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NCT07097142ClinicalTrials.gov

Testing Shorter Duration Radiation Therapy Versus the Usual Radiation Therapy in Patients Receiving the Usual Chemotherapy Treatment for Bladder Cancer, ARCHER Study

The Phase III Adaptive Radiation and Chemotherapy for Muscle Invasive Bladder Cancer Trial (ARCHER)

قيد التجنيديقبل مشاركين الآن، وفقاً لسجل السجل.
التواصل مع هذه الدراسة

باختصار

This phase III trial compares the effect of decreased number of radiation (ultra-hypofractionated) treatments to the usual radiation number of treatments (hypofractionation) with standard of care chemotherapy, with cisplatin, gemcitabine or mitomycin and 5-fluorouracil for the treatment of patients with…

المرحلة 3مطلوب 486 مشاركاً211 موقعاًدولة واحدة

الفئات

مسجَّلة في سجل واحد

يمكن أن تُسجَّل دراسة واحدة في عدة سجلات. نعرضها مرة واحدة ونربط بكل سجل نحتفظ به.

تُعرض معلومات التجربة كما نشرها السجل، بلغتها الأصلية.

هل أنت مهتم بهذه الدراسة؟

تسجيل الدخول أو أنشئ حسابًا لتسجيل اهتمامك ومتابعة هذه الدراسة.

How this study is set up

The points below are drawn from the public registry record for this study. Each one cites the field or sentence it came from. A dash (—) means the record does not state something — not that it is missing or wrong. Many well-run studies, especially small ones, leave some of these blank.

  • Present: Registered before enrolment beganFirst posted 2025-07-31; recorded start 2025-10-07
  • Present: Has a defined primary outcomeA primary outcome measure is listed in the record
  • Present: The primary outcome states a time frameThe primary outcome measure records a time frame
  • Present: Participants are randomly assignedAllocation is recorded as randomised
  • Present: Has a comparison groupThe record lists a placebo or comparator arm, or more than one study arm
  • Not stated: Open label (no blinding)Masking is recorded as none (open label)
  • Not stated: An ethics committee is not stated in the registry recordThis registry's ingested record has no ethics-committee field
  • Not stated: Regulatory oversight (such as an IND or IDE) is not stated in the registry recordThis registry's ingested record has no regulatory-authorisation field
  • Not stated: A data monitoring committee is not stated in the registry recordThis registry's ingested record has no data-monitoring-committee fieldA data monitoring committee is not required for many smaller studies, and its absence here is not unusual.
  • Present: No cost to participants is mentioned in the recordChecked the summary, description and eligibility text; no cost-to-participant phrase found
  • Present: Sponsor has 49 other studies in this databaseCounted from the lead sponsor named in the record (NRG Oncology)
  • Present: Sponsor has posted results for at least one studyBased on the sponsor’s studies in this database
  • The record lists 3 conditions.
  • Lead sponsor type recorded as: other.
  • Intervention regulatory context: investigational, within a phased regulatory pathway.

Trial stature

Three independent measures of this study, described from its registry record — not a recommendation about it. A rigorous study by investigators nobody has heard of is better evidence than a weak study led by a famous one. How these are scored.

Methodological rigourSTRONG

A strong methodological design for a phase 3 study, judged from its ClinicalTrials.gov record.

How this score is built
  • Randomised allocation20/20

    Participants are randomly allocated between arms

  • Blinding0/20

    Open-label

  • Control arm15/15

    Active-comparator control arm

  • Primary-outcome specificity10/10

    Named primary outcome with a defined time frame

  • Endpoint type10/10

    Mortality / MACE endpoint (hard clinical outcome)

  • Multi-centre8/8

    Multi-centre: 211 sites

  • Data monitoring committee0/7

    No data monitoring committee stated

  • Prospective registration5/5

    Registered before the study start date

  • Protocol / SAP posted0/5

    No protocol or SAP posted to the registry

ScaleMEDIUM

A medium-sized study: 486 participants (target), run at 211 sites.

How this score is built
  • Enrolment26/40

    486 participants (target)

  • Site count25/25

    211 sites

  • Country count0/15

    Single country

  • Planned duration10/10

    Planned over about 57 months

  • Sponsor scale6/10

    NRG Oncology has led 49 trials in our corpus

Investigator standingUNKNOWN

We have no verifiable track record for the investigator named on this trial. That is common for early-career investigators and for records held outside ClinicalTrials.gov — it is not a negative signal.

