ID

10043

Descrizione

F1 Radiation Therapy Oncology Group Phase III Prostate 3D / IMRT Follow-up Form Radiation Therapy in Treating Patients With Stage II Prostate Cancer NCT00033631 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CEC00B-902D-4DD5-E044-0003BA3F9857

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CEC00B-902D-4DD5-E044-0003BA3F9857

Keywords

versioni (3)
  1. 19/09/12 19/09/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
  3. 21/03/15 21/03/15 - Martin Dugas
Caricato su

21 marzo 2015

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer RTOG (NCT00033631)

Inglese

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 moduli  
Header
Descrizione

Header

Amended Data
Descrizione

AmendedData

Tipo di dati

text

RTOG Study
Descrizione

RTOGStudy

Tipo di dati

text

Case #
Descrizione

Case#

Tipo di dati

text

Institution Name
Descrizione

InstitutionName

Tipo di dati

text

Institution No.
Descrizione

InstitutionNo.

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Initials
Descrizione

Patient Initials

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
RTOG Patient ID
Descrizione

Trial subject ID RTOG

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
If this is a revised or corrected form, indicate by checking box.
Descrizione

CaseReportFormModifiedInd-2

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25573
COMMENTS
Descrizione

Comments

Tipo di dati

text

SIGNATURE
Descrizione

Signature

Tipo di dati

text

DATE
Descrizione

Date

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Patient characteristics
Descrizione

Patient characteristics

Alias
UMLS CUI-1
C0815172
PATIENT'S VITAL STATUS
Descrizione

Patient'sVitalStatus

Tipo di dati

text

DATE OF LAST CONTACT OR DEATH
Descrizione

DeathDate/LastContactDate

Tipo di dati

date

CAUSE OF DEATH (IF DEAD)
Descrizione

CAUSE OF DEATH (IF DEAD)

Tipo di dati

text

Alias
UMLS CUI-1
C0007465
Due to other cause, specify (cause of death)
Descrizione

Primary Cause of Death, specify

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS CUI-1
C0007465
NCI Thesaurus ObjectClass-2
C25251
NCI Metathesaurus ObjectClass
C0007465
NCI Thesaurus Property
C17649
NCI Thesaurus Property-2
C25365
NCI Thesaurus ValueDomain
C25685
HAS THE PATIENT HAD A DOCUMENTED CLINICAL ASSESSMENT FOR PROSTATE CANCER SINCE SUBMISSION OF THE PREVIOUS FOLLOWUP FORM?
Descrizione

HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C25180
UMLS CUI-1
C3251071
DATE OF LAST CLINICAL ASSESSMENT
Descrizione

CancerFollow-upStatusDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus Property
C25365
UMLS CUI-1
C3694716
PERFORMANCE STATUS (ZUBROD 0-4)
Descrizione

PERFORMANCESTATUS

Tipo di dati

text

Follow-up PSA Value(s) (Prostate: PSA Measurements)
Descrizione

Follow-upPSAValue(s)

Tipo di dati

float

Alias
UMLS CUI-1
C0138741
Date of PSA Assessment(s)
Descrizione

DateofPSAAssessment(s)

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
HAS THE PATIENT HAD A PROSTATE BIOPSY SINCE SUBMISSION OF THE LAST FOLLOWUP FORM?
Descrizione

HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C25180
UMLS CUI-1
C0194804
Biopsy Date
Descrizione

BiopsyDate

Tipo di dati

date

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

HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C25180
UMLS CUI-1
C0178874
HAS THE PATIENT BEEN DIAGNOSED WITH BIOCHEMICAL RECURRENCE SINCE SUBMISSION OF LAST FOLLOW-UP FORM? (See Protocol Section 11)
Descrizione

ProgressionInd,Biochemical

Tipo di dati

boolean

Alias
UMLS CUI-1
C2985506
PSA Value at progression (B)
Descrizione

ProgressionPSAValue

Tipo di dati

float

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

HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C25180
UMLS CUI-1
C0027643
DATE OF FIRST LOCAL-REGIONAL PROGRESSION (LOCAL)
Descrizione

ProgressionDate,FirstLocal-Regional

Tipo di dati

date

WHAT WAS THE METHOD USED TO DETERMINE local/regional PROGRESSION (LOCAL)
Descrizione

WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION

Tipo di dati

text

Alias
UMLS CUI-1
C0430022
HAS THE PATIENT BEEN DIAGNOSED WITH FIRST DISTANT RECURRENCE SINCE SUBMISSION OF THE LAST FOLLOW-UP FORM? (REGIONAL OR)
Descrizione

HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C25180
UMLS CUI-1
C1269798
DATE OF FIRST DISTANT PROGRESSION (REGIONAL OR)
Descrizione

ProgressionDate,FirstDistant

Tipo di dati

date

SITE(S) OF FIRST DISTANT PROGRESSION (REGIONAL OR)
Descrizione

Site(s)ofFirstDistantProgression

Tipo di dati

text

WHAT WAS THE METHOD USED TO DETERMINE distant PROGRESSION (REGIONAL OR)
Descrizione

WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION

Tipo di dati

text

Alias
UMLS CUI-1
C0430022
Other, specify (method used to determine distant progression)
Descrizione

Other,specify(methodusedtodeterminedistantprogression)

Tipo di dati

text

Non-protocol Therapy
Descrizione

Non-protocol Therapy

Alias
UMLS CUI-1
C1518384
UMLS CUI-2
C0087111
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.)
Descrizione

DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ValueDomain-2
C25180
UMLS 2011AA ValueDomain-2
C1522602
Non-Protocol Therapy Type
Descrizione

Non-ProtocolTherapyAdministeredType

Tipo di dati

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
Date of first non-protocol therapy
Descrizione

Non-ProtocolTherapyDate,First

Tipo di dati

date

Specify (non-protocol prostate cancer therapy)
Descrizione

Specify(non-protocolprostatecancertherapy)

Tipo di dati

text

New Primary Site (HAS A NEW PRIMARY CANCER OR MDS MYELODYSPLASTIC SYNDROME BEEN DIAGNOSED THAT HAS NOT BEEN PREVIOUSLY REPORTED?)
Descrizione

NewCancerDiagnosisAnatomicSite

Tipo di dati

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
New Primary Cancer Date
Descrizione

NewPrimaryCancerDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Specify (new primary site)
Descrizione

Specify(newprimarysite)

Tipo di dati

text

Adverse event
Descrizione

Adverse event

Alias
UMLS CUI-1
C0877248
LATE RADIATION THERAPY ADVERSE EVENTS (Arms 1 and 2 only)
Descrizione

LATERADIATIONTHERAPYADVERSEEVENTS

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ValueDomain-2
C25180
UMLS 2011AA ValueDomain-2
C1522602
Late RT Adverse Event Grade
Descrizione

LateRTAdverseEventGrade

Tipo di dati

text

Late RT Adverse Event Term
Descrizione

LateRTAdverseEventTerm

Tipo di dati

text

BLADDER/OTHER GU Specify (late adverse event)
Descrizione

BLADDER/OTHERGUSpecify(lateadverseevent)

Tipo di dati

text

SMALL/LARGE INTESTINE, specify (late adverse event)
Descrizione

SMALL/LARGEINTESTINE,specify(lateadverseevent)

Tipo di dati

text

OTHER GI, specify (late adverse event)
Descrizione

OTHERGI,specify(lateadverseevent)

Tipo di dati

text

OTHER, specify (late adverse event)
Descrizione

OTHER,specify(lateadverseevent)

Tipo di dati

text

Late RT Adverse Event Onset Date
Descrizione

LateRTAdverseEventOnsetDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
URINARY INCONTINENCE, Severity Grade (0-3)
Descrizione

URINARYINCONTINENCE,SeverityGrade

Tipo di dati

text

URINARY INCONTINENCE, Attribution (Attribution)
Descrizione

URINARYINCONTINENCE,Attribution

Tipo di dati

text

Specify if other cause (urinary incontinence, attribution)
Descrizione

Specifyifothercause(urinaryincontinence,attribution)

Tipo di dati

text

URINARY INCONTINENCE, AER Begin Date
Descrizione

URINARYINCONTINENCE,AERBeginDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
URINARY FREQUENCY/URGENCY, Severity Grade (0-3)
Descrizione

URINARYFREQUENCY/URGENCY,SeverityGrade

Tipo di dati

text

URINARY FREQUENCY/URGENCY, Attribution (Attribution)
Descrizione

URINARYFREQUENCY/URGENCY,Attribution

Tipo di dati

text

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

Specifyifothercause(urinaryfrequency/urgency,attribution)

