ID
10029
Beskrivning
FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT Interstitial Brachytherapy With or Without External-Beam Radiation Therapy in Treating Patients With Prostate Cancer NCT00063882 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA892EFD-56AF-589E-E034-0003BA12F5E7
Länk
Nyckelord
Versioner (2)
- 2012-09-19 2012-09-19 -
- 2015-03-19 2015-03-19 - Martin Dugas
Uppladdad den
19 mars 2015
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer Brachytherapy (FS RTOG Phase III Randomized Study NCT00063882)
INSTRUCTIONS: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT
Beskrivning
Patient data
Beskrivning
PATIENT'S VITAL STATUS
Datatyp
text
Alias
- UMLS CUI-1
- C1148433
Beskrivning
DeathDate/LastContactDate
Datatyp
date
Beskrivning
DeathReason
Datatyp
text
Beskrivning
PrimaryCauseDeathOtherReasonSpecify
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass-2
- C25251
- UMLS 2011AA ObjectClass-2
- C0205225
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Beskrivning
CancerFollow-upStatusInd
Datatyp
text
Beskrivning
CancerFollow-upStatusDate
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beskrivning
PerformanceStatus
Datatyp
text
Beskrivning
Follow-upPSAValue(s)
Datatyp
text
Beskrivning
AssessmentDate
Datatyp
date
Beskrivning
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
Biopsy Date
Datatyp
date
Alias
- UMLS CUI-1
- C0005558
- UMLS CUI-2
- C0011008
Beskrivning
ProgressionInd
Datatyp
boolean
Alias
- UMLS CUI-1
- C0242656
Beskrivning
ProgressionInd,Biochemical
Datatyp
text
Beskrivning
ProgressionDate,FirstBiochemical
Datatyp
date
Beskrivning
ProgressionPSAValue
Datatyp
float
Beskrivning
ProgressionInd,FirstLocal-Regional
Datatyp
text
Beskrivning
ProgressionDate,FirstLocal-Regional
Datatyp
date
Beskrivning
ProgressionSite(s),FirstLocal-Regional
Datatyp
text
Beskrivning
AssessmentType
Datatyp
text
Beskrivning
AssessmentType,Specify
Datatyp
text
Beskrivning
ProgressionInd,FirstDistant
Datatyp
text
Beskrivning
ProgressionDate,FirstDistant
Datatyp
date
Beskrivning
ProgressionSite,FirstDistant
Datatyp
text
Beskrivning
NewPrimarySite
Datatyp
text
Beskrivning
NewPrimaryCancerDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Specify(newprimarysite)
Datatyp
text
Beskrivning
Non-Protocol Therapy
Alias
- UMLS CUI-1
- C1518384
Beskrivning
Non-ProtocolTherapyInd
Datatyp
text
Beskrivning
Non-ProtocolTherapyAdministeredType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beskrivning
Radiationtoothersites,specify(non-protocoltherapytype)
Datatyp
text
Beskrivning
Non-ProtocolTherapyType
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass-2
- C2167
- UMLS 2011AA ObjectClass-2
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beskrivning
SurgicalprocedurerelatedtopreviousRT,specify(non-protocoltherapytype)
Datatyp
text
Beskrivning
ComplementaryAlternativeMedicine,specify(non-protocoltherapytype)
Datatyp
text
Beskrivning
Non-ProtocolTherapyDate,First
Datatyp
date
Beskrivning
Specify(non-protocolprostatecancertherapy)
Datatyp
text
Beskrivning
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beskrivning
NEWORCONTINUINGTOXICITY(>SeverityGrade3)SINCETHELASTREPORT?
Datatyp
boolean
Alias
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Beskrivning
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatyp
text
Beskrivning
CTCAdverseEventTerm
Datatyp
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Beskrivning
CTCAdverseEventCategory
Datatyp
text
Beskrivning
CTCAdverseEventGrade
Datatyp
text
Alias
- UMLS CUI-1
- C2985911
Beskrivning
CTCAdverseEventReportBeginDate
Datatyp
date
Beskrivning
CTCAdverseEventAttributionCode
Datatyp
text
Beskrivning
CTCAdverseEventTerm,Other
Datatyp
text
Beskrivning
Specify
Datatyp
text
Beskrivning
Comments
Datatyp
text
Beskrivning
SignatureofPersonCompletingThisForm
Datatyp
text
Beskrivning
FormCompletionDate,Original
Datatyp
date
Similar models
INSTRUCTIONS: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C0439673 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25251 (NCI Thesaurus ObjectClass-2)
C0205225 (UMLS 2011AA ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS CUI-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
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)
C0549184 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass-2)
C1443775 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C3537125 (UMLS CUI-2)
C2826934 (UMLS CUI-2)