How this score is built
  • Investigator standing0/100

    No investigator recorded in the registry for this trial

These describe the registry record only, and today we hold ClinicalTrials.gov data. Absent fields lower a score, and absence often reflects registration practice rather than study quality. A high-stature trial is not necessarily safer or a better choice for you — enrolling in a large definitive trial can mean a higher chance of receiving placebo, while a small early-phase study may be the only route to a new therapy.

ملخص

This phase III trial compares the effect of decreased number of radiation (ultra-hypofractionated) treatments to the usual radiation number of treatments (hypofractionation) with standard of care chemotherapy, with cisplatin, gemcitabine or mitomycin and 5-fluorouracil for the treatment of patients with muscle invasive bladder cancer. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a short period of time. Ultra-hypofractionated radiation therapy delivers radiation over an even shorter period of time than hypofractionated radiation therapy. Cisplatin is in a class of medications known as platinum-containing compounds. It works by killing, stopping or slowing the growth of tumor cells. Gemcitabine is a chemotherapy drug that blocks the cells from making DNA and may kill tumor cells. Chemotherapy drugs, such as mitomycin-C and 5-fluorouracil (5-FU), 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 ultra-hypofractionated radiation may be equally effective as hypofractionated therapy for patients with muscle invasive bladder cancer.

PRIMARY OBJECTIVE: I. Demonstrate non-inferiority of ultra-hypofractionated (stereotactic body radiation therapy \[SBRT\]) compared to hypofractionated radiation therapy (RT) with a 10% non-inferiority margin (from 50% to 40%) in the rate of bladder-intact event-free survival (BI-EFS) at 3 years (corresponding to a hazard ratio \< 1.32). SECONDARY OBJECTIVES: I. Compare the rates of urinary and bowel toxicity, patient-reported outcomes (PRO), event-free survival (EFS), metastasis-free survival (MFS), and overall survival (OS) between the two treatment arms. II. Compare and evaluate symptomatic adverse events and quality of life measures that are most meaningful to patients. III. Evaluate circulating tumor deoxyribonucleic acid (ctDNA) as a biomarker to determine whether it is predictive of disease recurrence and as a secondary outcome variable. EXPLORATORY OBJECTIVES: I. Evaluate ctDNA, tissue-free minimal residual disease (tfMRD) and urine tumor DNA (utDNA) as biomarkers for predicting recurrence. II. Evaluate tfMRD, obtained at the time of progression, to determine if it captures the presence of disease. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive hypofractionated radiation therapy (RT) once daily (QD), Monday to Friday, for 20 treatments in the absence of disease progression or unacceptable toxicity. Patients also receive one of 3 systemic chemotherapy regimens per treating physician's choice: 1) cisplatin intravenously (IV) weekly for 4 weeks; 2) gemcitabine IV on days 1, 4, 8, 11, 15, 18, 22 and 25 or weekly for 4 weeks; or 3) mitomycin-C IV on day 1 and fluorouracil (5 FU), over 120 hours on days 1-5 and 22-26. Treatment is given in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) scan and/or magnetic resonance imaging (MRI) or fluorodeoxyglucose (FDG) positron emission tomography (PET) throughout the study. In addition, patients may undergo optional blood and urine sample collection throughout the study, as well as an optional biopsy during cystoscopy during follow up. ARM II: Patients receive ultra-hypofractionated RT QD, no more than twice weekly, for 5 treatments in the absence of disease progression or unacceptable toxicity. Patients also receive one of 3 systemic chemotherapy regimens per treating physician's choice: 1) cisplatin IV weekly for 4 weeks; 2) gemcitabine IV on days 1, 4, 8, 11, 15, 18, 22 and 25 or weekly for 4 weeks; or 3) mitomycin-C IV on day 1 and 5 FU, over 120 hours on days 1-5 and 22-26. Treatment given in the absence of disease progression or unacceptable toxicity. Patients also undergo CT scan and/or MRI or FDG PET throughout the study. In addition, patients may undergo optional blood and urine sample collection throughout the study, as well as an optional biopsy during cystoscopy during follow up. After completion of study treatment, patients are followed up at week 16, every 3 months for 3 years then every 6 months to year 5.

