Clinical trial NCT04031677: Surgery With or Without Neoadjuvant Chemotherapy in High Risk RetroPeritoneal Sarcoma
Official title: A Randomized Phase III Study of Neoadjuvant Chemotherapy Followed by Surgery Versus Surgery Alone for Patients With High Risk RetroPeritoneal Sarcoma (RPS)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Retroperitoneal Sarcoma
Liposarcoma
Leiomyosarcoma
Lead sponsor: European Organisation for Research and Treatment of Cancer - EORTC
Sponsor class: NETWORK
Collaborators: name: Canadian Cancer Trials Group
name: ECOG-ACRIN Cancer Research Group
name: Anticancer Fund, Belgium
name: Australia and New Zealand Sarcoma Association
name: Japan Clinical Oncology Group
First posted: 2019-07-24
Enrollment: 250
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a multicenter, randomized, open label phase lll trial to assess whether preoperative chemotherapy, as an adjunct to curative-intent surgery, improves the prognosis of high risk DDLPS (dedifferentiated Liposarcoma) and LMS (Leiomyosarcoma) patients as measured by disease free survival.

After confirmation of eligibility criteria, patients will be randomized to either the standard arm or experimental arm.

Detailed description: Standard arm:

* Large en-bloc curative-intent surgery within 4 weeks following randomization- Experimental arm

Experimental arm:

* 3 cycles of neoadjuvant chemotherapy starting within 2 weeks following randomization:

  * High grade LPS: ADM (doxorubicin) 75 mg/m2 (or the equivalent EpiADM 120 mg/m2) + ifosfamide 9 g/m3 Q3 weeks.
  * LMS: ADM 75 mg/m2 + DTIC (dacarbazine) 1 g/m2 Q3 weeks
* re-assessment of operability
* curative-intent surgery within 3-6 weeks of last cycle of chemotherapy

Eligibility criteria: 1. STRASS 2

   Inclusion Criteria:
   * Histologically proven primary high risk leiomyosarcoma (LMS) or Liposarcoma (LPS) of retroperitoneal space or infra-peritoneal spaces of pelvis.
   * LMS:

     * Any grade LMS can be included
     * Minimum size of LMS tumor should be 5 cm
   * LPS:

     * Diagnosis should be confirmed based on MDM2 (Mouse double minute 2 homolog) and CDK4 (Cyclin-dependent kinase 4) expression on IHC (immunohistochemistry), while proof of MDM2 amplification is highly recommended.
     * All grade 3 DDLPS can be included.
     * DDLPS with confirmed grade 2 on biopsy can be included when:

       * The grade 2 DDLPS has an FNCLCC score=5 (Fédération Nationale des Centres de Lutte Contre Le Cancer), and clear necrosis on imaging (whether or not present on the biopsy).
       * The tumors carry a high risk gene profile as determined by the Complexity INdex in SARComas (CINSARC-high)
     * Unifocal tumour
     * Resectable tumour: resectability is based on pre-operative imaging (CT-abdomen, potentially also with MRI) and has to be defined by the local treating sarcoma team. A patient is not considered resectable when the expectation is that only an R2 resection is feasible.
     * Criteria for non-resectability are:
     * Involvement of the superior mesenteric artery, aorta, coeliac trunk and/or portal vein
     * Involvement of bone
     * Growth into the spinal canal
     * Progression of retro-hepatic inferior vena cava leiomyosarcoma towards the right atrium
     * Infiltration of multiple major organs like liver, pancreas and or major vessels
     * Patient must have radiologically measurable disease (RECIST 1.1), as confirmed by imaging. CT thorax abdomen pelvis with IV contrast is the preferred imaging modality. In case of any contra-indications (medical or regulatory), it is allowed to perform a non-contrast CT thorax + MRI abdomen \& pelvis
     * Collection of tumour tissue for central pathology review is mandatory.
     * For patients with LMS: if there is not enough tissue for assessing the grading, this is acceptable.
     * If tumour tissue is not available for the central pathology review, patient will not be eligible.
     * If the biopsy was not done or the FFPE of the biopsy not available but at least 10 unstained slides or one pathological block are available for the central review, that will be considered as acceptable.
     * For the biopsy if fine needle aspiration (FNA) is performed instead of core needle biopsy (CNB) recommended by the standard guidelines, please contact the EORTC medical monitors for further evaluation.
     * Collection of tumour tissue and blood samples for translational research is mandatory.
     * In case there is not enough tissue for TR, a new biopsy is not required and if the patient fulfils all other eligibility criteria, he/she will be eligible.
     * If the blood samples are not collected, patient will not be eligible.
     * If the patient refuses the collection of biomaterial for TR, patient will not be eligible even if he/she fulfils all other eligibility criteria
     * ≥ 18 years old (no upper age limit)
     * WHO performance status ≤ 2
     * Adequate haematological and organ function
     * American Society of Anaesthesiologist (ASA) score \< 3
     * Women of childbearing potential (WOCBP) must have a negative serum pregnancy test within 3 days prior to randomization.

