ID

10212

Beschrijving

LUNG CARCINOMA RADIATION THERAPY FORM S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC NCT00020709 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E343E83-5FEB-119F-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E343E83-5FEB-119F-E034-080020C9C0E0

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 08-05-15 08-05-15 - Martin Dugas
Geüploaded op

8 mei 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Lung Cancer RADIATION THERAPY NCT00020709

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
    1. No Instruction available.
Header
Beschrijving

Header

Alias
UMLS CUI-1
C1320722
SWOG Patient ID
Beschrijving

SWOGPatientID

Datatype

text

SWOG Study No.
Beschrijving

SWOGStudyNo.

Datatype

text

Registration Step
Beschrijving

RegistrationStep

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C16154
UMLS 2011AA ValueDomain-2
C1704379
Patient Initials (L, F,M)
Beschrijving

PatientInitials

Datatype

text

Social Security No.
Beschrijving

SocialSecurityNo.

Datatype

text

Institution / Affiliate
Beschrijving

Institution/Affiliate

Datatype

text

Physician
Beschrijving

Physician

Datatype

text

Hosp. No.
Beschrijving

Hosp.No.

Datatype

text

Group Name (Groups other than SWOG )
Beschrijving

GroupName

Datatype

text

Study No. (Groups other than SWOG )
Beschrijving

StudyNo.

Datatype

float

Pt. ID (Groups other than SWOG )
Beschrijving

Pt.ID

Datatype

text

Treating Radiation Oncologist
Beschrijving

TreatingRadiationOncologist

Datatype

text

RT Facility
Beschrijving

RTFacility

Datatype

text

RT Facility Code
Beschrijving

RTFacilityCode

Datatype

text

Form completed by
Beschrijving

Formcompletedby

Datatype

text

Facility
Beschrijving

Facility

Datatype

text

Telephone Number
Beschrijving

TelephoneNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain-2
C25395
UMLS 2011AA ValueDomain-2
C0039457
Date
Beschrijving

Date

Datatype

text

Radiation Oncologist's Signature
Beschrijving

RadiationOncologyPhysicianSignatureText

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C25741
NCI Thesaurus ObjectClass-2
C17833
UMLS CUI-1
C1514693
UMLS CUI-2
C1519316
Notes
Beschrijving

Notes

Datatype

text

Treatment Information
Beschrijving

Treatment Information

Alias
UMLS CUI-1
C0087111
Radiation Therapy Start Date
Beschrijving

Radiation Therapy Start Date

Datatype

date

Alias
UMLS CUI-1
C1522449
UMLS CUI-2
C0808070
RT End Date
Beschrijving

RT End Date

Datatype

date

Alias
UMLS CUI-1
C1522449
UMLS CUI-2
C0806020
Were there any unscheduled interruptions in radiation therapy?
Beschrijving

Werethereanyunscheduledinterruptionsinradiationtherapy?

Datatype

boolean

Alias
UMLS CUI-1
C1522449
UMLS CUI-2
C1512900
If Yes, Specify RT Interruptions Reason
Beschrijving

IfYes,SpecifyRTInterruptionsReason

Datatype

text

Alias
UMLS CUI-1
C0566251
UMLS CUI-2
C0457454
Total Dose to Isocenter (cGy)
Beschrijving

TotalDosetoIsocenter

Datatype

text

Total Fractions
Beschrijving

TotalFractions

Datatype

text

Number of Days
Beschrijving

NumberofDays

Datatype

text

Radiation Source
Beschrijving

Radiation Source

Datatype

integer

Alias
UMLS CUI-1
C0449418
Other, specify
Beschrijving

CytogeneticAnalysis,OtherReason,NoSuccess

Datatype

text

Specify
Beschrijving

Specify

Datatype

text

Dose
Beschrijving

Dose

Datatype

float

Maateenheden
  • cGy
Alias
NCI Thesaurus ObjectClass
C15313
NCI Thesaurus Property
C25256
UMLS CUI-1
C1522449
UMLS CUI-2
C0178602
cGy
Fractions
Beschrijving

Fractions

Datatype

text

Alias
UMLS CUI-1
C1264633
Radiation Energy
Beschrijving

Radiation Energy

Datatype

float

Maateenheden
  • MeV
Alias
UMLS CUI-1
C3516073
MeV
Maximum Dose to Critical Structures
Beschrijving

