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Reduced Craniospinal Radiation Therapy and Chemotherapy in Treating Younger Patients With Newly Diagnosed WNT-Driven Medulloblastoma
Study Purpose
This phase II trial studies how well reduced doses of radiation therapy to the brain and spine (craniospinal) and chemotherapy work in treating patients with newly diagnosed type of brain tumor called WNT)/Wingless (WNT)-driven medulloblastoma. Recent studies using chemotherapy and radiation therapy have been shown to be effective in treating patients with WNT-driven medulloblastoma. However, there is a concern about the late side effects of treatment, such as learning difficulties, lower amounts of hormones, or other problems in performing daily activities. Radiotherapy uses high-energy radiation from x-rays to kill cancer cells and shrink tumors. Drugs used in chemotherapy, such as cisplatin, vincristine sulfate, cyclophosphamide and lomustine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving reduced craniospinal radiation therapy and chemotherapy may kill tumor cells and may also reduce the late side effects of treatment.
Recruitment Criteria
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Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
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Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
| Eligible Ages | 3 Years - 21 Years |
| Gender | All |
Inclusion Criteria:
- - Patients must be greater than or equal to 3 years and less than 22 years of age at the time of enrollment.
- - Patients must be newly diagnosed and have: - Eligibility confirmed by rapid central pathology and molecular screening review on APEC14B1: - Classical histologic type (non LC/A) WNT medulloblastoma.
- - Positive nuclear beta-catenin by immunohistochemistry (IHC) - Positive for CTNNB1 mutation by Sanger sequencing.
- - Negative for MYC and MYCN by fluorescence in situ hybridization (FISH) - Patient must have negative lumbar cerebrospinal fluid (CSF) cytology.
- - Note: CSF cytology for staging should be performed no sooner than 14 days post operatively to avoid false positive CSF; ideally, CSF should be obtained between day 14 and day 21 to allow for final staging status before enrollment onto the study; patients with positive CSF cytology obtained 0 to 14 days after surgery should have cytology repeated to determine eligibility and final CSF status; patients with negative CSF cytology from lumbar puncture obtained 0 to 14 days after surgery do not need cytology repeated; patients with negative CSF cytology from lumbar puncture obtained prior to surgery do not need cytology repeated post-operatively.
- - Patients must have eligibility confirmed by Rapid Central Imaging Review on APEC14B1; patients must have =< 1.5 cm^2 maximal cross-sectional area of residual tumor; whole brain magnetic resonance imaging (MRI) with and without gadolinium and spine MRI with gadolinium must be performed.
- - Patients must be enrolled, and protocol therapy must be projected to begin, no later than 36 days after definitive diagnostic surgery (day 0) - Peripheral absolute neutrophil count (ANC) >= 1000/uL.
- - Platelet count >= 100,000/uL (transfusion independent) - Hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions) - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows: - 3 to < 6 years of age: maximum (max) serum creatinine 0.8 mg/dL (males and females) - 6 to < 10 years of age: max serum creatinine 1 mg/dL (males and females) - 10 to < 13 years of age: max serum creatinine 1.2 mg/dL (males and females) - 13 to < 16 years of age: max serum creatinine 1.5 md/dL (males) and 1.4 md/dL (females) - >= 16 years of age: max serum creatinine 1.7 mg/dL (males) and 1.4 mg/dL (females) - The threshold creatinine values were derived from the Schwartz formula for estimating GFR utilizing child length and stature data published by the Centers for Disease Control and Prevention (CDC) - Total or direct bilirubin =< 1.5 x upper limit of normal (ULN) for age, and.
- - Serum glutamate pyruvate (SGPT) (alanine aminotransferase [ALT]) =< 135 U/L (3x ULN); for the purpose of this study, the ULN for SGPT is 45 U/L.
- - Central nervous system function defined as: - Patients with seizure disorder may be enrolled if on anticonvulsants and well controlled.
- - Patients must not be in status epilepticus, a coma or on assisted ventilation at the time of study enrollment.
- - Patients must have receptive and expressive language skills in English, French, or Spanish to complete the QoL and neurocognitive assessments; if a patient meets these criteria but the parent/guardian speaks a language other than English, French, or Spanish, the patient may still be enrolled and tested, and the parent-report measures should be omitted.
