ID

10212

Beskrivning

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

Länk

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

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-05-08 2015-05-08 - Martin Dugas
Uppladdad den

8 maj 2015

DOI

För en begäran logga in.

Licens

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

Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
    1. No Instruction available.
Header
Beskrivning

Header

Alias
UMLS CUI-1
C1320722
SWOG Patient ID
Beskrivning

SWOGPatientID

Datatyp

text

SWOG Study No.
Beskrivning

SWOGStudyNo.

Datatyp

text

Registration Step
Beskrivning

RegistrationStep

Datatyp

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)
Beskrivning

PatientInitials

Datatyp

text

Social Security No.
Beskrivning

SocialSecurityNo.

Datatyp

text

Institution / Affiliate
Beskrivning

Institution/Affiliate

Datatyp

text

Physician
Beskrivning

Physician

Datatyp

text

Hosp. No.
Beskrivning

Hosp.No.

Datatyp

text

Group Name (Groups other than SWOG )
Beskrivning

GroupName

Datatyp

text

Study No. (Groups other than SWOG )
Beskrivning

StudyNo.

Datatyp

float

Pt. ID (Groups other than SWOG )
Beskrivning

Pt.ID

Datatyp

text

Treating Radiation Oncologist
Beskrivning

TreatingRadiationOncologist

Datatyp

text

RT Facility
Beskrivning

RTFacility

Datatyp

text

RT Facility Code
Beskrivning

RTFacilityCode

Datatyp

text

Form completed by
Beskrivning

Formcompletedby

Datatyp

text

Facility
Beskrivning

Facility

Datatyp

text

Telephone Number
Beskrivning

TelephoneNumber

Datatyp

text

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

Date

Datatyp

text

Radiation Oncologist's Signature
Beskrivning

RadiationOncologyPhysicianSignatureText

Datatyp

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
Beskrivning

Notes

Datatyp

text

Treatment Information
Beskrivning

Treatment Information

Alias
UMLS CUI-1
C0087111
Radiation Therapy Start Date
Beskrivning

Radiation Therapy Start Date

Datatyp

date

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

RT End Date

Datatyp

date

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

Werethereanyunscheduledinterruptionsinradiationtherapy?

Datatyp

boolean

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

IfYes,SpecifyRTInterruptionsReason

Datatyp

text

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

TotalDosetoIsocenter

Datatyp

text

Total Fractions
Beskrivning

TotalFractions

Datatyp

text

Number of Days
Beskrivning

NumberofDays

Datatyp

text

Radiation Source
Beskrivning

Radiation Source

Datatyp

integer

Alias
UMLS CUI-1
C0449418
Other, specify
Beskrivning

CytogeneticAnalysis,OtherReason,NoSuccess

Datatyp

text

Specify
Beskrivning

Specify

Datatyp

text

Dose
Beskrivning

Dose

Datatyp

float

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

Fractions

Datatyp

text

Alias
UMLS CUI-1
C1264633
Radiation Energy
Beskrivning

Radiation Energy

Datatyp

float

Måttenheter
  • MeV
Alias
UMLS CUI-1
C3516073
MeV
Maximum Dose to Critical Structures
Beskrivning

MaximumDosetoCriticalStructures

Datatyp

text

Spinal Cord
Beskrivning

Spinal Cord

Datatyp

text

Alias
UMLS CUI-1
C0037925
Heart
Beskrivning

Heart

Datatyp

text

Alias
UMLS CUI-1
C0018787
Esophagus
Beskrivning

Esophagus

Datatyp

text

Alias
UMLS CUI-1
C0014876
Other structures
Beskrivning

TumorExtension,OtherStructures

Datatyp

text

%Of Total Lung Receiving>=2000 cGy
Beskrivning

%Of Total Lung Receiving>=2000 cGy

Datatyp

float

%Of Left Lung Receiving>=2000 cGy
Beskrivning

%Of Left Lung Receiving>=2000 cGy

Datatyp

float

%Of Right Lung Receiving>=2000 cGy
Beskrivning

%Of Right Lung Receiving>=2000 cGy

Datatyp

float

Primary Tumor location
Beskrivning

Primary Tumor location

Datatyp

text

Alias
UMLS CUI-1
C0677930
Tillbaka till toppen

Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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