   Note: a woman is considered of childbearing potential, i.e., fertile, if she is following menarche. She remains of childbearing potential until she becomes post-menopausal or permanently sterile.Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy.

   A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However, in the absence of 12 consecutive months without menses, a single FSH measurement is insufficient.
   * WOCBP in both arms should use highly effective birth control measures, during the study treatment period and for at least 6 months after the last dose of chemotherapy or date of surgery (except for women receiving chemotherapy with ifosfamide who should continue contraception until 1 year after last day of treatment). A highly effective method of birth control is defined as a method which results in a low failure rate (i.e., less than 1% per year) when used consistently and correctly.
   * For men in the experimental arm: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive measures, and agreement to refrain from donating sperm.
   * Female subjects who are breast feeding should discontinue nursing prior to the first day of study treatment and until 6months after the last study treatment.
   * Before patient randomization, written informed consent must be given according to ICH/GCP, and national/local regulations.

   Exclusion criteria:
   * Sarcoma originating from bone structure, abdominal or gynecological viscera
   * Extension through the sciatic notch or across the diaphragm
   * Metastatic disease
   * Any previous surgery (excluding diagnostic biopsy), radiotherapy or systemic therapy for the present tumour
   * Hypersensitivity to doxorubicin, ifosfamide, dacarbazine or to any of their metabolites or to any of their excipients
   * Congestive heart failure
   * Angina pectoris
   * Myocardial infarction within 1 year before randomization
   * Uncontrolled arterial hypertension defined as blood pressure ≥ 150/100 mm Hg despite optimal medical therapy.

   Note: in case of high blood pressure: 1) initiation or adjustment of antihypertensive medication(s) is permitted prior to study entry; 2) blood pressure must be re-assessed on two occasions that are separated by a minimum of 1 hour. The mean SBP / DBP values from each blood pressure assessment must be ≤ 150/90mmHg in order for a patient to be eligible for the study.
   * Uncontrolled cardiac arrhythmia
   * Previous treatment with maximum cumulative doses (450mg/m² Doxorubicin or equivalent 900mg/m² Epirubicin) of doxorubicin, daunorubicin, epirubicin, idarubicin, and/or other anthracyclines and anthracenediones
   * Active and uncontrolled infections
   * Vaccination with live vaccines within 30 days prior to study entry
   * Inflammation of the urinary bladder (interstitial cystitis) and/or obstructions of the urine flow.
   * Other invasive malignancy within 5 years, with the exception of adequately treated non-melanoma skin cancer, localized cervical cancer, localized and Gleason ≤ 6prostate cancer.
   * Uncontrolled severe illness, infection, medical condition (including uncontrolled diabetes), other than the primary LPS or LMS of the retroperitoneum.
   * Female patients who are pregnant or breastfeeding or female and male patients of reproductive potential who are not willing to employ effective birth control method.
   * Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before randomization in the trial
   * Known contraindication to imaging tracer and to MRI
2. Selection criteria for STREXIT 2

   * Patients with histologically proven primary resectable localized high-risk DDLPS or LMS of retroperitoneal space or infra-peritoneal spaces of pelvis (as described in the inclusion criteria of STRASS 2) and amenable to receive chemotherapy but for whom the list of eligibility criteria for the study is too restrictive (tumour grading not available, inadequate organ function, concomitant diseases)
   * Patients who meet all eligibility criteria of STRASS 2 but do not consent to randomization or are not enrolled for any other reason.
   * Patients enrolled in a Registry collecting data on primary RPS patients in the centres participating in STRASS 2 (e.g., RESAR) and who satisfy the above criteria.
3. Selection criteria for preferences for neoadjuvant chemotherapy in STRASS 2 substudy

All patients recruited to STRASS 2 in participating centres (Australia +/- international sites) that are able to read, comprehend and write in English at a sufficient level to complete study materials.