- - All patients and/or their parents or legal guardians must sign a written informed consent; assent, when appropriate, will be obtained according to institutional guidelines.
- - All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.
Exclusion Criteria:
- - Patients with metastatic disease by either MRI evaluation (brain and spine) or lumbar CSF cytology are not eligible; patients who are unable to undergo a lumbar puncture for assessment of CSF cytology are ineligible.
- - Patients must not have received any prior radiation therapy or chemotherapy (tumor-directed therapy) other than surgical intervention and/or corticosteroids.
- - Pregnancy and Breast Feeding.
- - Female patients who are pregnant are ineligible due to risks of fetal and teratogenic adverse events as seen in animal/human studies.
- - Lactating females are not eligible unless they have agreed not to breastfeed their infants.
- - Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained.
- - Sexually active patients of reproductive potential are not eligible unless they have agreed to use an effective contraceptive method for the duration of their study participation.
- - Patients with a history of moderate to profound intellectual disability (i.e., intelligence quotient [Q)]=< 55) are not eligible for enrollment; PLEASE NOTE: Children with a prior history of attention deficit hyperactivity disorder (ADHD) or a specific learning disability (e.g., dyslexia) are eligible for this study.
Trial Details
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Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT02724579 |
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Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 2 |
|
Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
Children's Oncology Group |
|
Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Nicholas J Gottardo |
| Principal Investigator Affiliation | Children's Oncology Group |
|
Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
Other, NIH |
| Overall Status | Active, not recruiting |
| Countries | Australia, Canada, Puerto Rico, Saudi Arabia, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Medulloblastoma |
PRIMARY OBJECTIVE:
- I. To estimate the progression-free survival (PFS) of children >= 3 years of age with wingless-type MMTV integration site family (WNT)-driven average-risk medulloblastoma using reduced craniospinal radiotherapy (CSI) (18 Gray [Gy]) with a limited target volume boost to the tumor bed of 36 Gy for a total of 54 Gy and reduced chemotherapy approach (no vincristine [vincristine sulfate] during radiotherapy and reduced-dose maintenance chemotherapy) and to monitor the PFS for early evidence that the outcome is unacceptable.
- I. To prospectively test the hypothesis that deoxyribonucleic acid (DNA) methylation profiling will accurately classify WNT-driven medulloblastoma.
- II. To prospectively evaluate and longitudinally model the cognitive, social, emotional, behavioral, and quality of life (QoL) functioning of children who are treated with reduced CSI (18 Gy) with a limited target volume boost to the tumor bed (to a total of 54 Gy) and reduced chemotherapy (reduced cisplatin, vincristine, and lomustine [CCNU]).
- I. To explore whether DNA methylation profiling of medulloblastoma samples will result in a predictive classification scheme for the Sonic Hedgehog (SHH), Group 3, and Group 4 medulloblastoma subgroups according to the Heidelberg classifier.
- II. To describe the audiologic and endocrinologic toxicities, as well as peripheral neuropathy, in children treated with reduced CSI (18 Gy) with a limited target volume boost to the tumor bed (to a total of 54 Gy) and reduced cisplatin and vincristine chemotherapy.
Arms
Experimental: Treatment (reduced radiation therapy and chemotherapy)
RADIATION THERAPY: Beginning 4-5 weeks after surgery, patients undergo craniospinal radiation therapy 5 days a week for 6 weeks. MAINTENANCE THERAPY (WEEKS 1, 3, 5, and 7): Beginning 4-6 weeks after completion of radiation therapy patients receive lomustine PO on day 1, vincristine sulfate IV over 1 minute or via minibag on days 1, 8, and 15, and cisplatin IV over 6 hours on day 1. Treatment repeats every 42 days in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY (WEEKS 2, 4, AND 6): Patients receive cyclophosphamide IV over 30-60 minutes on days 1 and 2, mesna IV over 15-30 minutes on days 1 and 2, and vincristine sulfate IV over 1 minute or via minibag on days 1 and 8. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo MRI throughout the trial.