الحالات

  • Muscle Invasive Bladder Urothelial Carcinoma
  • Stage II Bladder Cancer AJCC v8
  • Stage IIIA Bladder Cancer AJCC v8

الأهلية

الأهلية
الجنسالجميع
الأعمار18 Yearsلا حد أقصى
المتطوعون الأصحّاءلا

الأهلية كما كُتبت في السجل

Inclusion Criteria: * Histologically proven, cT2-T3,N0M0 urothelial carcinoma of the bladder prior to randomization. * Note: Patients with mixed urothelial carcinoma will be eligible for the trial, but the presence of small cell carcinoma will make a patient ineligible * Must undergo a transurethral resection of bladder tumor (TURBT) prior to randomization. Patients may have either completely or partially resected tumors as long as the treating urologist attempted maximal resection * Must undergo radiological staging prior to randomization. Imaging of chest, abdomen, and pelvis must be performed using CT or MRI (with or without contrast is acceptable). Patients must not have evidence of T4 or node positive disease. Fluorodeoxyglucose (FDG) PET imaging is acceptable for radiological staging * If any lymph nodes ≥ 1.0 cm in shortest cross-sectional diameter are noted on imaging (CT / MRI of abdomen and pelvis), then the patient must have had a biopsy of the enlarged lymph node showing no tumor involvement prior to randomization * No diffuse carcinoma in situ (CIS) based on cystoscopy and biopsy * No definitive clinical or radiologic evidence of metastatic disease * Must not have had urothelial carcinoma or histological variant at any site outside of the urinary bladder within 24 months prior to registration except Ta/T1/Carcinoma in situ (CIS) of the upper urinary tract including renal pelvis and ureter if the patient had undergone complete nephroureterectomy * Age ≥ 18 * Zubrod performance status of ≤ 2 * Not pregnant and not nursing * Negative urine or serum pregnancy test (in persons of childbearing potential) within 14 days prior to registration. Childbearing potential is defined as any person who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal * Absolute neutrophil count (ANC) ≥ 1,500 cells/mm\^3 * Platelets ≥ 100,000 cells/mm\^3 * Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin \[Hgb\]) ≥ 8.0 g/dl is acceptable) * Creatinine clearance (CrCL) of ≥ 30 mL/min by the Cockcroft-Gault formula * Total bilirubin ≤ 2 x institutional upper limit of normal (ULN) * Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3 x institutional ULN * All adverse events associated with any prior therapy must have resolved to Common Terminology Criteria for Adverse Events (CTCAE) grade ≤ 3 prior to randomization * For patients who have completed neoadjuvant therapy, they are eligible if the pre-neoadjuvant therapy diagnosis (TURBT path) is within 180 days before randomization * Must not have had prior pelvic radiation * New York Heart Association Functional Classification II or better (NYHA Functional Classification III/IV are not eligible) (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification.) * No active infection requiring IV antibiotics * Patients with hydronephrosis are eligible if they have unilateral hydronephrosis and kidney function meet criteria specified

الأهلية في عبارات بسيطة

لم تُقسَّم معايير هذا السجل إلى عبارات منفصلة بعد. نص السجل أعلاه كامل وهو النسخة المُعتمَدة.

تصميم الدراسة

تصميم الدراسة
نوع الدراسةتدخّلية
المرحلةالمرحلة 3
التخصيصمعشّاة
نموذج التدخّلPARALLEL
الغرض الأساسيTREATMENT
التعميةNONE (0)
التجنيدمطلوب 486 مشاركاً

الجهة الراعية والمتعاونون

  • NRG Oncology الجهة الراعية

الأذرع والتدخلات

  • Arm I (hypofractionated radiation therapy)ACTIVE_COMPARATOR

    Patients receive hypofractionated RT QD, Monday to Friday, for 20 treatments in the absence of disease progression or unacceptable toxicity. Patients also receive one of 3 systemic chemotherapy regimens per treating physician's choice: 1) cisplatin IV weekly for 4 weeks; 2) gemcitabine IV on days 1, 4, 8, 11, 15, 18, 22 and 25 or weekly for 4 weeks; or 3) mitomycin-C IV on day 1 and 5 FU, over 120 hours on days 1-5 and 22-26. Treatment is given in the absence of disease progression or unacceptable toxicity. Patients also undergo CT scan and/or MRI or FDG PET throughout the study. In addition, patients may undergo optional blood and urine sample collection throughout the study, as well as an optional biopsy during cystoscopy during follow up.