Primary outcomes:
measure: Disease free survival
timeFrame: 7 years from first patient in
Secondary outcomes:
measure: Overall survival (OS)
timeFrame: 8 years from first patient in
measure: Recurrence free survival
timeFrame: 8 years from first patient in
measure: Distant metastases free survival
timeFrame: 8 years from first patient in
measure: Cumulative incidence of local recurrences
timeFrame: 8 years from first patient in
measure: Cumulative incidence of distant metastases
timeFrame: 8 years from first patient in
measure: Radiological response to neoadjuvant chemotherapy according to RECIST
timeFrame: 8 years from first patient in
measure: Radiological response to neoadjuvant chemotherapy according to CHOI
timeFrame: 8 years from first patient in
measure: Pathological response
timeFrame: 8 years from first patient in
measure: Safety and toxicity of neoadjuvant chemotherapy
timeFrame: 8 years from first patient in
measure: Perioperative complications
timeFrame: 8 years from first patient in
measure: Late complications
timeFrame: 8 years from first patient in
measure: Health-Related Quality of life (EORTC QLQ-C30 + Item list from QLQ-STO22)
timeFrame: 8 years from first patient in
measure: Health utility, calculated from the collected patient-reported HRQoL data and patient demographics economics.
timeFrame: 8 years from first patient in
Other outcomes:
Locations:
city: Phoenix
country: United States
facility: Mayo Clinic Hospital in Arizona
state: Arizona
city: Duarte
country: United States
facility: City of Hope Comprehensive Cancer Center
state: California
city: Orange
country: United States
facility: UC Irvine Health/Chao Family Comprehensive Ca Ctr
state: California
city: Aurora
country: United States
facility: UCHealth University of Colorado Hospital
state: Colorado
city: Derby
country: United States
facility: Smilow Cancer Hospital-Derby Care Center
state: Connecticut
city: Fairfield
country: United States
facility: Smilow Cancer Hospital Care Center-Fairfield
state: Connecticut
city: Glastonbury
country: United States
facility: Smilow Cancer Hospital Care Center at Glastonbury
state: Connecticut
city: Greenwich
country: United States
facility: Smilow Cancer Hospital Care Center at Greenwich
state: Connecticut
city: Guilford
country: United States
facility: Smilow Cancer Hospital Care Center - Guiford
state: Connecticut
city: Hartford
country: United States
facility: Smilow Cancer Hospital Care Ctr at Saint Francis
state: Connecticut
city: New Haven
country: United States
facility: Yale University
state: Connecticut
city: North Haven
country: United States
facility: Yale-New Haven Hospital North Haven Medical Center
state: Connecticut
city: Stamford
country: United States
facility: Smilow Cancer Hospital Care Center at Long Ridge
state: Connecticut
city: Trumbull
country: United States
facility: Smilow Cancer Hospital Care Center-Trumbull
state: Connecticut
city: Waterbury
country: United States
facility: Smilow Cancer Hospital-Waterbury Care Center
state: Connecticut
city: Waterford
country: United States
facility: Smilow Cancer Hospital Care Center - Waterford
state: Connecticut
city: Jacksonville
country: United States
facility: Mayo Clinic in Florida
state: Florida
city: Tampa
country: United States
facility: Moffitt Cancer Center-International Plaza
state: Florida
city: Tampa
country: United States
facility: Moffitt Cancer Center - McKinley Campus
state: Florida
city: Tampa
country: United States
facility: Moffitt Cancer Center
state: Florida
city: Atlanta
country: United States
facility: Emory University Hospital Midtown
state: Georgia
city: Chicago
country: United States
facility: Northwestern University
state: Illinois
city: Chicago
country: United States
facility: University of Illinois at Chicago MBCCOP
state: Illinois
city: Indianapolis
country: United States
facility: Indiana Univ/Melvin and Bren Simon Cancer Center
state: Indiana
city: Kansas City
country: United States
facility: University of Kansas Cancer Center
