ID

10026

Description

FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CE883A-971B-476A-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CE883A-971B-476A-E044-0003BA3F9857

Mots-clés

Clinical Trial

Prostatatumoren

Verlaufsstudien

19/09/2012 19/09/2012 -
18/03/2015 18/03/2015 - Martin Dugas

Téléchargé le

18 mars 2015

DOI

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Creative Commons BY-NC 3.0 Legacy

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Prostate cancer (FS RTOG) Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO

model
Détails

INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.

1 Formulaires

StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
1. INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.

Name

Type

Description | Question | Decode (Coded Value)

Type de données

Alias

Header

Item Group

RTOGStudy

Item

RTOG Study

text

Case#

Item

Case #

text

InstitutionName

Item

Institution Name

text

InstitutionNo.

Item

Institution No.

text

C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)

PatientName,Last

Item

Patient Name, Last

text

PatientName,First

Item

Patient Name, First (13)

text

AmendedData

Item

AMENDED DATA

text

DATEfrom

Item

DATE from (Q2)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

Comments

Item

COMMENTS

text

Signature

Item

SIGNATURE

text

Date

Item

DATE

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

Patient data

Item Group

Patient'sVitalStatus

Item

PATIENT'S VITAL STATUS (2)

text

CL.1

Code List

PATIENT'S VITAL STATUS (2)

CL Item

Alive (Alive)

CL Item

Dead (Dead)

CL Item

Unknown or not applicable (Unknown or not applicable)

DeathDate/LastContactDate

Item

DATE OF LAST CONTACT OR DEATH (3)

date

Causeofdeath

Item

CAUSE OF DEATH (IF DEAD)

text

CL.2

Code List

CAUSE OF DEATH (IF DEAD)

CL Item

Due To This Disease (Due to this disease)

CL Item

Due To Protocol Treatment (Due to protocol treatment)

CL Item

Due to other cause, specify (Due to other cause, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Cause of death, specify

Item

Due to other cause, specify (cause of death) (4)

text

C16960 (NCI Thesaurus ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C0007465 (UMLS CUI-1)

Documented clinical assessment for prostate cancer

Item

HAS THE PATIENT HAD A DOCUMENTED CLINICAL ASSESSMENT FOR PROSTATE CANCER SINCE SUBMISSION OF THE PREVIOUS FOLLOWUP FORM?

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)

CancerFollow-upStatusDate

Item

DATE OF LAST CLINICAL ASSESSMENT (5)

date

C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

PERFORMANCESTATUS

Item

PERFORMANCE STATUS (ZUBROD 0-4)

integer

CL.4

Code List

PERFORMANCE STATUS (ZUBROD 0-4)

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

CL Item

4 (4)

CL Item

-1 (-1)

Follow-upPSAValue(s)

Item

Follow-up PSA Value(s)

text

DateofPSAAssessment(s)

Item

Date of PSA Assessment(s) (7)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

Prostate biopsy since last follow-up

Item

HAS THE PATIENT HAD A PROSTATE BIOPSY SINCE SUBMISSION OF THE LAST FOLLOWUP FORM?

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0194804 (UMLS CUI-1)

BiopsyDate

Item

Biopsy Date

date

C0005558 (UMLS CUI-1)
C0011008 (UMLS CUI-2)

First progression

Item

HAS THE PATIENT DEVELOPED A FIRST PROGRESSION THAT HAS NOT BEEN PREVIOUSLY REPORTED? (A)

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0242656 (UMLS CUI-1)

Biochemical recurrence

Item

HAS THE PATIENT BEEN DIAGNOSED WITH BIOCHEMICAL RECURRENCE SINCE SUBMISSION OF LAST FOLLOW-UP FORM? (See Protocol Section 11)

boolean

Progression date, biochemical

Item

DATE OF FIRST BIOCHEMICAL PROGRESSION

date

ProgressionPSAValue

Item

PSA Value at progression (B)

float

First local-regional recurrence

Item

HAS THE PATIENT BEEN DIAGNOSED WITH FIRST LOCAL-REGIONAL RECURRENCE SINCE SUBMISSION OF LAST FOLLOW-UP FORM? (See Protocol Section 11)

