Surgery With or Without Neoadjuvant Chemotherapy in High Risk RetroPeritoneal Sarcoma

Recruitment Status
RECRUITING
(See Contacts and Locations)Verified February 2026 by European Organisation for Research and Treatment of Cancer - EORTC
Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
Information Provided by (Responsible Party)
European Organisation for Research and Treatment of Cancer - EORTC
Clinicaltrials.gov Identifier
NCT04031677
Other Study ID Numbers:
EORTC 1809-STBSG
First Submitted
July 21, 2019
First Posted
July 23, 2019
Last Update Posted
March 30, 2026
Last Verified
February 2026

ClinicalTrials.gov processed this data on March 2026. Link to the current ClinicalTrials.gov record .

History of Changes

Study Details

Study 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

Condition or DiseaseIntervention/Treatment
Retroperitoneal SarcomaLiposarcomaLeiomyosarcoma
Procedure: SurgeryDrug: Preoperative chemotherapy

Study Design

Study TypeInterventional
Actual Enrollment250 participants
Design AllocationRandomized
Interventional ModelParallel Assignment
MaskingNone (Open Label)
Primary PurposeTreatment
Official TitleA Randomized Phase III Study of Neoadjuvant Chemotherapy Followed by Surgery Versus Surgery Alone for Patients With High Risk RetroPeritoneal Sarcoma (RPS)
Study Start DateJanuary 19, 2021
Actual Primary Completion Date11mos 2w from now
Actual Study Completion Date1yr 11mos from now

Groups and Cohorts

Group/CohortIntervention/Treatment
Standard arm
Surgery alone
Procedure: Surgery
Large en-bloc curative-intent surgery
Experimental arm
Preoperative chemotherapy and surgery
Drug: Preoperative chemotherapy
* High grade LPS: ADM 75 mg/m2 (or the equivalent EpiADM 120 mg/m2) + ifosfamide 9 g/m2 Q3 weeks * LMS: ADM 75 mg/m2 + DTIC 1g/m2 Q3 weeks Note: the recommended dose of Doxorubicin (or Epirubicin) can be modified according to national/institutional guidelines, given that the minimal threshold must be Doxorubicin 60 mg/m2 per cycle (or the equivalent Epirubicin 95 mg/m2 per cycle); the recommended dose of Ifosfamide can be modified according to national/institutional guidelines, given that the minimal threshold must be 7.5 g/m2 per cycle; the recommended dose of Dacarbazine can be modified according to national/institutional guidelines, given that the minimal threshold must be 900 mg/m2 per cycle. The schedule of administration of above chemotherapies can be modified according to national/institutional guidelines provided that the minimal threshold of doses, and the treatment periods with chemotherapies remain the same.