state: Kansas
city: Overland Park
country: United States
facility: University of Kansas Cancer Center-Overland Park
state: Kansas
city: Westwood
country: United States
facility: University of Kansas Hospital-Westwood Cancer Ctr
state: Kansas
city: Louisville
country: United States
facility: James Graham Brown Ca Ctr at Univ of Louisville
state: Kentucky
city: Baton Rouge
country: United States
facility: LSU Health Baton Rouge-North Clinic
state: Louisiana
city: Baton Rouge
country: United States
facility: Our Lady of The Lake Hospital
state: Louisiana
city: Baton Rouge
country: United States
facility: Our Lady of the Lake Physician Group
state: Louisiana
city: Baltimore
country: United States
facility: Johns Hopkins Univ/Sidney Kimmel Cancer Center
state: Maryland
city: Boston
country: United States
facility: Dana-Farber/Harvard Cancer Center
state: Massachusetts
city: Ann Arbor
country: United States
facility: University of Michigan Comprehensive Cancer Center
state: Michigan
city: Bemidji
country: United States
facility: Sanford Joe Lueken Cancer Center
state: Minnesota
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: Creve Coeur
country: United States
facility: Siteman Cancer Center-West County
state: Missouri
city: Saint Louis
country: United States
facility: Washington University School of Medicine - Siteman Cancer Center
state: Missouri
city: Saint Louis
country: United States
facility: Siteman Cancer Center-South Country
state: Missouri
city: Bellevue
country: United States
facility: Nebraska Medicine-Bellevue
state: Nebraska
city: Omaha
country: United States
facility: Nebraska Medicine-Bellevue
state: Nebraska
city: Omaha
country: United States
facility: University of Nebraska Medical Center
state: Nebraska
city: Lebanon
country: United States
facility: Dartmouth Hitchcock Med Ctr/Dartmouth Cancer Ctr
state: New Hampshire
city: Hackensack
country: United States
facility: HMH-Hackensack University Medical Center
state: New Jersey
city: New Brunswick
country: United States
facility: Rutgers Cancer Institute of New Jersey
state: New Jersey
city: Buffalo
country: United States
facility: Roswell Park Cancer Institute
state: New York
city: Mineola
country: United States
facility: NYU Langone Hospital - Long Island
state: New York
city: New York
country: United States
facility: Laura and Issac Perlmutter Ca Ctr at NYU Langone
state: New York
city: Rochester
country: United States
facility: University of Rochester
state: New York
city: Stony Brook
country: United States
facility: Stony Brook University Medical Center
state: New York
city: Durham
country: United States
facility: Duke University Medical Center
state: North Carolina
city: Bismarck
country: United States
facility: Sanford Bismarck Medical Center
state: North Dakota
city: Fargo
country: United States
facility: Sanford Broadway Medical Center
state: North Dakota
city: Fargo
country: United States
facility: Sanford Roger Maris Cancer Center
state: North Dakota
city: Columbus
country: United States
facility: Ohio State University Comprehensive Cancer Center
state: Ohio
city: Oklahoma City
country: United States
facility: University of Oklahoma Health Sciences Center
state: Oklahoma
city: Portland
country: United States
facility: Oregon Health and Science University
state: Oregon
city: Erie
country: United States
facility: Saint Vincent Hospital
state: Pennsylvania
city: Jefferson Hills
country: United States
facility: Jefferson Hospital
state: Pennsylvania
city: Monroeville
country: United States
facility: Forbes Hospital
state: Pennsylvania
city: Natrona Heights
country: United States
facility: Allegheny Valley Hospital
state: Pennsylvania
city: Philadelphia
country: United States
facility: University of Pennsylvania/Abramson Cancer Center
state: Pennsylvania
city: Philadelphia
country: United States
facility: Pennsylvania Hospital
state: Pennsylvania
city: Philadelphia
country: United States
facility: Thomas Jefferson University Hospital