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)

ProgressionDate,FirstLocal-Regional

Item

DATE OF FIRST LOCAL-REGIONAL PROGRESSION

date

SITE(S)OFLOCAL/REGIONALPROGRESSION

Item

SITE(S) OF LOCAL/REGIONAL PROGRESSION

text

Method to determine progression

Item

WHAT WAS THE METHOD USED TO DETERMINE local/regional PROGRESSION

text

CL.9

Code List

WHAT WAS THE METHOD USED TO DETERMINE local/regional PROGRESSION

CL Item

Physical Exam (Physical exam)

CL Item

Pathologic (Pathologic)

C25610 (NCI Thesaurus)
C1521733 (UMLS 2011AA)

CL Item

Radiographic (Radiographic)

CL Item

Nuclear Scan (Nuclear scan)

CL Item

Other, Specify (Other, specify)

Method to determine progression, specify

Item

Other, specify (method used to determine local/regional progression) (C)

text

Distant metastasis

Item

HAS THE PATIENT BEEN DIAGNOSED WITH FIRST DISTANT RECURRENCE SINCE SUBMISSION OF THE LAST FOLLOW-UP FORM?

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1269798 (UMLS CUI-1)

ProgressionDate,FirstDistant

Item

DATE OF FIRST DISTANT PROGRESSION

date

Site(s)ofFirstDistantProgression

Item

SITE(S) OF FIRST DISTANT PROGRESSION

text

Method to determine distant progression

Item

WHAT WAS THE METHOD USED TO DETERMINE distant PROGRESSION

text

CL.11

Code List

WHAT WAS THE METHOD USED TO DETERMINE distant PROGRESSION

CL Item

Physical Exam (Physical exam)

CL Item

Pathologic (Pathologic)

C25610 (NCI Thesaurus)
C1521733 (UMLS 2011AA)

CL Item

Radiographic (Radiographic)

CL Item

Nuclear Scan (Nuclear scan)

CL Item

Other, Specify (Other, specify)

Other,specify(methodusedtodeterminedistantprogression)

Item

Other, specify (method used to determine distant progression)

text

Radiation therapy

Item Group

C1522449 (UMLS CUI-1)

Total dose prostate

Item

TOTAL DOSE TO PROSTATE (Gy)

float

C25209 (NCI Thesaurus ValueDomain)

Total dose pelvis

Item

TOTAL DOSE TO PELVIS

float

C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS CUI-1)

RTBeginDate

Item

RADIATION THERAPY START DATE

date

RTEndDate

Item

RADIATION THERAPY END DATE

date

Unscheduled interruptions in radiation therapy

Item

WERE THERE ANY UNSCHEDULED INTERRUPTIONS IN RADIATION THERAPY?

text

CL.12

Code List

WERE THERE ANY UNSCHEDULED INTERRUPTIONS IN RADIATION THERAPY?

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes, Due To Toxicity (Yes, due to toxicity)

CL Item

Yes, due to other reason (Yes, due to other reason)

RT interruption reason

Item

Specify RT interruption reason

text

C25685 (NCI Thesaurus ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C25211 (NCI Thesaurus Property-2)
C25542 (NCI Thesaurus Property-3)

Reason end of radiation therapy

Item

REASON RADIATION THERAPY TREATMENT ENDED

text

CL.13

Code List

REASON RADIATION THERAPY TREATMENT ENDED

CL Item

Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)

CL Item

Disease Progression/relapse During Active Treatment (Disease progression, relapse during active treatment)

CL Item

Toxicity/side Effects/complications (Toxicity/side effects/complications)

CL Item

Death On Study (Death on study)

CL Item

Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal after beginning protocol therapy)

CL Item

Patient Withdrawal Or Refusal Prior To Beginning Protocol Therapy (Patient withdrawal or refusal prior to beginning protocol therapy)

CL Item

Alternative Therapy (Alternative therapy, specify)

