ID
10029
Beschrijving
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
Link
Trefwoorden
Versies (2)
- 19-09-12 19-09-12 -
- 19-03-15 19-03-15 - Martin Dugas
Geüploaded op
19 maart 2015
DOI
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Licentie
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
Beschrijving
Patient data
Beschrijving
PATIENT'S VITAL STATUS
Datatype
text
Alias
- UMLS CUI-1
- C1148433
Beschrijving
DeathDate/LastContactDate
Datatype
date
Beschrijving
DeathReason
Datatype
text
Beschrijving
PrimaryCauseDeathOtherReasonSpecify
Datatype
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
Beschrijving
CancerFollow-upStatusInd
Datatype
text
Beschrijving
CancerFollow-upStatusDate
Datatype
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
PerformanceStatus
Datatype
text
Beschrijving
Follow-upPSAValue(s)
Datatype
text
Beschrijving
AssessmentDate
Datatype
date
Beschrijving
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beschrijving
Biopsy Date
Datatype
date
Alias
- UMLS CUI-1
- C0005558
- UMLS CUI-2
- C0011008
Beschrijving
ProgressionInd
Datatype
boolean
Alias
- UMLS CUI-1
- C0242656
Beschrijving
ProgressionInd,Biochemical
Datatype
text
Beschrijving
ProgressionDate,FirstBiochemical
Datatype
date
Beschrijving
ProgressionPSAValue
Datatype
float
Beschrijving
ProgressionInd,FirstLocal-Regional
Datatype
text
Beschrijving
ProgressionDate,FirstLocal-Regional
Datatype
date
Beschrijving
ProgressionSite(s),FirstLocal-Regional
Datatype
text
Beschrijving
AssessmentType
Datatype
text
Beschrijving
AssessmentType,Specify
Datatype
text
Beschrijving
ProgressionInd,FirstDistant
Datatype
text
Beschrijving
ProgressionDate,FirstDistant
Datatype
date
Beschrijving
ProgressionSite,FirstDistant
Datatype
text
Beschrijving
NewPrimarySite
Datatype
text
Beschrijving
NewPrimaryCancerDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
Specify(newprimarysite)
Datatype
text
Beschrijving
Non-Protocol Therapy
Alias
- UMLS CUI-1
- C1518384
Beschrijving
Non-ProtocolTherapyInd
Datatype
text
Beschrijving
Non-ProtocolTherapyAdministeredType
Datatype
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
Beschrijving
Radiationtoothersites,specify(non-protocoltherapytype)
Datatype
text
Beschrijving
Non-ProtocolTherapyType
Datatype
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
Beschrijving
SurgicalprocedurerelatedtopreviousRT,specify(non-protocoltherapytype)
Datatype
text
Beschrijving
ComplementaryAlternativeMedicine,specify(non-protocoltherapytype)
Datatype
text
Beschrijving
Non-ProtocolTherapyDate,First
Datatype
date
Beschrijving
Specify(non-protocolprostatecancertherapy)
Datatype
text
Beschrijving
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beschrijving
NEWORCONTINUINGTOXICITY(>SeverityGrade3)SINCETHELASTREPORT?
Datatype
boolean
Alias
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Beschrijving
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatype
text
Beschrijving
CTCAdverseEventTerm
Datatype
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Beschrijving
CTCAdverseEventCategory
Datatype
text
Beschrijving
CTCAdverseEventGrade
Datatype
text
Alias
- UMLS CUI-1
- C2985911
Beschrijving
CTCAdverseEventReportBeginDate
Datatype
date
Beschrijving
CTCAdverseEventAttributionCode
Datatype
text
Beschrijving
CTCAdverseEventTerm,Other
Datatype
text
Beschrijving
Specify
Datatype
text
Beschrijving
Comments
Datatype
text
Beschrijving
SignatureofPersonCompletingThisForm
Datatype
text
Beschrijving
FormCompletionDate,Original
Datatype
date
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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)