Interventions
Drug: - Cisplatin
Given IV
Drug: - Cyclophosphamide
Given IV
Other: - Laboratory Biomarker Analysis
Correlative studies
Drug: - Lomustine
Given PO
Procedure: - Magnetic Resonance Imaging
Undergo MRI
Radiation: - Radiation Therapy
Undergo craniospinal radiation therapy
Drug: - Vincristine
Given IV or via minibag
Drug: - Vincristine Sulfate
Given IV or via minibag
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
Address
Children's Hospital of Alabama
Birmingham, Alabama, 35233
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USA Health Strada Patient Care Center
Mobile, Alabama, 36604
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Providence Alaska Medical Center
Anchorage, Alaska, 99508
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Banner Children's at Desert
Mesa, Arizona, 85202
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Phoenix Childrens Hospital
Phoenix, Arizona, 85016
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Address
Arkansas Children's Hospital
Little Rock, Arkansas, 72202-3591
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Kaiser Permanente Downey Medical Center
Downey, California, 90242
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Address
Loma Linda University Medical Center
Loma Linda, California, 92354
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Address
Miller Children's and Women's Hospital Long Beach
Long Beach, California, 90806
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Children's Hospital Los Angeles
Los Angeles, California, 90027
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Cedars Sinai Medical Center
Los Angeles, California, 90048
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Mattel Children's Hospital UCLA
Los Angeles, California, 90095
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Valley Children's Hospital
Madera, California, 93636
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Address
UCSF Benioff Children's Hospital Oakland
Oakland, California, 94609
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Address
Kaiser Permanente-Oakland
Oakland, California, 94611
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Children's Hospital of Orange County
Orange, California, 92868
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Lucile Packard Children's Hospital Stanford University
Palo Alto, California, 94304
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Sutter Medical Center Sacramento
Sacramento, California, 95816
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Address
University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
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Rady Children's Hospital - San Diego
San Diego, California, 92123
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UCSF Medical Center-Mission Bay
San Francisco, California, 94158
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Address
Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
Torrance, California, 90502
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Children's Hospital Colorado
Aurora, Colorado, 80045
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Address
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
Denver, Colorado, 80218
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Connecticut Children's Medical Center
Hartford, Connecticut, 06106
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Alfred I duPont Hospital for Children
Wilmington, Delaware, 19803
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MedStar Georgetown University Hospital
Washington, District of Columbia, 20007
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Address
Golisano Children's Hospital of Southwest Florida
Fort Myers, Florida, 33908
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Address
University of Florida Health Science Center - Gainesville
Gainesville, Florida, 32610
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Address
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood, Florida, 33021
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Address
Nemours Children's Clinic-Jacksonville
Jacksonville, Florida, 32207
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University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
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Address
Nicklaus Children's Hospital
Miami, Florida, 33155
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AdventHealth Orlando
Orlando, Florida, 32803
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Arnold Palmer Hospital for Children
Orlando, Florida, 32806
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Nemours Children's Hospital
Orlando, Florida, 32827
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Address
Nemours Children's Clinic - Pensacola
Pensacola, Florida, 32504
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Sacred Heart Hospital
Pensacola, Florida, 32504
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Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, 33701
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Address
Tampa General Hospital
Tampa, Florida, 33606
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Address
Saint Joseph's Hospital/Children's Hospital-Tampa
Tampa, Florida, 33607
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Address
Saint Mary's Medical Center
West Palm Beach, Florida, 33407
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Address
Children's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta, Georgia, 30329
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Memorial Health University Medical Center
Savannah, Georgia, 31404
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Address
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
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Address
Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
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Lurie Children's Hospital-Chicago
Chicago, Illinois, 60611
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University of Illinois
Chicago, Illinois, 60612
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University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
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Address
Loyola University Medical Center
Maywood, Illinois, 60153
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Advocate Children's Hospital-Oak Lawn
Oak Lawn, Illinois, 60453
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Advocate Children's Hospital-Park Ridge
Park Ridge, Illinois, 60068
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Saint Jude Midwest Affiliate
Peoria, Illinois, 61637
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Southern Illinois University School of Medicine
Springfield, Illinois, 62702
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Riley Hospital for Children
Indianapolis, Indiana, 46202
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Address
Ascension Saint Vincent Indianapolis Hospital
Indianapolis, Indiana, 46260
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Blank Children's Hospital
Des Moines, Iowa, 50309
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Address
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
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Address
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
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Address
Norton Children's Hospital
Louisville, Kentucky, 40202
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Address
Children's Hospital New Orleans
New Orleans, Louisiana, 70118
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Address
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