CL Item

Other Complicating Disease (Other complicating disease, specify)

CL Item

Other, Specify: (Other, specify)

Alternativetherapy,specify(reasonradiationtherapyended)

Item

Alternative therapy, specify (reason radiation therapy ended)

text

Othercomplicatingdisease,specify(reasonradiationtherapyended)

Item

Other complicating disease, specify (reason radiation therapy ended)

text

Other,specify(reasonradiationtherapyended)

Item

Other, specify (reason radiation therapy ended) (10)

text

Protocol Hormones continued

Item

PROTOCOL HORMONES CONTINUING (11)

text

CL.14

Code List

PROTOCOL HORMONES CONTINUING (11)

CL Item

N/a - Arm 2 - No Hormones (N/A - Arm 2 - No hormones)

CL Item

No, terminated since last report period (No, terminated since last report period)

CL Item

No, Previously Reported (No, previously reported)

CL Item

Yes, Per Protocol (Yes, per protocol)

CL Item

Other, Explain (Other (explain in comments))

Non-protocol Therapy

Item

DID THE PATIENT RECEIVE ANY NON-PROTOCOL PROSTATE CANCER THERAPY SINCE THE LAST FOLLOW-UP (If yes, enter therapy type and date for each therapy delivered during the follow-up period.)

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1518384 (UMLS CUI-1)

Non-ProtocolTherapyAdministeredType

Item

Non-Protocol Therapy Type

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

CL.16

Code List

Non-Protocol Therapy Type

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Radiation To Pelvis (Radiation to pelvis)

CL Item

Radiation To Other Sites, Specify (Radiation to other sites, specify)

CL Item

Surgery (Surgery)

C17173 (NCI Thesaurus)
C0038894 (UMLS 2011AA)

CL Item

Chemotherapy (Chemotherapy)

C15632 (NCI Thesaurus)
C0392920 (UMLS 2011AA)

CL Item

Hormones (Hormones)

CL Item

Other Specify (Other, specify)

CL Item

Surgical Procedure Related To Previous Rt, Specify (Surgical procedure related to previous RT, specify)

CL Item

Complementary Alternative Medicine, Specify (Complementary Alternative Medicine, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Non-ProtocolTherapyDate,First

Item

Date of first non-protocol therapy

date

Specify(non-protocolprostatecancertherapy)

Item

Specify (non-protocol prostate cancer therapy) (12)

text

Renal or genitourinary toxicity

Item

RENAL/GENITOURINARY TOXICITY ADVERSE EVENT REPORTS (AER) (Use CTC 2.0 to code severity)

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)

URINARYINCONTINENCE,SeverityGrade

Item

URINARY INCONTINENCE, Severity Grade (0-3)

text

CL.18

Code List

URINARY INCONTINENCE, Severity Grade (0-3)

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

URINARYINCONTINENCE,Attribution

Item

URINARY INCONTINENCE, Attribution (see table below)

text

CL.19

Code List

URINARY INCONTINENCE, Attribution (see table below)

CL Item

Radiotherapy only (Radiotherapy only)

CL Item

Combined Modality (hormone, Rt) (Combined modality (Hormone, RT))

CL Item

Tumor And Rx (Tumor and Rx)

CL Item

Hormones (Hormones)

CL Item

Other Cause, Specify (Other cause, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Specifyifothercause(urinaryincontinence,attribution)

Item

Specify if other cause (urinary incontinence, attribution)

text

URINARYINCONTINENCE,AERBeginDate

Item

URINARY INCONTINENCE, AER Begin Date

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

URINARYFREQUENCY/URGENCY,SeverityGrade

Item

URINARY FREQUENCY/URGENCY, Severity Grade (0-3)

text

CL.20

Code List

URINARY FREQUENCY/URGENCY, Severity Grade (0-3)

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

URINARYFREQUENCY/URGENCY,Attribution

Item

URINARY FREQUENCY/URGENCY, Attribution (see table below)

text

CL.21

Code List

URINARY FREQUENCY/URGENCY, Attribution (see table below)

