Philadelphia, Pennsylvania, 19107, United States
Tufts Medical Center

Boston, Massachusetts, 02111, United States
Tulane University Health Sciences Center

New Orleans, Louisiana, 70112, United States
UC San Diego Moores Cancer Center

La Jolla, California, 92093, United States
UCHealth Memorial Hospital Central

Colorado Springs, Colorado, 80909, United States
UF Cancer Center at Orlando Health

Orlando, Florida, 32806, United States
UH Seidman Cancer Center at Southwest General Hospital

Middleburg Heights, Ohio, 44130, United States
UHHS-Westlake Medical Center

Westlake, Ohio, 44145, United States
UM Baltimore Washington Medical Center/Tate Cancer Center

Glen Burnie, Maryland, 21061, United States
UM Saint Joseph Medical Center

Towson, Maryland, 21204, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables

Coral Gables, Florida, 33146, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida, 33442, United States
UM Upper Chesapeake Medical Center

Bel Air, Maryland, 21014, United States
UNC Lineberger Comprehensive Cancer Center

Chapel Hill, North Carolina, 27599, United States
USC / Norris Comprehensive Cancer Center

Los Angeles, California, 90033, United States
UTMB Cancer Center at Victory Lakes

League City, Texas, 77573, United States
UW Cancer Center Johnson Creek

Johnson Creek, Wisconsin, 53038, United States
Unity Hospital

Fridley, Minnesota, 55432, United States
University Hospitals Parma Medical Center

Parma, Ohio, 44129, United States
University of California San Diego

San Diego, California, 92103, United States
University of Chicago Comprehensive Cancer Center

Chicago, Illinois, 60637, United States
University of Kansas Cancer Center

Kansas City, Kansas, 66160, United States
University of Kansas Cancer Center-Overland Park

Overland Park, Kansas, 66210, United States
University of Kentucky/Markey Cancer Center

Lexington, Kentucky, 40536, United States
University of Maryland/Greenebaum Cancer Center

Baltimore, Maryland, 21201, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida, 33136, United States
University of Nebraska Medical Center

Omaha, Nebraska, 68198, United States
University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, 73104, United States
University of Rochester

Rochester, New York, 14642, United States
University of Texas Medical Branch

Galveston, Texas, 77555-0565, United States
University of Wisconsin Hospital and Clinics

Madison, Wisconsin, 53792, United States
Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee, 37232, United States
Vince Lombardi Cancer Clinic - Oshkosh

Oshkosh, Wisconsin, 54904, United States
Vince Lombardi Cancer Clinic-Two Rivers

Two Rivers, Wisconsin, 54241, United States
Virginia Commonwealth University/Massey Cancer Center

Richmond, Virginia, 23298, United States
Virginia Mason Medical Center

Seattle, Washington, 98101, United States
Washington University School of Medicine

St Louis, Missouri, 63110, United States
Wayne State University/Karmanos Cancer Institute

Detroit, Michigan, 48201, United States
Wentworth-Douglass Hospital

Dover, New Hampshire, 03820, United States
Wesley Medical Center

Wichita, Kansas, 67214, United States
West Michigan Cancer Center

Kalamazoo, Michigan, 49007, United States
West Virginia University Healthcare

Morgantown, West Virginia, 26506, United States
Wheeling Hospital/Schiffler Cancer Center

Wheeling, West Virginia, 26003, United States
Zablocki Veterans Administration Medical Center

Milwaukee, Wisconsin, 53295, United States

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