state: Pennsylvania
city: Philadelphia
country: United States
facility: Fox Chase Cancer Center
state: Pennsylvania
city: Pittsburgh
country: United States
facility: Allegheny General Hospital
state: Pennsylvania
city: Pittsburgh
country: United States
facility: West Penn Hospital
state: Pennsylvania
city: Pittsburgh
country: United States
facility: UPMC Hillman Cancer Center
state: Pennsylvania
city: Wexford
country: United States
facility: Wexford Health and Wellness Pavilion
state: Pennsylvania
city: Providence
country: United States
facility: Rhode Island Hospital
state: Rhode Island
city: Westerly
country: United States
facility: Smilow Cancer Hospital Care Center - Westerly
state: Rhode Island
city: Sioux Falls
country: United States
facility: Sanford Cancer Center Oncology Clinic
state: South Dakota
city: Sioux Falls
country: United States
facility: Sanford USD Medical Center - Sioux Falls
state: South Dakota
city: Nashville
country: United States
facility: Vanderbilt University/Ingram Cancer Center
state: Tennessee
city: Houston
country: United States
facility: M D Anderson Cancer Center
state: Texas
city: Salt Lake City
country: United States
facility: Huntsman Cancer Institute/University of Utah
state: Utah
city: Mechanicsville
country: United States
facility: VCU Massey Cancer Center at Hanover Medical Park
state: Virginia
city: Richmond
country: United States
facility: VCU Massey Cancer Center at Stony Point
state: Virginia
city: Richmond
country: United States
facility: Virginia Commonwealth Univ/Massey Cancer Center
state: Virginia
city: Roanoke
country: United States
facility: Carilion Roanoke Memorial Hospital
state: Virginia
city: South Hill
country: United States
facility: VCU Community Memorial Health Center
state: Virginia
city: Seattle
country: United States
facility: FHCC South Lake Union
state: Washington
city: Seattle
country: United States
facility: Fred Hutchinson Cancer Center
state: Washington
city: Seattle
country: United States
facility: University of Washington Medical Center - Montlake
state: Washington
city: Eau Claire
country: United States
facility: Marshfield Medical Center-EC Cancer Center
state: Wisconsin
city: Marshfield
country: United States
facility: Marshfield Medical Center
state: Wisconsin
city: Milwaukee
country: United States
facility: Medical College of Wisconsin
state: Wisconsin
city: Minocqua
country: United States
facility: Marshfield Medical Center
state: Wisconsin
city: Rice Lake
country: United States
facility: Marshfield Medical Center
state: Wisconsin
city: Stevens Point
country: United States
facility: Marshfield Med Ctr-River Region at Stevens Point
state: Wisconsin
city: Weston
country: United States
facility: Marshfield Medical Center
state: Wisconsin
city: Woolloongabba
country: Australia
facility: Princess Alexandra Hospital - University Of Queensland
state: Queensland
city: Melbourne
country: Australia
facility: Peter Maccallum Cancer Institute
state: Victoria
city: Camperdown
country: Australia
facility: Chris O'Brian Life House - Chris O'Brien Lifehouse
city: Vancouver
country: Canada
facility: BCCA - Vancouver Cancer Centre
state: British Columbia
city: London
country: Canada
facility: London Regional Cancer Center
state: Ontario
city: Ottawa
country: Canada
facility: The Ottawa Hospital - General Campus
state: Ontario
city: Montréal
country: Canada
facility: Hopital Maisonneuve Rosemont
state: Quebec
city: Montréal
country: Canada
facility: The Research Institute of the McGill University Health Centre
state: Quebec
city: Toronto
country: Canada
facility: Mount Sinai Hospital
city: Stróvolos
country: Cyprus
facility: Bank Of Cyprus Oncology Centre
city: Brno
country: Czechia
facility: Masaryk Memorial Cancer Institute
city: Herlev
country: Denmark
facility: Herlev Hospital - University Copenhagen
state: Copenhagen
city: Aarhus
country: Denmark
facility: Aarhus University Hospitals - Aarhus University Hospital-Skejby
city: Lyon
country: France
facility: Centre Leon Berard