CL Item

Radiotherapy only (Radiotherapy only)

CL Item

Combined Modality (hormone, Rt) (Combined modality (Hormone, RT))

CL Item

Tumor And Rx (Tumor and Rx)

CL Item

Hormones (Hormones)

CL Item

Other Cause, Specify (Other cause, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Specifyifothercause(urinaryfrequency/urgency,attribution)

Item

Specify if other cause (urinary frequency/urgency, attribution)

text

URINARYFREQUENCY/URGENCY,AERBeginDate

Item

URINARY FREQUENCY/URGENCY, AER Begin Date

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

ERECTILEIMPOTENCE,SeverityGrade

Item

ERECTILE IMPOTENCE, Severity Grade (0-3)

text

CL.22

Code List

ERECTILE IMPOTENCE, Severity Grade (0-3)

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

ERECTILEIMPOTENCE,Attribution

Item

ERECTILE IMPOTENCE, Attribution (see table below)

text

CL.23

Code List

ERECTILE IMPOTENCE, Attribution (see table below)

CL Item

Radiotherapy only (Radiotherapy only)

CL Item

Combined Modality (hormone, Rt) (Combined modality (Hormone, RT))

CL Item

Tumor And Rx (Tumor and Rx)

CL Item

Hormones (Hormones)

CL Item

Other Cause, Specify (Other cause, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Specifyifothercause(erectileimpotence,attribution)

Item

Specify if other cause (erectile impotence, attribution)

text

ERECTILEIMPOTENCE,AERBeginDate

Item

ERECTILE IMPOTENCE, AER Begin Date

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

Adverse event

Item Group

C0877248 (UMLS CUI-1)

Toxicity grade 3 or more

Item

NEW OR CONTINUING TOXICITY (>= Severity Grade 3) SINCE THE LAST REPORT? (Report impotence, urinary incontinence, urinary frequency in Q12)

boolean

C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)

IMT code adverse event

Item

IMT CODE ADVERSE EVENT BASED ON CTEP TOXICITY TERM

text

CTCAdverseEventTerm

Item

CTC ADVERSE EVENT TERM

text

CTC category

Item

COMMON TOXICITY GENERAL CATEGORY

text

CL.25

Code List

COMMON TOXICITY GENERAL CATEGORY

CL Item

Allergy / Immunology (Allergy / Immunology)

CL Item

Auditory/hearing (Auditory/Hearing)

CL Item

Blood/bone Marrow (Blood/Bone marrow)

CL324677 (NCI Metathesaurus)

CL Item

Cardiovascular (arrhythmia) (Cardiovascular (Arrhythmia))

CL Item

Cardiovascular (general) (Cardiovascular (General))

CL Item

Coagulation (Coagulation)

C20812 (NCI Thesaurus)
C0005778 (UMLS 2011AA)

CL Item

Constitutional Symptoms (Constitutional Symptoms)

CL Item

Dermatology/skin (Dermatology/Skin)

CL Item

Endocrine (Endocrine)

C0521425 (NCI Metathesaurus)

CL Item

Gastrointestinal (Gastrointestinal)

C13359 (NCI Thesaurus)
C0521362 (UMLS 2011AA)

CL Item

Hemorrhage (Hemorrhage)

C26791 (NCI Thesaurus)
C0019080 (UMLS 2011AA)

CL Item

Hepatic (Hepatic)

C13308 (NCI Thesaurus)
C0205054 (UMLS 2011AA)

CL Item

Infection Febrile Neutropenia (Infection Febrile Neutropenia)

CL Item

Lymphatics (Lymphatics)

CL Item

Metabolic/laboratory (Metabolic/Laboratory)

CL Item

Musculoskeletal (Musculoskeletal)

C25348 (NCI Thesaurus)
C0497254 (UMLS 2011AA)

CL Item

Neurology (Neurology)

C16908 (NCI Thesaurus)
C0027855 (UMLS 2011AA)

CL Item

Ocular/visual (Ocular/Visual)

CL Item

Pain (Pain)