  • Arm II (Ultrahypofractionated radiation therapy)EXPERIMENTAL

    Patients receive ultra-hypofractionated RT QD, no more than twice weekly, for 5 treatments in the absence of disease progression or unacceptable toxicity. Patients also receive one of 3 systemic chemotherapy regimens per treating physician's choice: 1) cisplatin IV weekly for 4 weeks; 2) gemcitabine IV on days 1, 4, 8, 11, 15, 18, 22 and 25 or weekly for 4 weeks; or 3) mitomycin-C IV on day 1 and 5 FU, over 120 hours on days 1-5 and 22-26. Treatment given in the absence of disease progression or unacceptable toxicity. Patients also undergo CT scan and/or MRI or FDG PET throughout the study. In addition, patients may undergo optional blood and urine sample collection throughout the study, as well as an optional biopsy during cystoscopy during follow up.

التدخلات

  • إجراء Biospecimen Collection

    Undergo blood, tissue, and urine sample collection

  • دواء Cisplatin

    Given IV

  • إجراء Computed Tomography

    Undergo CT scan

  • دواء Fluorouracil

    Given IV

  • دواء Gemcitabine

    Given IV

  • إشعاع Hypofractionated Radiation Therapy

    Undergo hypofractionated radiation therapy

  • إجراء Magnetic Resonance Imaging

    Undergo MRI

  • دواء Mitomycin

    Given IV

  • إجراء Positron Emission Tomography

    Undergo PET scan

  • أخرى Survey Administration

    Ancillary studies

  • إشعاع Ultrahypofractionated Radiation Therapy

    Undergo ultrahypofractionated radiation therapy.

مقاييس النتائج

  1. مقياس النتيجة الأولي

    Bladder-intact event-free survival (BI-EFS)

    Defined as histologically proven presence of muscle invasive bladder cancer (MIBC), radiographic evidence of nodal or metastatic disease, performance of radical cystectomy, or death from any cause. Time to event will be calculated from the date of randomization. BI-EFS will be estimated in the two treatment groups using the Kaplan-Meier method and the hazard ratio between ultra-hypofractionation and hypofractionation estimated by fitting a Cox proportional hazards regression model, including a treatment arm indicator variable and adjusting for the three stratification factors employed in the randomization.

    الإطار الزمني Up to 3 years

  2. مقياس النتيجة الثانوي

    Incidence of urinary adverse events

    Will be graded per Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v 5.0). The proportion of patients experiencing grade 3 or higher urinary/bowel toxicity within two years of initiation of treatment will be compared between the two treatment groups using a chi-square test. The 95% confidence interval (CI) width for the true difference will be at most ± 8.9%.

    الإطار الزمني Up to year 2

  3. مقياس النتيجة الثانوي

    Incidence of bowel adverse events

    Will be graded per CTCAE v 5.0. The proportion of patients experiencing grade 3 or higher urinary/bowel toxicity within two years of initiation of treatment will be compared between the two treatment groups using a chi-square test. The 95% CI width for the true difference will be at most ± 8.9%.

    الإطار الزمني Up to year 2

  4. مقياس النتيجة الثانوي

    Quality of life

    As measured by the Functional Assessment of Cancer Therapy-Bladder instrument.

    الإطار الزمني At baseline, 4 weeks, 16 weeks, 13 months, 25 months, and 37 months

  5. مقياس النتيجة الثانوي

    Event free survival

    Kaplan-Meier curves will be generated and the groups compared using a stratified logrank test (stratified by the randomization stratification factors). In addition, a Cox regression model will be fit, including treatment arm and the stratification factors.

    الإطار الزمني From randomization to histologically proven presence of MIBC, radiographic evidence of nodal or metastatic disease, or death from any cause, up to 5 years

  6. مقياس النتيجة الثانوي

    Metastasis-free survival

    Kaplan-Meier curves will be generated and the groups compared using a stratified logrank test. A Cox regression model will also be fit, including treatment arm and the stratification factors.

