ID

10043

Descrição

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

Link

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

Palavras-chave

Versões (3)
  1. 19/09/2012 19/09/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 21/03/2015 21/03/2015 - Martin Dugas
Transferido a

21 de março de 2015

DOI

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Licença

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

Inglês

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 Formulários  
Header
Descrição

Header

Amended Data
Descrição

AmendedData

Tipo de dados

text

RTOG Study
Descrição

RTOGStudy

Tipo de dados

text

Case #
Descrição

Case#

Tipo de dados

text

Institution Name
Descrição

InstitutionName

Tipo de dados

text

Institution No.
Descrição

InstitutionNo.

Tipo de dados

text

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

Patient Initials

Tipo de dados

text

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

Trial subject ID RTOG

Tipo de dados

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.
Descrição

CaseReportFormModifiedInd-2

Tipo de dados

text

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

Comments

Tipo de dados

text

SIGNATURE
Descrição

Signature

Tipo de dados

text

DATE
Descrição

Date

Tipo de dados

date

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

Patient characteristics

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

Patient'sVitalStatus

Tipo de dados

text

DATE OF LAST CONTACT OR DEATH
Descrição

DeathDate/LastContactDate

Tipo de dados

date

CAUSE OF DEATH (IF DEAD)
Descrição

CAUSE OF DEATH (IF DEAD)

Tipo de dados

text

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

Primary Cause of Death, specify

Tipo de dados

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?
Descrição

HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?

Tipo de dados

boolean

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

CancerFollow-upStatusDate

Tipo de dados

date

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

PERFORMANCESTATUS

Tipo de dados

text

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

Follow-upPSAValue(s)

Tipo de dados

float

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

DateofPSAAssessment(s)

Tipo de dados

date

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

HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?

Tipo de dados

boolean

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

BiopsyDate

Tipo de dados

date

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

HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?

Tipo de dados

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)
Descrição

ProgressionInd,Biochemical

Tipo de dados

boolean

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

ProgressionPSAValue

Tipo de dados

float

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

HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?

Tipo de dados

boolean

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

ProgressionDate,FirstLocal-Regional

Tipo de dados

date

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

WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION

Tipo de dados

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)
Descrição

HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?

Tipo de dados

boolean

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

ProgressionDate,FirstDistant

Tipo de dados

date

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

Site(s)ofFirstDistantProgression

Tipo de dados

text

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

WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION

Tipo de dados

text

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

Other,specify(methodusedtodeterminedistantprogression)

Tipo de dados

text

Non-protocol Therapy
Descrição

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.)
Descrição

DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP

Tipo de dados

text

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

Non-ProtocolTherapyAdministeredType

Tipo de dados

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
Descrição

Non-ProtocolTherapyDate,First

Tipo de dados

date

Specify (non-protocol prostate cancer therapy)
Descrição

Specify(non-protocolprostatecancertherapy)

Tipo de dados

text

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

NewCancerDiagnosisAnatomicSite

Tipo de dados

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
Descrição

NewPrimaryCancerDate

Tipo de dados

date

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

Specify(newprimarysite)

Tipo de dados

text

Adverse event
Descrição

Adverse event

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

LATERADIATIONTHERAPYADVERSEEVENTS

Tipo de dados

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
Descrição

LateRTAdverseEventGrade

Tipo de dados

text

Late RT Adverse Event Term
Descrição

LateRTAdverseEventTerm

Tipo de dados

text

BLADDER/OTHER GU Specify (late adverse event)
Descrição

BLADDER/OTHERGUSpecify(lateadverseevent)

Tipo de dados

text

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

SMALL/LARGEINTESTINE,specify(lateadverseevent)

Tipo de dados

text

OTHER GI, specify (late adverse event)
Descrição

OTHERGI,specify(lateadverseevent)

Tipo de dados

text

OTHER, specify (late adverse event)
Descrição

OTHER,specify(lateadverseevent)

Tipo de dados

text

Late RT Adverse Event Onset Date
Descrição

LateRTAdverseEventOnsetDate

Tipo de dados

date

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

URINARYINCONTINENCE,SeverityGrade

Tipo de dados

text

URINARY INCONTINENCE, Attribution (Attribution)
Descrição

URINARYINCONTINENCE,Attribution

Tipo de dados

text

Specify if other cause (urinary incontinence, attribution)
Descrição

Specifyifothercause(urinaryincontinence,attribution)

Tipo de dados

text

URINARY INCONTINENCE, AER Begin Date
Descrição

URINARYINCONTINENCE,AERBeginDate

Tipo de dados

date

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

URINARYFREQUENCY/URGENCY,SeverityGrade

Tipo de dados

text

URINARY FREQUENCY/URGENCY, Attribution (Attribution)
Descrição

URINARYFREQUENCY/URGENCY,Attribution

Tipo de dados

text

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

Specifyifothercause(urinaryfrequency/urgency,attribution)

Tipo de dados

text

URINARY FREQUENCY/URGENCY, AER Begin Date
Descrição

URINARYFREQUENCY/URGENCY,AERBeginDate

Tipo de dados

date

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

ERECTILEIMPOTENCE,SeverityGrade

Tipo de dados

text

ERECTILE IMPOTENCE, Attribution (see table below)
Descrição

ERECTILEIMPOTENCE,Attribution

Tipo de dados

text

Specify if other cause (erectile impotence, attribution)
Descrição

Specifyifothercause(erectileimpotence,attribution)

Tipo de dados

text

ERECTILE IMPOTENCE, AER Begin Date
Descrição

ERECTILEIMPOTENCE,AERBeginDate

Tipo de dados

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 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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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