C3303 (NCI Thesaurus)
C0030193 (UMLS 2011AA)

CL Item

Pulmonary (Pulmonary)

C13304 (NCI Thesaurus)
C2709248 (UMLS 2011AA)

CL Item

Renal/genitourinary (Renal/Genitourinary)

CL328688 (NCI Metathesaurus)

CL Item

Second Malignancy (Second Malignancy)

CL Item

Sexual/reproductive Functions (Sexual/Reproductive Functions)

CL Item

Syndromes (Syndromes)

CTC AE grade

Item

CTC ADVERSE EVENT GRADE

text

C2985911 (UMLS CUI-1)

CL.26

Code List

CTC ADVERSE EVENT GRADE

CL Item

3 (3)

CL Item

4 (4)

CL Item

5 (5)

CL Item

9 (9)

CTCADVERSEEVENTONSETDATE

Item

CTC ADVERSE EVENT ONSET DATE (GRADE >=3)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

CTCADVERSEEVENTATTRIBUTIONCODE

Item

CTC ADVERSE EVENT ATTRIBUTION CODE

text

CL.27

Code List

CTC ADVERSE EVENT ATTRIBUTION CODE

CL Item

Radiotherapy only (Radiotherapy only)

CL Item

Combined Modality (hormone, Rt) (Combined modality (Hormone, RT))

CL Item

Tumor And Rx (Tumor and Rx)

CL Item

Hormones (Hormones)

CL Item

Other Cause, Specify (Other cause, specify)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Othercause,specify(adverseeventattribution)

Item

Other cause, specify (adverse event attribution)

text

Specify(adverseevent)

Item

SPECIFY (adverse event)

text

HQUse

Item

HQ Use (14 HAS A NEW PRIMARY CANCER OR MDS MYELODYSPLASTIC SYNDROME BEEN DIAGNOSED THAT HAS NOT BEEN PREVIOUSLY REPORTED?)

text

New cancer

Item Group

C0205314 (UMLS CUI-1)
C0006826 (UMLS CUI-2)

NewCancerDiagnosisAnatomicSite

Item

New Primary Site

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)

CL.28

Code List

New Primary Site

CL Item

None (None)

C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)

CL Item

Aml/mds (AML/MDS)

C9441 (NCI Thesaurus)

CL Item

Bcc (BCC)

CL Item

Bladder (Bladder)

C12414 (NCI Thesaurus)
C0005682 (UMLS 2011AA)

CL Item

Brain (Brain)

C12439 (NCI Thesaurus)
C0006104 (UMLS 2011AA)

CL Item

Colorectal (Colorectal)

C13363 (NCI Thesaurus)
C0555952 (UMLS 2011AA)

CL Item

Esophageal (Esophageal)

C37950 (NCI Thesaurus)
C1522619 (UMLS 2011AA)

CL Item

Gastric (Gastric)

C13307 (NCI Thesaurus)
C1704242 (UMLS 2011AA)

CL Item

Liver (Liver)

C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)

CL Item

Lung (Lung)

C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)

CL Item

Melanoma (Melanoma)

C3224 (NCI Thesaurus)
C0025202 (UMLS 2011AA)

CL Item

Nhl (NHL)

CL Item

Pancreatic (Pancreatic)

C25726 (NCI Thesaurus)
C0030274 (UMLS 2011AA)

CL Item

Renal (Renal)

C25225 (NCI Thesaurus)
C0022646 (UMLS 2011AA)

CL Item

Squamous-skin (Squamous-Skin)

CL Item

Other Hematologic, Specify (Other Hematologic, specify)

CL Item

Other Solid, Specify (Other solid, specify)

CL Item

Unknown Primary (Unknown primary)

NewPrimaryCancerDate

Item

New Primary Cancer Date

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

Specify(newprimarysite)

Item

Specify (new primary site)

text

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ID

Description

Lien

Mots-clés

Versions (2)

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DOI

Licence

Modèle Commentaires :

Groupe Item commentaires pour :

Item commentaires pour :

Prostate cancer (FS RTOG) Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO

INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.

Description

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