    الإطار الزمني From randomization to radiographic evidence of metastatic disease or death due to any cause, up to 5 years

  7. مقياس النتيجة الثانوي

    Overall survival

    Kaplan-Meier curves will be generated and the groups compared using a stratified logrank test. A Cox regression model will also be fit, including treatment arm and the stratification factors.

    الإطار الزمني From randomization to death from any cause, up to 5 years

  8. مقياس النتيجة الثانوي

    Incidence of adverse events (AE)

    Will be graded using CTCAE v 5.0. AE rates between the two treatment groups will be compared using chi-square or Fisher exact tests.

    الإطار الزمني Up to year 2

  9. مقياس النتيجة الثانوي

    Circulating tumor deoxyribonucleic acid (ctDNA)

    The association between the ctDNA results and imaging scans will be examined by generating 2x2 tables (presence/absence of minimal residual disease vs. positive/negative scan) at each time point and assessing the concordance between the results. For subjects who are ctDNA-positive at baseline, the proportion that clear ctDNA at the conclusion of RT treatment will be estimated in each arm. A point estimate of these proportions and their associated 95% Wilson score confidence interval will be reported. Clearance rates between the two arms will be compared using a chi-square or Fisher's exact test as appropriate.

    الإطار الزمني At baseline, end of treatment (week 4), weeks 16, 28, 40, 56, and at disease progression or last follow-up visit

  10. مقياس نتيجة آخر

    ctDNA

    Will be analyzed as prognostic markers by fitting Cox regression models for BI-EFS.

    الإطار الزمني At baseline, 4, 16, 28, 40, and 56 weeks from start of chemotherapy

  11. مقياس نتيجة آخر

    Tissue free minimal residual disease

    Will be obtained at the time of progression to determine if it captures the presence of disease. Will be analyzed as prognostic markers by fitting Cox regression models for BI-EFS.

    الإطار الزمني At time of progression

  12. مقياس نتيجة آخر

    Urine tumor deoxyribonucleic acid

    Will be analyzed as prognostic markers by fitting Cox regression models for BI-EFS.

    الإطار الزمني At baseline, 4, 16, 28, 40, and 56 weeks from start of chemotherapy

  13. مقياس نتيجة آخر

    Primary outcome treatment effect by sex

    The corresponding 95% CIs will be provided.

    الإطار الزمني Up to 5 years

  14. مقياس نتيجة آخر

    Primary outcome treatment effect by race

    The corresponding 95% CIs will be provided.

    الإطار الزمني Up to 5 years

  15. مقياس نتيجة آخر

    Primary outcome treatment effect by ethnicity

    The corresponding 95% CIs will be provided.

    الإطار الزمني Up to 5 years

التواريخ

التواريخ
تاريخ البدء7 أكتوبر 2025 (فعلي)
الإتمام الأولي31 مايو 2030 (تقديري)
الإتمام31 مايو 2035 (تقديري)
أول نشر31 يوليو 2025 (فعلي)
آخر تحديث18 أغسطس 2026
النتائج منشورةغير مذكور في سجل السجل
آخر تأكيد للحالةأغسطس 2026

فعلي يعني أن الحدث وقع. تقديري يعني أن الجهة الراعية تتوقعه. للكلمتين معنيان مختلفان.