MaximumDosetoCriticalStructures

Datatype

text

Spinal Cord
Beschrijving

Spinal Cord

Datatype

text

Alias
UMLS CUI-1
C0037925
Heart
Beschrijving

Heart

Datatype

text

Alias
UMLS CUI-1
C0018787
Esophagus
Beschrijving

Esophagus

Datatype

text

Alias
UMLS CUI-1
C0014876
Other structures
Beschrijving

TumorExtension,OtherStructures

Datatype

text

%Of Total Lung Receiving>=2000 cGy
Beschrijving

%Of Total Lung Receiving>=2000 cGy

Datatype

float

%Of Left Lung Receiving>=2000 cGy
Beschrijving

%Of Left Lung Receiving>=2000 cGy

Datatype

float

%Of Right Lung Receiving>=2000 cGy
Beschrijving

%Of Right Lung Receiving>=2000 cGy

Datatype

float

Primary Tumor location
Beschrijving

Primary Tumor location

Datatype

text

Alias
UMLS CUI-1
C0677930
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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)
PatientInitials
Item
Patient Initials (L, F,M)
text
SocialSecurityNo.
Item
Social Security No.
text
Institution/Affiliate
Item
Institution / Affiliate
text
Physician
Item
Physician
text
Hosp.No.
Item
Hosp. No.
text
GroupName
Item
Group Name (Groups other than SWOG )
text
StudyNo.
Item
Study No. (Groups other than SWOG )
float
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
TreatingRadiationOncologist
Item
Treating Radiation Oncologist
text
RTFacility
Item
RT Facility
text
RTFacilityCode
Item
RT Facility Code
text
Formcompletedby
Item
Form completed by
text
Facility
Item
Facility
text
TelephoneNumber
Item
Telephone Number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS 2011AA ValueDomain-2)
Date
Item
Date
text
Radiation oncologist signature
Item
Radiation Oncologist's Signature
text
C25704 (NCI Thesaurus ValueDomain)
C25678 (NCI Thesaurus Property)
C25741 (NCI Thesaurus ObjectClass)
C17833 (NCI Thesaurus ObjectClass-2)
C1514693 (UMLS CUI-1)
C1519316 (UMLS CUI-2)
Notes
Item
Notes
text
Item Group
Treatment Information
C0087111 (UMLS CUI-1)
RTBeginDate
Item
Radiation Therapy Start Date
date
C1522449 (UMLS CUI-1)
C0808070 (UMLS CUI-2)
RTEndDate
Item
RT End Date
date
C1522449 (UMLS CUI-1)
C0806020 (UMLS CUI-2)
Unscheduled interruptions in radiation therapy
Item
Were there any unscheduled interruptions in radiation therapy?
boolean
C1522449 (UMLS CUI-1)
C1512900 (UMLS CUI-2)
Reason for interruption
Item
If Yes, Specify RT Interruptions Reason
text
C0566251 (UMLS CUI-1)
C0457454 (UMLS CUI-2)
TotalDosetoIsocenter
Item
Total Dose to Isocenter (cGy)
text
TotalFractions
Item
Total Fractions
text
NumberofDays
Item
Number of Days
text
Item
Radiation Source
integer
C0449418 (UMLS CUI-1)
CL.2
Code List
Radiation Source
CL Item
Co 60 (1)
C1306541 (UMLS CUI-1)
CL Item
Megavoltage (2)
C0454064 (UMLS CUI-1)
CL Item
Electron (3)
C3463986 (UMLS CUI-1)
CL Item
Combination (4)
C0205195 (UMLS CUI-1)
CL Item
Other, specify (5)
C3844311 (UMLS CUI-1)
Cytogenetic Analysis Other Reason
Item
Other, specify
text
Specify
Item
Specify
text
Radiation Therapy Dose
Item
Dose
float
C15313 (NCI Thesaurus ObjectClass)
C25256 (NCI Thesaurus Property)
C1522449 (UMLS CUI-1)
C0178602 (UMLS CUI-2)
Fractions
Item
Fractions
text
C1264633 (UMLS CUI-1)
Radiation Energy
Item
Radiation Energy
float
C3516073 (UMLS CUI-1)
MaximumDosetoCriticalStructures
Item
Maximum Dose to Critical Structures
text
Spinal Cord
Item
Spinal Cord
text
C0037925 (UMLS CUI-1)
Heart
Item
Heart
text
C0018787 (UMLS CUI-1)
Esophagus
Item
Esophagus
text
C0014876 (UMLS CUI-1)
TumorExtension,OtherStructures
Item
Other structures
text
%OfTotalLungReceiving>=2000cGy
Item
%Of Total Lung Receiving>=2000 cGy
float
%OfLeftLungReceiving>=2000cGy
Item
%Of Left Lung Receiving>=2000 cGy
float
%OfRightLungReceiving>=2000cGy
Item
%Of Right Lung Receiving>=2000 cGy
float
Item
Primary Tumor location
text
C0677930 (UMLS CUI-1)
CL.5
Code List
Primary Tumor location
CL Item
Left lung (1)
C0225730 (UMLS CUI-1)
CL Item
Right lung (2)
C0225706 (UMLS CUI-1)
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