Outcome Measures

Primary Outcome Measures
  1. Disease free survival
    Disease free survival will be measured from the date of randomization (as reference) to the date of recurrence or death, whichever occurs first.
Secondary Outcome Measures
  1. Overall survival (OS)
    OS will be measured from the date of randomization to the date of death, whatever the cause. Alive patients will be censored at the date of last follow-up.
  2. Recurrence free survival
    Recurrence free survival will be measured in patients who were successfully operated (R0/R1 resection) from the date of surgery (as reference) to the date of recurrence (local or distant) or death, whichever occurs first. Patients without one of these events will be censored at the date of last follow-up.
  3. Distant metastases free survival
    Distant metastases free survival will be from the date of randomization (as reference) to the date of distant metastases or death (whatever the cause), whichever occurs first. Patients without any of these events will be censored at the date of last follow-up.
  4. Cumulative incidence of local recurrences
    Cumulative incidence of local recurrences will be measured from the date of randomization (as reference) to the date of local recurrence.
  5. Cumulative incidence of distant metastases
    Cumulative incidence of distant metastases will be measured from the date of randomization to the date of occurrence of distant metastases.
  6. Radiological response to neoadjuvant chemotherapy according to RECIST
    For patients receiving neo-adjuvant chemotherapy, the radiological response will be assessed using RECIST 1.1 by comparison of the baseline and preoperative imaging.
  7. Radiological response to neoadjuvant chemotherapy according to CHOI
    For patients receiving neo-adjuvant chemotherapy, the radiological response will be also assessed using Choi criteria by comparison of the baseline and preoperative imaging.
  8. Pathological response
    Response evaluation will be done according to the EORTC response score.
  9. Safety and toxicity of neoadjuvant chemotherapy
    Safety and toxicity of neoadjuvant chemotherapy will be evaluated and graded using CTCAE V5.0.
  10. Perioperative complications
    Perioperative complications will be evaluated with the Dindo scale for the events related to the surgery and CTCAE V5.0 will be used for all other events.
  11. Late complications
    Late complications (after the 60th day following the surgery) will be evaluated and graded according to the CTCAE version 5.0.
  12. Health-Related Quality of life (EORTC QLQ-C30 + Item list from QLQ-STO22)
    Health-Related Quality of life assessment will be based on the EORTC QLQ C30 questionnaire version 3.0, with additional questions from the QLQ-STO22 module.
  13. Health utility, calculated from the collected patient-reported HRQoL data and patient demographics economics.
    he EORTC QLQ C30 data will be mapped to health utility values using an established indirect mapping approach.

Eligibility Criteria

Ages Eligible for Study(Adult, Older Adult)
Sexes Eligible for StudyAll
Accepts Healthy VolunteersNo
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
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.

