ID

10106

Description

RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer That Cannot Be Removed By Surgery NCT00113399 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB499DEC-47D0-3F31-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB499DEC-47D0-3F31-E034-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 3/30/15 3/30/15 - Martin Dugas
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March 30, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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Head and Neck Cancer Staging Diagrams Oral Cavity NCT00113399 RTOG-0421 I6

English

No Instruction available.

1 forms  
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity
    1. No Instruction available.
Header
Description

Header

Alias
UMLS CUI-1
C1320722
RTOG Study
Description

Protocol ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Case #
Description

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ObjectClass-2
C19778
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C49152
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C0868928
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution No.
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Study No.
Description

Trial subject ID RTOG

Data type

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.
Description

CaseReportFormModifiedInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25573
Signature
Description

Signature

Data type

text

Date
Description

ResponsiblePersonSignatureDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C25657
UMLS 2011AA ObjectClass-2
C1273518
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
Head and Neck cancer characteristics
Description

Head and Neck cancer characteristics

Indicate side of lesion (R or L)
Description

HeadandNeckTumorSideType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25306
UMLS CUI-1
C0441987
CHARACTERISTICS OF TUMOR
Description

HeadandNeckTumorCharacteristicsType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25447
UMLS CUI-1
C0027651
UMLS CUI-2
C1521970
LOCATION OF TUMOR ( all that apply)
Description

HeadandNeckTumorSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass-2
C12418
UMLS CUI-1
C0872338
SITE OF ORIGIN
Description

HeadandNeckTumorOriginLocationStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C12418
NCI Thesaurus ObjectClass-2
C3077
NCI Thesaurus Property
C13717
NCI Thesaurus Property-2
C42703
NCI Metathesaurus ValueDomain
CL052713
UMLS CUI-1
C0449689
SITE(S) ALSO INVOLVED
Description

HeadandNeckTumorInvolvedLocationStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C12418
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C25547
NCI Metathesaurus ValueDomain
CL052713
UMLS CUI-1
C2732472
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1 forms
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Oral Cavity
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol ID RTOG
Item
RTOG Study
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Case ID
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C49152 (NCI Thesaurus Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0868928 (UMLS CUI-1)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
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
Patient Study No.
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)
Signature
Item
Signature
text
ResponsiblePersonSignatureDate
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C1273518 (UMLS 2011AA ObjectClass-2)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
Item Group
Head and Neck cancer characteristics
Item
Indicate side of lesion (R or L)
text
C25284 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25306 (NCI Thesaurus Property)
C0441987 (UMLS CUI-1)
Side
Code List
Indicate side of lesion (R or L)
CL Item
right (R)
C0205090 (UMLS CUI-1)
CL Item
left (L)
C0205091 (UMLS CUI-1)
Item
CHARACTERISTICS OF TUMOR
text
C25284 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25447 (NCI Thesaurus Property)
C0027651 (UMLS CUI-1)
C1521970 (UMLS CUI-2)
CL.1
Code List
CHARACTERISTICS OF TUMOR
CL Item
Deeply Infiltrating (Deeply infiltrating)
CL Item
Normal Mobility Of Tongue (Normal mobility of tongue)
CL Item
Impaired Mobility Of Tongue (Impaired mobility of tongue)
CL Item
Fixed Tongue (Fixed tongue)
CL Item
Gross Erosion Of Bone (Gross erosion of bone)
CL Item
Radiographic Bone Destruction (Radiographic bone destruction)
Item
LOCATION OF TUMOR ( all that apply)
text
C13717 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C12418 (NCI Thesaurus ObjectClass-2)
C0872338 (UMLS CUI-1)
CL.2
Code List
LOCATION OF TUMOR ( all that apply)
CL Item
Oral Tongue (Oral tongue)
CL Item
Floor Of Mouth (Floor of mouth)
C0026638 (NCI Metathesaurus)
CL Item
Retromolar Trigone (Retromolar Trigone)
CL Item
Upper gingiva (Upper gingiva)
CL Item
Lower Gingiva (Lower gingiva)
CL Item
Buccal Mucosa (Buccal mucosa)
C12505 (NCI Thesaurus)
C1578559 (UMLS 2011AA)
CL Item
Hard Palate (Hard palate)
C12230 (NCI Thesaurus)
C0226901 (UMLS 2011AA)
CL Item
Upper gingiva (Upper gingiva)
CL Item
Upper Lip (Upper lip)
CL Item
Lower Lip (Lower lip)
CL Item
Commissure (Commissure)
Item
SITE OF ORIGIN
text
C12418 (NCI Thesaurus ObjectClass)
C3077 (NCI Thesaurus ObjectClass-2)
C13717 (NCI Thesaurus Property)
C42703 (NCI Thesaurus Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
C0449689 (UMLS CUI-1)
CL.3
Code List
SITE OF ORIGIN
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
Item
SITE(S) ALSO INVOLVED
text
C3262 (NCI Thesaurus ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C25341 (NCI Thesaurus Property)
C25547 (NCI Thesaurus Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
C2732472 (UMLS CUI-1)
CL.4
Code List
SITE(S) ALSO INVOLVED
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
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