ID
10042
Beskrivning
FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer NCT00023829 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A56DC7B3-8145-10C4-E034-080020C9C0E0
Länk
Nyckelord
Versioner (2)
- 2012-09-19 2012-09-19 -
- 2015-03-21 2015-03-21 - Martin Dugas
Uppladdad den
21 mars 2015
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer adjuvant therapy (FS RTOG Phase III Study NCT00023829)
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.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
Beskrivning
Patient characteristics
Alias
- UMLS CUI-1
- C0815172
Beskrivning
Patient'sVitalStatus
Datatyp
text
Beskrivning
DeathDate/LastContactDate
Datatyp
date
Beskrivning
Causeofdeath
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
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
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
DateofPSAAssessment(s)
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0194804
Beskrivning
BiopsyDate
Datatyp
date
Beskrivning
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0242656
Beskrivning
ProgressionInd,Biochemical
Datatyp
text
Beskrivning
ProgressionDate,FirstBiochemical
Datatyp
date
Beskrivning
ProgressionPSAValue
Datatyp
float
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0027643
Beskrivning
ProgressionDate,FirstLocal-Regional
Datatyp
date
Alias
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0027643
Beskrivning
SITE(S)OFLOCAL/REGIONALPROGRESSION
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminelocal/regionalprogression)
Datatyp
text
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Beskrivning
ProgressionDate,FirstDistant
Datatyp
date
Beskrivning
Site(s)ofFirstDistantProgression
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminedistantprogression)
Datatyp
text
Beskrivning
NewCancerDiagnosisAnatomicSite
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C9305
- UMLS 2011AA ObjectClass-2
- C0006826
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
Beskrivning
NewPrimaryCancerDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Specify(newprimarysite)
Datatyp
text
Beskrivning
HQUse
Datatyp
text
Beskrivning
PROTOCOLHORMONESCONTINUING
Datatyp
text
Beskrivning
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Beskrivning
Non-ProtocolTherapyAdministeredType
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C25590
- NCI Thesaurus Property
- C25382
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Beskrivning
Non-ProtocolTherapyDate,First
Datatyp
date
Beskrivning
Specify(non-protocolprostatecancertherapy)
Datatyp
text
Beskrivning
Radiation therapy
Alias
- UMLS CUI-1
- C1522449
Beskrivning
TOTALDOSETOPROSTATE
Datatyp
float
Måttenheter
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0033572
Beskrivning
TOTALDOSETOPELVIS
Datatyp
float
Måttenheter
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0030797
Beskrivning
RTBeginDate
Datatyp
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0808070
Beskrivning
RTEndDate
Datatyp
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0806020
Beskrivning
RTInterruptionsInd
Datatyp
text
Beskrivning
RadiationTherapyUnscheduledInterruptionSpecify
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C15313
- NCI Thesaurus Property
- C25594
- NCI Thesaurus Property-2
- C25211
- NCI Thesaurus Property-3
- C25542
- UMLS CUI-1
- C0392360
- UMLS CUI-2
- C1522449
- UMLS CUI-3
- C1512900
Beskrivning
REASONRADIATIONTHERAPYTREATMENTENDED
Datatyp
text
Alias
- UMLS CUI-1
- C3166257
- UMLS CUI-2
- C1522449
Beskrivning
Alternativetherapy,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Other,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beskrivning
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Beskrivning
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatyp
text
Beskrivning
CTC ADVERSE EVENT TERM
Datatyp
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Beskrivning
COMMONTOXICITYGENERALCATEGORY
Datatyp
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C0683312
Beskrivning
CTC ADVERSE EVENT GRADE
Datatyp
integer
Alias
- UMLS CUI-1
- C2985911
Beskrivning
CTC ADVERSE EVENT ONSET DATE (GRADE >=3)
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0332162
Beskrivning
CTCADVERSEEVENTATTRIBUTIONCODE
Datatyp
text
Alias
- UMLS CUI-1
- C1706735
Beskrivning
Othercause,specify(adverseeventattribution)
Datatyp
text
Beskrivning
Specify(adverseevent)
Datatyp
text
Beskrivning
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1527021
- UMLS CUI-2
- C1522602
Beskrivning
URINARYINCONTINENCE,SeverityGrade
Datatyp
text
Alias
- UMLS CUI-1
- C0042024
- UMLS CUI-2
- C0392364
Beskrivning
URINARYINCONTINENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryincontinence,attribution)
Datatyp
text
Beskrivning
URINARYINCONTINENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
URINARYFREQUENCY/URGENCY,SeverityGrade
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryfrequency/urgency,attribution)
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
ERECTILE IMPOTENCE, Severity Grade (0-3)
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(erectileimpotence,attribution)
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Similar models
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.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
C0237753 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
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)
C25180 (NCI Thesaurus ValueDomain-2)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0205448 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0194804 (UMLS CUI-1)
C25180 (NCI Thesaurus ValueDomain-2)
C0242656 (UMLS CUI-1)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C0027643 (UMLS CUI-1)
C0027643 (UMLS CUI-2)
C1521733 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C1521733 (UMLS 2011AA)
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)
C0549184 (UMLS 2011AA)
C0005682 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C0555952 (UMLS 2011AA)
C1522619 (UMLS 2011AA)
C1704242 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0025202 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
C0549184 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C2169193 (UMLS CUI-1)
C0033572 (UMLS CUI-2)
C2169193 (UMLS CUI-1)
C0030797 (UMLS CUI-2)
C0808070 (UMLS CUI-2)
C0806020 (UMLS CUI-2)
C1298908 (UMLS 2011AA)
C15313 (NCI Thesaurus ObjectClass)
C25594 (NCI Thesaurus Property)
C25211 (NCI Thesaurus Property-2)
C25542 (NCI Thesaurus Property-3)
C0392360 (UMLS CUI-1)
C1522449 (UMLS CUI-2)
C1512900 (UMLS CUI-3)
C1522449 (UMLS CUI-2)
C25180 (NCI Thesaurus ValueDomain-2)
C1519275 (UMLS CUI-1)
C3537125 (UMLS CUI-2)
C2826934 (UMLS CUI-2)
C0683312 (UMLS CUI-2)
C0005778 (UMLS 2011AA)
C0521362 (UMLS 2011AA)
C0019080 (UMLS 2011AA)
C0205054 (UMLS 2011AA)
C0497254 (UMLS 2011AA)
C0027855 (UMLS 2011AA)
C0030193 (UMLS 2011AA)
C2709248 (UMLS 2011AA)
C0011008 (UMLS CUI-1)
C0877248 (UMLS CUI-2)
C0332162 (UMLS CUI-3)
C0439673 (UMLS 2011AA)
C25180 (NCI Thesaurus ValueDomain-2)
C1527021 (UMLS CUI-1)
C1522602 (UMLS CUI-2)
C0392364 (UMLS CUI-2)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
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