Tipo di dati

text

URINARY FREQUENCY/URGENCY, AER Begin Date
Descrizione

URINARYFREQUENCY/URGENCY,AERBeginDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
ERECTILE IMPOTENCE, Severity Grade (0-3)
Descrizione

ERECTILEIMPOTENCE,SeverityGrade

Tipo di dati

text

ERECTILE IMPOTENCE, Attribution (see table below)
Descrizione

ERECTILEIMPOTENCE,Attribution

Tipo di dati

text

Specify if other cause (erectile impotence, attribution)
Descrizione

Specifyifothercause(erectileimpotence,attribution)

Tipo di dati

text

ERECTILE IMPOTENCE, AER Begin Date
Descrizione

ERECTILEIMPOTENCE,AERBeginDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
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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.

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Header
AmendedData
Item
Amended Data
text
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)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
RTOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
CaseReportFormModifiedInd-2
Item
If this is a revised or corrected form, indicate by checking box.
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25573 (NCI Thesaurus Property)
Comments
Item
COMMENTS
text
Signature
Item
SIGNATURE
text
Date
Item
DATE
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Patient characteristics
C0815172 (UMLS CUI-1)
Item
PATIENT'S VITAL STATUS
text
CL.1
Code List
PATIENT'S VITAL STATUS
CL Item
Alive (Alive)
CL Item
Dead (Dead)
DeathDate/LastContactDate
Item
DATE OF LAST CONTACT OR DEATH
date
Item
CAUSE OF DEATH (IF DEAD)
text
C0007465 (UMLS CUI-1)
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 (Due to other cause, specify)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Primary Cause of Death, specify
Item
Due to other cause, specify (cause of death)
text
C16960 (NCI Thesaurus ObjectClass)
C0007465 (UMLS CUI-1)
C25251 (NCI Thesaurus ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
Assessment since previous follow-up
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)
C3251071 (UMLS CUI-1)
CancerFollow-upStatusDate
Item
DATE OF LAST CLINICAL ASSESSMENT
date
C2991 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C3694716 (UMLS CUI-1)
Item
PERFORMANCE STATUS (ZUBROD 0-4)
text
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)
PSA
Item
Follow-up PSA Value(s) (Prostate: PSA Measurements)
float
C0138741 (UMLS CUI-1)
DateofPSAAssessment(s)
Item
Date of PSA Assessment(s)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Prostate biopsy
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
First Progression
Item
HAS THE PATIENT DEVELOPED A FIRST PROGRESSION THAT HAS NOT BEEN PREVIOUSLY REPORTED?
boolean
C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C0178874 (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
C2985506 (UMLS CUI-1)
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)
C0027643 (UMLS CUI-1)
ProgressionDate,FirstLocal-Regional
Item
DATE OF FIRST LOCAL-REGIONAL PROGRESSION (LOCAL)
date
Item
WHAT WAS THE METHOD USED TO DETERMINE local/regional PROGRESSION (LOCAL)
text
C0430022 (UMLS CUI-1)
CL.9
Code List
WHAT WAS THE METHOD USED TO DETERMINE local/regional PROGRESSION (LOCAL)
CL Item
Not Applicable (0)
C1272460 (UMLS CUI-1)
CL Item
Physical Exam (1)
C0031809 (UMLS CUI-1)
CL Item
Pathologic (2)
C1521733 (UMLS CUI-1)
First distant recurrence
Item
HAS THE PATIENT BEEN DIAGNOSED WITH FIRST DISTANT RECURRENCE SINCE SUBMISSION OF THE LAST FOLLOW-UP FORM? (REGIONAL OR)
boolean
C25704 (NCI Thesaurus ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1269798 (UMLS CUI-1)
ProgressionDate,FirstDistant
Item
DATE OF FIRST DISTANT PROGRESSION (REGIONAL OR)
date
Site(s)ofFirstDistantProgression
Item
SITE(S) OF FIRST DISTANT PROGRESSION (REGIONAL OR)
text
Item
WHAT WAS THE METHOD USED TO DETERMINE distant PROGRESSION (REGIONAL OR)
text
C0430022 (UMLS CUI-1)
CL.11
Code List
WHAT WAS THE METHOD USED TO DETERMINE distant PROGRESSION (REGIONAL OR)
CL Item
Not Applicable (NOT APPLICABLE)
C48660 (NCI Thesaurus)
C1272460 (UMLS CUI-1)
CL Item