city: Montpellier
country: France
facility: Institut du Cancer de Montpellier
city: Paris
country: France
facility: Institut Curie- Hopital de Paris
city: Strasbourg
country: France
facility: Hopitaux Universitaires de Strasbourg - Hautepierre
city: Villejuif
country: France
facility: Institut Gustave Roussy
city: Goettigen
country: Germany
facility: Universitaetsmedizin Goettingen - Georg-August Universitaet
state: Lower Saxony
city: Dresden
country: Germany
facility: Universitaetsklinikum Carl Gustav Carus
city: Mannheim
country: Germany
facility: UniversitaetsMedizin Mannheim
city: Aviano
country: Italy
facility: Centro Di Riferimento Oncologico
city: Candiolo
country: Italy
facility: IRCCS - Fondazione Piemonte Inst di Candiolo
city: Meldola
country: Italy
facility: IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori"
city: Milano
country: Italy
facility: Istituto Clinico Humanitas
city: Milano
country: Italy
facility: Istituto Europeo di Oncologia
city: Milan
country: Italy
facility: IRCCS - Istituto Nazionale dei Tumori
city: Padova
country: Italy
facility: IRCCS - Istituto Oncologico Veneto
city: Roma
country: Italy
facility: Policlinico Universitario Campus Bio-Medico- Oncology Center
city: Higashi-ku
country: Japan
facility: Kyushu University Hospital
state: Fukuoka
city: Yokohama
country: Japan
facility: Yokohama City University Hospital
state: Kanagawa
city: Yokohama
country: Japan
facility: Kanagawa Cancer Center
state: Kanagawa
city: Sendai
country: Japan
facility: Tohoku University Hospital
state: Miyagi
city: Chikusa-ku
country: Japan
facility: Aichi Cancer Center
state: Nagoya
city: Showa-ku
country: Japan
facility: Nagoya University Hospital
state: Nagoya
city: Niigata City
country: Japan
facility: Niigata University Medical and Dental Hospital
state: Niigata
city: Kita-ku
country: Japan
facility: Okayama University Hospital
state: Okayama
city: Chuo-ku
country: Japan
facility: Osaka International Cancer Institute
state: Osaka
city: Chuo-ku
country: Japan
facility: National Cancer Center Hospital
state: Tokyo
city: Koto-ku
country: Japan
facility: Cancer Institute Hospital of JFCR
state: Tokyo
city: Saitama
country: Japan
facility: Saitama Medical Center, Jichi Medical University
city: Amsterdam
country: Netherlands
facility: The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis
city: Leiden
country: Netherlands
facility: Leiden University Medical Centre
city: Nijmegen
country: Netherlands
facility: Radboudumc - Radboud University Medical Center Nijmegen
city: Warsaw
country: Poland
facility: Maria Sklodowska-Curie Memorial Cancer Centre - Maria Sklodowska-Curie National Research Institute of Oncology
city: Bratislava
country: Slovakia
facility: National Cancer Institute
city: Barcelona
country: Spain
facility: Hospital De La Santa Creu I Sant Pau
city: Barcelona
country: Spain
facility: Institut Catala d'Oncologia - ICO Badalona - Hospital Germans Trias i Pujol
city: Madrid
country: Spain
facility: Hospital General Universitario Gregorio Maranon
city: Madrid
country: Spain
facility: Hospital Universitario San Carlos
city: Birmingham
country: United Kingdom
facility: University Hospitals Birmingham - Queen Elisabeth Medical Centre
city: Glasgow
country: United Kingdom
facility: NHS Greater Glasgow and Clyde - Beatson West of Scotland Cancer Centre - Gartnavel General Hospital
city: Leeds
country: United Kingdom
facility: Leeds Teaching Hospitals NHS Trust - St. James's University Hospital
city: London
country: United Kingdom
facility: the Royal Marsden Hospital
city: Newcastle
country: United Kingdom
facility: Newcastle Hospitals - Freeman Hospital, Northern Centre For Cancer Care
city: Nottingham
country: United Kingdom
facility: Nottingham University Hospitals NHS Trust - City Hospital
city: Oxford
country: United Kingdom
facility: Oxford University Hospitals NHS Trust - Churchill Hospital
city: Wirral
country: United Kingdom
facility: Clatterbridge cancer center
Study officials:
References: