ID
10042
Description
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
Lien
Mots-clés
Versions (2)
- 19/09/2012 19/09/2012 -
- 21/03/2015 21/03/2015 - Martin Dugas
Téléchargé le
21 mars 2015
DOI
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Licence
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
Description
Patient characteristics
Alias
- UMLS CUI-1
- C0815172
Description
Patient'sVitalStatus
Type de données
text
Description
DeathDate/LastContactDate
Type de données
date
Description
Causeofdeath
Type de données
text
Description
PrimaryCauseDeathOtherReasonSpecify
Type de données
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
Description
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Description
CancerFollow-upStatusDate
Type de données
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
PERFORMANCESTATUS
Type de données
text
Description
Follow-upPSAValue(s)
Type de données
text
Description
DateofPSAAssessment(s)
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0194804
Description
BiopsyDate
Type de données
date
Description
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0242656
Description
ProgressionInd,Biochemical
Type de données
text
Description
ProgressionDate,FirstBiochemical
Type de données
date
Description
ProgressionPSAValue
Type de données
float
Description
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C0027643
Description
ProgressionDate,FirstLocal-Regional
Type de données
date
Alias
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0027643
Description
SITE(S)OFLOCAL/REGIONALPROGRESSION
Type de données
text
Description
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Type de données
text
Description
Other,specify(methodusedtodeterminelocal/regionalprogression)
Type de données
text
Description
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
Description
ProgressionDate,FirstDistant
Type de données
date
Description
Site(s)ofFirstDistantProgression
Type de données
text
Description
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Type de données
text
Description
Other,specify(methodusedtodeterminedistantprogression)
Type de données
text
Description
NewCancerDiagnosisAnatomicSite
Type de données
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
Description
NewPrimaryCancerDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Specify(newprimarysite)
Type de données
text
Description
HQUse
Type de données
text
Description
PROTOCOLHORMONESCONTINUING
Type de données
text
Description
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1518384
- UMLS CUI-2
- C0087111
Description
Non-ProtocolTherapyAdministeredType
Type de données
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
Description
Non-ProtocolTherapyDate,First
Type de données
date
Description
Specify(non-protocolprostatecancertherapy)
Type de données
text
Description
Radiation therapy
Alias
- UMLS CUI-1
- C1522449
Description
TOTALDOSETOPROSTATE
Type de données
float
Unités de mesure
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0033572
Description
TOTALDOSETOPELVIS
Type de données
float
Unités de mesure
- Gy
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS CUI-1
- C2169193
- UMLS CUI-2
- C0030797
Description
RTBeginDate
Type de données
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0808070
Description
RTEndDate
Type de données
date
Alias
- UMLS CUI-1
- C1522449
- UMLS CUI-2
- C0806020
Description
RTInterruptionsInd
Type de données
text
Description
RadiationTherapyUnscheduledInterruptionSpecify
Type de données
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
Description
REASONRADIATIONTHERAPYTREATMENTENDED
Type de données
text
Alias
- UMLS CUI-1
- C3166257
- UMLS CUI-2
- C1522449
Description
Alternativetherapy,specify(reasonradiationtherapyended)
Type de données
text
Description
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Type de données
text
Description
Other,specify(reasonradiationtherapyended)
Type de données
text
Description
Adverse event
Alias
- UMLS CUI-1
- C0877248
Description
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1519275
- UMLS CUI-2
- C3537125
Description
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Type de données
text
Description
CTC ADVERSE EVENT TERM
Type de données
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Description
COMMONTOXICITYGENERALCATEGORY
Type de données
text
Alias
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C0683312
Description
CTC ADVERSE EVENT GRADE
Type de données
integer
Alias
- UMLS CUI-1
- C2985911
Description
CTC ADVERSE EVENT ONSET DATE (GRADE >=3)
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0011008
- UMLS CUI-2
- C0877248
- UMLS CUI-3
- C0332162
Description
CTCADVERSEEVENTATTRIBUTIONCODE
Type de données
text
Alias
- UMLS CUI-1
- C1706735
Description
Othercause,specify(adverseeventattribution)
Type de données
text
Description
Specify(adverseevent)
Type de données
text
Description
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Type de données
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS CUI-1
- C1527021
- UMLS CUI-2
- C1522602
Description
URINARYINCONTINENCE,SeverityGrade
Type de données
text
Alias
- UMLS CUI-1
- C0042024
- UMLS CUI-2
- C0392364
Description
URINARYINCONTINENCE,Attribution
Type de données
text
Description
Specifyifothercause(urinaryincontinence,attribution)
Type de données
text
Description
URINARYINCONTINENCE,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
URINARYFREQUENCY/URGENCY,SeverityGrade
Type de données
text
Description
URINARYFREQUENCY/URGENCY,Attribution
Type de données
text
Description
Specifyifothercause(urinaryfrequency/urgency,attribution)
Type de données
text
Description
URINARYFREQUENCY/URGENCY,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
ERECTILE IMPOTENCE, Severity Grade (0-3)
Type de données
text
Description
ERECTILEIMPOTENCE,Attribution
Type de données
text
Description
Specifyifothercause(erectileimpotence,attribution)
Type de données
text
Description
ERECTILEIMPOTENCE,AERBeginDate
Type de données
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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