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Address
Eastern Maine Medical Center
Bangor, Maine, 04401
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Address
Maine Children's Cancer Program
Scarborough, Maine, 04074
Status
Address
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
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Address
Tufts Children's Hospital
Boston, Massachusetts, 02111
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Address
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
Status
Address
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
Status
Address
UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
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Address
C S Mott Children's Hospital
Ann Arbor, Michigan, 48109
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Address
Children's Hospital of Michigan
Detroit, Michigan, 48201
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Address
Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
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Address
Michigan State University Clinical Center
East Lansing, Michigan, 48824
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Address
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
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Address
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, 49503
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Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
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Address
West Michigan Cancer Center
Kalamazoo, Michigan, 49007
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Address
Corewell Health Children's
Royal Oak, Michigan, 48073
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Address
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
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Address
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, 55455
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Address
Mayo Clinic in Rochester
Rochester, Minnesota, 55905
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Address
University of Mississippi Medical Center
Jackson, Mississippi, 39216
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Address
University of Missouri Children's Hospital
Columbia, Missouri, 65212
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Address
Children's Mercy Hospitals and Clinics
Kansas City, Missouri, 64108
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Address
Cardinal Glennon Children's Medical Center
Saint Louis, Missouri, 63104
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Address
Washington University School of Medicine
Saint Louis, Missouri, 63110
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Address
Mercy Hospital Saint Louis
Saint Louis, Missouri, 63141
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Address
Children's Hospital and Medical Center of Omaha
Omaha, Nebraska, 68114
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Address
University of Nebraska Medical Center
Omaha, Nebraska, 68198
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Address
University Medical Center of Southern Nevada
Las Vegas, Nevada, 89102
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Address
Sunrise Hospital and Medical Center
Las Vegas, Nevada, 89109
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Address
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada, 89135
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Address
Summerlin Hospital Medical Center
Las Vegas, Nevada, 89144
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Address
Renown Regional Medical Center
Reno, Nevada, 89502
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Address
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
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Hackensack University Medical Center
Hackensack, New Jersey, 07601
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Morristown Medical Center
Morristown, New Jersey, 07960
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Saint Peter's University Hospital
New Brunswick, New Jersey, 08901
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Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
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Newark Beth Israel Medical Center
Newark, New Jersey, 07112
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Saint Joseph's Regional Medical Center
Paterson, New Jersey, 07503
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Albany Medical Center
Albany, New York, 12208
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Address
Montefiore Medical Center - Moses Campus
Bronx, New York, 10467
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Roswell Park Cancer Institute
Buffalo, New York, 14263
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Address
NYU Langone Hospital - Long Island
Mineola, New York, 11501
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The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park, New York, 11040
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Mount Sinai Hospital
New York, New York, 10029
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Memorial Sloan Kettering Cancer Center
New York, New York, 10065
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University of Rochester
Rochester, New York, 14642
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Address
Stony Brook University Medical Center
Stony Brook, New York, 11794
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State University of New York Upstate Medical University
Syracuse, New York, 13210
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New York Medical College
Valhalla, New York, 10595
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Mission Hospital
Asheville, North Carolina, 28801
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UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
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Address
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
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Novant Health Presbyterian Medical Center
Charlotte, North Carolina, 28204
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Address
East Carolina University
Greenville, North Carolina, 27834
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Address
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
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Sanford Broadway Medical Center
Fargo, North Dakota, 58122
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Address
Children's Hospital Medical Center of Akron
Akron, Ohio, 44308
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Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
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Rainbow Babies and Childrens Hospital
Cleveland, Ohio, 44106
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Address
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
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Address
Nationwide Children's Hospital
Columbus, Ohio, 43205
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Dayton Children's Hospital
Dayton, Ohio, 45404
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Address
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
Toledo, Ohio, 43606
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Address
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
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Address
Legacy Emanuel Children's Hospital
Portland, Oregon, 97227
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Address
Oregon Health and Science University
Portland, Oregon, 97239
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Address