Contacts and Locations

Sponsors and CollaboratorsEuropean Organisation for Research and Treatment of Cancer - EORTC
Locations
University of Alabama at Birmingham Cancer Center | Birmingham Alabama, United States, 35233Mayo Clinic Hospital in Arizona | Phoenix Arizona, United States, 85054City of Hope Comprehensive Cancer Center | Duarte California, United States, 91010UCI Health-Chao Family Comp CC and Ambulatory Care | Irvine California, United States, 92612UC San Diego Moores Cancer Center | La Jolla California, United States, 92093UC Irvine Health/Chao Family Comprehensive Ca Ctr | Orange California, United States, 92668UCHealth University of Colorado Hospital | Aurora Colorado, United States, 80045Smilow Cancer Hospital-Derby Care Center | Derby Connecticut, United States, 06418Smilow Cancer Hospital Care Center-Fairfield | Fairfield Connecticut, United States, 06824Smilow Cancer Hospital Care Center at Glastonbury | Glastonbury Connecticut, United States, 06033Smilow Cancer Hospital Care Center at Greenwich | Greenwich Connecticut, United States, 06830Smilow Cancer Hospital Care Center - Guiford | Guilford Connecticut, United States, 06437Smilow Cancer Hospital Care Ctr at Saint Francis | Hartford Connecticut, United States, 06105Yale University | New Haven Connecticut, United States, 06520Yale-New Haven Hospital North Haven Medical Center | North Haven Connecticut, United States, 06385Smilow Cancer Hospital Care Center at Long Ridge | Stamford Connecticut, United States, 06902Smilow Cancer Hospital Care Center-Trumbull | Trumbull Connecticut, United States, 06611Smilow Cancer Hospital-Waterbury Care Center | Waterbury Connecticut, United States, 06708Smilow Cancer Hospital Care Center - Waterford | Waterford Connecticut, United States, 06385Univ of Florida Health Science Ctr - Gainesville | Gainesville Florida, United States, 32610Mayo Clinic in Florida | Jacksonville Florida, United States, 32224Moffitt Cancer Center-International Plaza | Tampa Florida, United States, 33607Moffitt Cancer Center - McKinley Campus | Tampa Florida, United States, 33612Moffitt Cancer Center | Tampa Florida, United States, 33612Emory University Hospital Midtown | Atlanta Georgia, United States, 30308Northwestern University | Chicago Illinois, United States, 60611Rush University Medical Center | Chicago Illinois, United States, 60612University of Illinois at Chicago MBCCOP | Chicago Illinois, United States, 60612Indiana Univ/Melvin and Bren Simon Cancer Center | Indianapolis Indiana, United States, 46202University of Kansas Cancer Center | Kansas City Kansas, United States, 66160University of Kansas Cancer Center-Overland Park | Overland Park Kansas, United States, 66210University of Kansas Hospital-Westwood Cancer Ctr | Westwood Kansas, United States, 66205James Graham Brown Ca Ctr at Univ of Louisville | Louisville Kentucky, United States, 40202UofL Health Medical Center Northeast | Louisville Kentucky, United States, 40245LSU Health Baton Rouge-North Clinic | Baton Rouge Louisiana, United States, 70805Our Lady of The Lake Hospital | Baton Rouge Louisiana, United States, 70808Our Lady of the Lake Physician Group | Baton Rouge Louisiana, United States, 70808Johns Hopkins Univ/Sidney Kimmel Cancer Center | Baltimore Maryland, United States, 21205Dana-Farber/Harvard Cancer Center | Boston Massachusetts, United States, 02215University of Michigan Comprehensive Cancer Center | Ann Arbor Michigan, United States, 48109Sanford Joe Lueken Cancer Center | Bemidji Minnesota, United States, 56601Mayo Clinic | Rochester Minnesota, United States, 55905Siteman Cancer Center-West County | Creve Coeur Missouri, United States, 63141Washington University School of Medicine - Siteman Cancer Center | St Louis Missouri, United States, 63110Siteman Cancer Center-South Country | St Louis Missouri, United States, 63129Nebraska Medicine-Bellevue | Bellevue Nebraska, United States, 68123Nebraska Medicine-Bellevue | Omaha Nebraska, United States, 68118University of Nebraska Medical Center | Omaha Nebraska, United States, 68198Renown Regional Medical Center | Reno Nevada, United States, 89502Dartmouth Hitchcock Med Ctr/Dartmouth Cancer Ctr | Lebanon New Hampshire, United States, 03756Cooper Hospital University Medical Center | Camden New