المواقع

204 مواقع قيد التجنيد

United States

United States
المنشأةالمدينةالولاية أو المنطقةالحالة
OSF Saint Anthony's Health CenterAltonIllinoisقيد التجنيد
UI Health Care Mission Cancer and Blood - Ankeny ClinicAnkenyIowaقيد التجنيد
University of Michigan Rogel Cancer CenterAnn ArborMichiganقيد التجنيد
Langlade Hospital and Cancer CenterAntigoWisconsinقيد التجنيد
Emory Saint Joseph's HospitalAtlantaGeorgiaقيد التجنيد
Grady Health SystemAtlantaGeorgiaقيد التجنيد
Emory University Hospital MidtownAtlantaGeorgiaقيد التجنيد
Emory University Hospital/Winship Cancer InstituteAtlantaGeorgiaقيد التجنيد
UCHealth University of Colorado HospitalAuroraColoradoقيد التجنيد
UH Seidman Cancer Center at UH Avon Health CenterAvonOhioقيد التجنيد
Memorial Sloan Kettering Basking RidgeBasking RidgeNew Jerseyقيد التجنيد
Mary Bird Perkins Cancer CenterBaton RougeLouisianaقيد التجنيد
Louisiana Hematology Oncology Associates LLCBaton RougeLouisianaقيد التجنيد
Bronson Battle CreekBattle CreekMichiganقيد التجنيد
UHHS-Chagrin Highlands Medical CenterBeachwoodOhioقيد التجنيد
Billings Clinic Cancer CenterBillingsMontanaقيد التجنيد
OSF Saint Joseph Medical CenterBloomingtonIllinoisقيد التجنيد
Illinois CancerCare-BloomingtonBloomingtonIllinoisقيد التجنيد
Central Care Cancer Center - BolivarBolivarMissouriقيد التجنيد
Massachusetts General Hospital Cancer CenterBostonMassachusettsقيد التجنيد
Bozeman Health Deaconess HospitalBozemanMontanaقيد التجنيد
University of Michigan - Brighton Center for Specialty CareBrightonMichiganقيد التجنيد
Henry Ford Cancer Institute-DownriverBrownstownMichiganقيد التجنيد
Minnesota Oncology - BurnsvilleBurnsvilleMinnesotaقيد التجنيد
Illinois CancerCare-CantonCantonIllinoisقيد التجنيد
Mercy Cancer Center - Cape GirardeauCape GirardeauMissouriقيد التجنيد
Saint Francis Medical CenterCape GirardeauMissouriقيد التجنيد
Memorial Hospital of CarbondaleCarbondaleIllinoisقيد التجنيد
SIH Cancer InstituteCartervilleIllinoisقيد التجنيد
Illinois CancerCare-CarthageCarthageIllinoisقيد التجنيد
Centralia Oncology ClinicCentraliaIllinoisقيد التجنيد
Christiana Care Health System-Concord Health CenterChadds FordPennsylvaniaقيد التجنيد
UNC Lineberger Comprehensive Cancer CenterChapel HillNorth Carolinaقيد التجنيد
Medical University of South CarolinaCharlestonSouth Carolinaقيد التجنيد
Memorial Hospital of Laramie CountyCheyenneWyomingقيد التجنيد
Rush MD Anderson Cancer CenterChicagoIllinoisقيد التجنيد
Northwestern UniversityChicagoIllinoisقيد التجنيد
University of IllinoisChicagoIllinoisقيد التجنيد
Case Western Reserve UniversityClevelandOhioقيد التجنيد
Henry Ford Macomb Hospital-Clinton TownshipClinton TownshipMichiganقيد التجنيد
Mercy Cancer Center-West LakesCliveIowaقيد التجنيد
UI Health Care Mission Cancer and Blood - West Des Moines ClinicCliveIowaقيد التجنيد
Kootenai Health - Coeur d'AleneCoeur d'AleneIdahoقيد التجنيد
MU Health - University Hospital/Ellis Fischel Cancer CenterColumbiaMissouriقيد التجنيد
Ohio State University Comprehensive Cancer CenterColumbusOhioقيد التجنيد
Memorial Sloan Kettering CommackCommackNew Yorkقيد التجنيد
MD Anderson in The WoodlandsConroeTexasقيد التجنيد
Mercy HospitalCoon RapidsMinnesotaقيد التجنيد
UM Sylvester Comprehensive Cancer Center at Coral GablesCoral GablesFloridaقيد التجنيد
Greater Regional Medical CenterCrestonIowaقيد التجنيد

يُدرَج 161 موقعاً إضافياً في سجل السجل.

مستندات الدراسة

لا تُرتبط أي مستندات في سجل السجل هذا.

التغيّرات عبر الزمن

لم تُسجَّل أي تغييرات منذ أن أدرجنا هذا السجل لأول مرة.

يُسجَّل تغيير في كل مرة تحدّث فيها الجهة الراعية سجل السجل. تظهر هنا الحالة والتواريخ والتجنيد والمواقع كلما تغيّرت.