Physical Exam (Physical exam)
C0031809 (UMLS CUI-1)
CL Item
Pathologic (Pathologic)
C25610 (NCI Thesaurus)
C1521733 (UMLS CUI-1)
CL Item
Radiographic (Radiographic)
C0444708 (UMLS CUI-1)
CL Item
Nuclear Scan (Nuclear scan)
C0034606 (UMLS CUI-1)
CL Item
Other, Specify (Other, specify)
C3844311 (UMLS CUI-1)
Other,specify(methodusedtodeterminedistantprogression)
Item
Other, specify (method used to determine distant progression)
text
Item Group
Non-protocol Therapy
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
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.)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
CL.12
Code List
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.)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
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.13
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)
text
Item
New Primary Site (HAS A NEW PRIMARY CANCER OR MDS MYELODYSPLASTIC SYNDROME BEEN DIAGNOSED THAT HAS NOT BEEN PREVIOUSLY REPORTED?)
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.14
Code List
New Primary Site (HAS A NEW PRIMARY CANCER OR MDS MYELODYSPLASTIC SYNDROME BEEN DIAGNOSED THAT HAS NOT BEEN PREVIOUSLY REPORTED?)
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
Item Group
Adverse event
C0877248 (UMLS CUI-1)
Item
LATE RADIATION THERAPY ADVERSE EVENTS (Arms 1 and 2 only)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
CL.21
Code List
LATE RADIATION THERAPY ADVERSE EVENTS (Arms 1 and 2 only)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Late RT Adverse Event Grade
text
CL.22
Code List
Late RT Adverse Event Grade
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
8 (8)
CL Item
9 (9)
CL Item
-1 (-1)
Item
Late RT Adverse Event Term
text
CL.23
Code List
Late RT Adverse Event Term
CL Item
Skin (SKIN)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Bladder/other Gu Specify (BLADDER/OTHER GU Specify)
CL Item
Small/large Intestine, Specify (SMALL/LARGE INTESTINE, specify)
CL Item
Other Gi, Specify (OTHER GI, specify)
CL Item
Other, Specify (OTHER, specify)
BLADDER/OTHERGUSpecify(lateadverseevent)
Item
BLADDER/OTHER GU Specify (late adverse event)
text
SMALL/LARGEINTESTINE,specify(lateadverseevent)
Item
SMALL/LARGE INTESTINE, specify (late adverse event)
text
OTHERGI,specify(lateadverseevent)
Item
OTHER GI, specify (late adverse event)
text
OTHER,specify(lateadverseevent)
Item
OTHER, specify (late adverse event)
text
LateRTAdverseEventOnsetDate
Item
Late RT Adverse Event Onset Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
URINARY INCONTINENCE, Severity Grade (0-3)
text
CL.15
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)
Item
URINARY INCONTINENCE, Attribution (Attribution)
text
CL.16
Code List
URINARY INCONTINENCE, Attribution (Attribution)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Radiotherapy only (Radiotherapy only)
CL Item
Tumor and Rx (Tumor and Rx)
CL Item
Other cause, specify (Other cause, specify)
CL Item
Unknown (Unknown)
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)
Item
URINARY FREQUENCY/URGENCY, Severity Grade (0-3)
text
CL.17
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)
Item
URINARY FREQUENCY/URGENCY, Attribution (Attribution)
text
CL.18
Code List
URINARY FREQUENCY/URGENCY, Attribution (Attribution)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Radiotherapy only (Radiotherapy only)
CL Item
Tumor and Rx (Tumor and Rx)
CL Item
Other cause, specify (Other cause, specify)
CL Item
Unknown (Unknown)
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)
Item
ERECTILE IMPOTENCE, Severity Grade (0-3)
text
CL.19
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)
Item
ERECTILE IMPOTENCE, Attribution (see table below)
text
CL.20
Code List
ERECTILE IMPOTENCE, Attribution (see table below)
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Radiotherapy only (Radiotherapy only)
CL Item
Tumor and Rx (Tumor and Rx)
CL Item
Other cause, specify (Other cause, specify)
CL Item
Unknown (Unknown)
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)
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