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
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Address
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
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Address
Geisinger Medical Center
Danville, Pennsylvania, 17822
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Address
Penn State Children's Hospital
Hershey, Pennsylvania, 17033
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Address
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
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Address
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania, 19134
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Address
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, 15224
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Address
Rhode Island Hospital
Providence, Rhode Island, 02903
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Address
Medical University of South Carolina
Charleston, South Carolina, 29425
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Address
Prisma Health Richland Hospital
Columbia, South Carolina, 29203
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Address
BI-LO Charities Children's Cancer Center
Greenville, South Carolina, 29605
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Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
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Address
T C Thompson Children's Hospital
Chattanooga, Tennessee, 37403
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Address
East Tennessee Childrens Hospital
Knoxville, Tennessee, 37916
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Address
The Children's Hospital at TriStar Centennial
Nashville, Tennessee, 37203
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Address
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37232
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Address
Dell Children's Medical Center of Central Texas
Austin, Texas, 78723
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Address
Driscoll Children's Hospital
Corpus Christi, Texas, 78411
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Address
Medical City Dallas Hospital
Dallas, Texas, 75230
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Address
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
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Address
El Paso Children's Hospital
El Paso, Texas, 79905
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Address
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
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Address
Covenant Children's Hospital
Lubbock, Texas, 79410
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Address
UMC Cancer Center / UMC Health System
Lubbock, Texas, 79415
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Address
Children's Hospital of San Antonio
San Antonio, Texas, 78207
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Address
Methodist Children's Hospital of South Texas
San Antonio, Texas, 78229
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Address
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
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Address
Scott and White Memorial Hospital
Temple, Texas, 76508
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Address
Primary Children's Hospital
Salt Lake City, Utah, 84113
Status
Address
University of Vermont and State Agricultural College
Burlington, Vermont, 05405
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Address
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
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Address
Inova Fairfax Hospital
Falls Church, Virginia, 22042
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Address
Children's Hospital of The King's Daughters
Norfolk, Virginia, 23507
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Address
Naval Medical Center - Portsmouth
Portsmouth, Virginia, 23708-2197
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Address
Virginia Commonwealth University/Massey Cancer Center
Richmond, Virginia, 23298
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Address
Carilion Children's
Roanoke, Virginia, 24014
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Address
Seattle Children's Hospital
Seattle, Washington, 98105
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Address
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, Washington, 99204
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Address
Mary Bridge Children's Hospital and Health Center
Tacoma, Washington, 98405
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Address
Madigan Army Medical Center
Tacoma, Washington, 98431
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Address
West Virginia University Healthcare
Morgantown, West Virginia, 26506
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Address
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
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Address
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
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Address
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
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Address
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226
International Sites
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John Hunter Children's Hospital
Hunter Regional Mail Centre, New South Wales, 2310
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Address
Women's and Children's Hospital-Adelaide
North Adelaide, South Australia, 5006
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Address
Princess Margaret Hospital for Children
Perth, Western Australia, 6008
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Address
Perth Children's Hospital
Perth, Western Australia, 6009
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Address
Alberta Children's Hospital
Calgary, Alberta, T3B 6A8
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Address
University of Alberta Hospital
Edmonton, Alberta, T6G 2B7
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Address
British Columbia Children's Hospital
Vancouver, British Columbia, V6H 3V4
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Address
CancerCare Manitoba
Winnipeg, Manitoba, R3E 0V9
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Address
Janeway Child Health Centre
Saint John's, Newfoundland and Labrador, A1B 3V6
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Address
IWK Health Centre
Halifax, Nova Scotia, B3K 6R8
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Address
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton, Ontario, L8N 3Z5
Status
Address
Kingston Health Sciences Centre
Kingston, Ontario, K7L 2V7
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Address
Children's Hospital
London, Ontario, N6A 5W9
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Address
Children's Hospital of Eastern Ontario
Ottawa, Ontario, K1H 8L1
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Address
Hospital for Sick Children
Toronto, Ontario, M5G 1X8
Status
Address
The Montreal Children's Hospital of the MUHC
Montreal, Quebec, H3H 1P3
Status
Address
Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec, H3T 1C5
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Address
Jim Pattison Children's Hospital
Saskatoon, Saskatchewan, S7N 0W8
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Address
Saskatoon Cancer Centre
Saskatoon, Saskatchewan, S7N 4H4
Status
Address
HIMA San Pablo Oncologic Hospital
Caguas, , 00726
Status
Address
University Pediatric Hospital
San Juan, , 00926
Status
Address
King Faisal Specialist Hospital and Research Centre
Riyadh, , 11211