Jersey, United States, 08103HMH-Hackensack University Medical Center | Hackensack New Jersey, United States, 07601Jersey Shore University Medical Center | Neptune City New Jersey, United States, 07753Rutgers Cancer Institute of New Jersey | New Brunswick New Jersey, United States, 08903John Theurer Cancer Center at From Road | Paramus New Jersey, United States, 07652Roswell Park Cancer Institute | Buffalo New York, United States, 14263NYU Langone Hospital - Long Island | Mineola New York, United States, 11501Laura and Issac Perlmutter Ca Ctr at NYU Langone | New York New York, United States, 10016University of Rochester | Rochester New York, United States, 14642Stony Brook University Medical Center | Stony Brook New York, United States, 11794Carolinas Medical Center/Levine Cancer Institute | Charlotte North Carolina, United States, 28203Duke University Medical Center | Durham North Carolina, United States, 27710Sanford Bismarck Medical Center | Bismarck North Dakota, United States, 58501Sanford Broadway Medical Center | Fargo North Dakota, United States, 58122Sanford Roger Maris Cancer Center | Fargo North Dakota, United States, 58122Ohio State University Comprehensive Cancer Center | Columbus Ohio, United States, 43210University of Oklahoma Health Sciences Center | Oklahoma City Oklahoma, United States, 73104Oregon Health and Science University | Portland Oregon, United States, 97239Saint Vincent Hospital | Erie Pennsylvania, United States, 16544Jefferson Hospital | Jefferson Hills Pennsylvania, United States, 15025Forbes Hospital | Monroeville Pennsylvania, United States, 15146Allegheny Valley Hospital | Natrona Heights Pennsylvania, United States, 15065University of Pennsylvania/Abramson Cancer Center | Philadelphia Pennsylvania, United States, 19104Pennsylvania Hospital | Philadelphia Pennsylvania, United States, 19107Thomas Jefferson University Hospital | Philadelphia Pennsylvania, United States, 19107Fox Chase Cancer Center | Philadelphia Pennsylvania, United States, 19111Allegheny General Hospital | Pittsburgh Pennsylvania, United States, 15212West Penn Hospital | Pittsburgh Pennsylvania, United States, 15224UPMC Hillman Cancer Center | Pittsburgh Pennsylvania, United States, 15232Wexford Health and Wellness Pavilion | Wexford Pennsylvania, United States, 15090Rhode Island Hospital | Providence Rhode Island, United States, 02903Smilow Cancer Hospital Care Center - Westerly | Westerly Rhode Island, United States, 02891Sanford Cancer Center Oncology Clinic | Sioux Falls South Dakota, United States, 57104Sanford USD Medical Center - Sioux Falls | Sioux Falls South Dakota, United States, 57117University of Tennessee - Knoxville | Knoxville Tennessee, United States, 37920Vanderbilt University/Ingram Cancer Center | Nashville Tennessee, United States, 37232UT Southwestern/Simmons Cancer Center-Dallas | Dallas Texas, United States, 75390M D Anderson Cancer Center | Houston Texas, United States, 77030Huntsman Cancer Institute/University of Utah | Salt Lake City Utah, United States, 84132University of Vermont Medical Center | Burlington Vermont, United States, 05401Vermont Regional Cancer Center | Burlington Vermont, United States, 05405VCU Massey Cancer Center at Hanover Medical Park | Mechanicsville Virginia, United States, 23116VCU Massey Cancer Center at Stony Point | Richmond Virginia, United States, 23235Virginia Commonwealth Univ/Massey Cancer Center | Richmond Virginia, United States, 23298Carilion Roanoke Memorial Hospital | Roanoke Virginia, United States, 24014VCU Community Memorial Health Center | South Hill Virginia, United States, 23970FHCC South Lake Union | Seattle Washington, United States, 98109Fred Hutchinson Cancer Center | Seattle Washington, United States, 98109University of Washington Medical Center - Montlake | Seattle Washington, United States, 98195Marshfield Medical Center-EC Cancer Center | Eau Claire Wisconsin, United States, 54701Marshfield Medical Center | Marshfield Wisconsin, United States, 54449Medical College of Wisconsin | Milwaukee Wisconsin, United States, 53226Marshfield Medical Center | Minocqua Wisconsin, United States, 54548Marshfield Medical Center | Rice Lake Wisconsin, United States, 54868Marshfield Med Ctr-River Region at Stevens Point | Stevens Point Wisconsin, United States, 54482Marshfield Medical Center | Weston Wisconsin, United States, 54476Princess Alexandra Hospital - University Of Queensland | Woolloongabba Queensland, Australia, QLD 4102Peter Maccallum Cancer Institute | Melbourne Victoria, Australia, 3000Chris O'Brian Life House - Chris O'Brien Lifehouse | Camperdown , Australia, 2050BCCA - Vancouver Cancer Centre | Vancouver British Columbia, Canada, V5Z 4E6London Regional Cancer Center | London Ontario, Canada, N6A 4L6The Ottawa Hospital - General Campus | Ottawa Ontario, Canada, Hopital Maisonneuve Rosemont | Montreal Quebec, Canada, H1T 2M4The Research Institute of the McGill University Health Centre | Montreal Quebec, Canada, H4A3J1Mount Sinai Hospital | Toronto , Canada, Bank Of Cyprus Oncology Centre | Stróvolos , Cyprus, 2006Masaryk Memorial Cancer Institute | Brno , Czechia, 656 53Herlev Hospital - University Copenhagen | Herlev Copenhagen, Denmark, 2730Aarhus University Hospitals - Aarhus University Hospital-Skejby | Aarhus , Denmark, 8250Centre Leon Berard | Lyon , France, 69008Institut du Cancer de Montpellier | Montpellier , France, 34298Institut Curie- Hopital de Paris | Paris , France, 75248Hopitaux Universitaires de Strasbourg - Hautepierre | Strasbourg , France, 67098Institut Gustave Roussy | Villejuif , France, 94805Universitaetsmedizin Goettingen - Georg-August Universitaet | Goettigen Lower Saxony, Germany, 37075Universitaetsklinikum Carl Gustav Carus | Dresden , Germany, 01307UniversitaetsMedizin Mannheim | Mannheim , Germany, 68167Centro Di Riferimento Oncologico | Aviano , Italy, 33081IRCCS - Fondazione Piemonte Inst di Candiolo | Candiolo , Italy, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" | Meldola , Italy, IRCCS - Istituto Nazionale dei Tumori | Milan , Italy, 20133Istituto Clinico Humanitas | Milan , Italy, Istituto Europeo di Oncologia | Milan , Italy, IRCCS - Istituto Oncologico Veneto | Padova , Italy, Policlinico Universitario Campus Bio-Medico- Oncology Center | Roma , Italy, Kyushu University Hospital | Higashiku Fukuoka, Japan, 812-8582Yokohama City University Hospital | Yokohama Kanagawa, Japan, 236-0004Kanagawa Cancer Center | Yokohama Kanagawa, Japan, 241-8515Tohoku University Hospital | Sendai Miyagi, Japan, 780-8574Aichi Cancer Center | Chikusa-ku Nagoya, Japan, 464-8681Nagoya University Hospital | Shōwaku Nagoya, Japan, 466-8550Niigata University Medical and Dental Hospital | Niigata Niigata, Japan, 951-8520Okayama University Hospital | Kita-ku Okayama-ken, Japan, 700-8558Osaka International Cancer Institute | Chuo-ku Osaka, Japan, 541-8567National Cancer Center Hospital | Chuo-ku Tokyo, Japan, 104-0045Cancer Institute Hospital of JFCR | Koto-ku Tokyo, Japan, 135-8550Saitama Medical Center, Jichi Medical University | Saitama , Japan, 330-8503The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis | Amsterdam , Netherlands, 1066Leiden University Medical Centre | Leiden , Netherlands, 2300 RCRadboudumc - Radboud University Medical Center Nijmegen | Nijmegen , Netherlands, 6525Maria Sklodowska-Curie Memorial Cancer Centre - Maria Sklodowska-Curie National Research Institute of Oncology | Warsaw , Poland, National Cancer Institute | Bratislava , Slovakia, SK 833 10Hospital De La Santa Creu I Sant Pau | Barcelona , Spain, 08041Institut Catala d'Oncologia - ICO Badalona - Hospital Germans Trias i Pujol | Barcelona , Spain, Hospital General Universitario Gregorio Maranon | Madrid , Spain, 28007Hospital Universitario San Carlos | Madrid , Spain, 28040University Hospitals Birmingham - Queen Elisabeth Medical Centre | Birmingham , United Kingdom, B15 2THNHS Greater Glasgow and Clyde - Beatson West of Scotland Cancer Centre - Gartnavel General Hospital | Glasgow , United Kingdom, Leeds Teaching Hospitals NHS Trust - St. James's University Hospital | Leeds , United Kingdom, LS9 7TFthe Royal Marsden Hospital | London , United Kingdom, Clatterbridge cancer center | Metropolitan Borough of Wirral , United Kingdom, CH63 4JYNewcastle Hospitals - Freeman Hospital, Northern Centre For Cancer Care | Newcastle , United Kingdom, NE7 7DNNottingham University Hospitals NHS Trust - City Hospital | Nottingham , United Kingdom, NG5 1PBOxford University Hospitals NHS Trust - Churchill Hospital | Oxford , United Kingdom, OX3 7LE