ID

10391

Descrizione

TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A46E13D3-E2C2-2CC3-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A46E13D3-E2C2-2CC3-E034-080020C9C0E0

Keywords

versioni (3)
  1. 19/09/12 19/09/12 - Philipp Bruland
  2. 28/05/15 28/05/15 -
  3. 03/06/15 03/06/15 -
Caricato su

28 maggio 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
Commenti del modello :

Puoi commentare il modello dati qui. Tramite i fumetti nei gruppi di articoli e articoli è possibile aggiungere commenti a quelli in modo specifico.

Torna ai commenti del modello
Commenti del gruppo di articoli per :

Commenti dell'articolo per :

Per scaricare i modelli di dati devi essere registrato. Per favore accesso o registrati GRATIS.

TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form

Inglese

INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.

1 moduli  
  1. StudyEvent: TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form
    1. INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.
RTOG clinical trial administrative data
Descrizione

RTOG clinical trial administrative data

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 Name, Last
Descrizione

PatientName,Last

Tipo di dati

text

Patient Name, First
Descrizione

PatientName,First

Tipo di dati

text

Amended Data
Descrizione

AmendedData

Tipo di dati

text

Chemotherapy status
Descrizione

Chemotherapy status

Agent (AGENT NAME)
Descrizione

Agent

Tipo di dati

text

(if other, specify) (agent)
Descrizione

(ifother,specify)(agent)

Tipo di dati

text

Agent total cumulative dose
Descrizione

AgentTotalCumulativeDose

Tipo di dati

float

First Date above agent protocol therapy was given
Descrizione

FirstDateaboveagentprotocoltherapywasgiven

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Last Date above agent protocol therapy was given
Descrizione

LastDateaboveagentprotocoltherapywasgiven

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Reason treatment ended (REASON TREATMENT ENDED)
Descrizione

OffTreatmentReason

Tipo di dati

text

(specify) (reason treatment ended)
Descrizione

(specify)(reasontreatmentended)

Tipo di dati

text

Comment
Descrizione

Comment

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
Ccrr Module For Tf Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Hormone Protocol Treatment Summary Form
Descrizione

Ccrr Module For Tf Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Hormone Protocol Treatment Summary Form

Ritorna all'inizio della pagina

Similar models

INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.

1 moduli
  1. StudyEvent: TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form
    1. INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
RTOG clinical trial administrative data
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)
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
AmendedData
Item
Amended Data
text
Item Group
Chemotherapy status
Item
Agent (AGENT NAME)
text
CL.1
Code List
Agent (AGENT NAME)
CL Item
Zoladex (Zoladex)
CL Item
Lupron (Lupron)
C0701459 (NCI Metathesaurus)
CL Item
Suprafact (Suprafact)
CL Item
Flutamide (Flutamide)
C509 (NCI Thesaurus)
C0016384 (UMLS 2011AA)
CL Item
Casodex (Casodex)
C0591237 (NCI Metathesaurus)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown Or Not Applicable (Unknown or not applicable)
(ifother,specify)(agent)
Item
(if other, specify) (agent)
text
AgentTotalCumulativeDose
Item
Agent total cumulative dose
float
FirstDateaboveagentprotocoltherapywasgiven
Item
First Date above agent protocol therapy was given
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
LastDateaboveagentprotocoltherapywasgiven
Item
Last Date above agent protocol therapy was given
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item
Reason treatment ended (REASON TREATMENT ENDED)
text
CL.2
Code List
Reason treatment ended (REASON TREATMENT ENDED)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
CL Item
Toxicity/side Effects/complications (Toxicity/side effects/complications)
CL Item
Death On Study (Death on study)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal after beginning protocol therapy)
CL Item
Patient Withdrawal Or Refusal Prior To Beginning Protocol Therapy (Patient withdrawal or refusal prior to beginning protocol therapy)
CL Item
Alternative Therapy (Alternative therapy, specify below)
CL Item
Other complicating disease, specify below (Other complicating disease, specify below)
CL Item
Other, Specify (Other, specify below)
CL Item
Unknown or not applicable (Unknown or not applicable)
(specify)(reasontreatmentended)
Item
(specify) (reason treatment ended)
text
Item Group
Comment
Comments
Item
Comments
text
Signature
Item
Signature
text
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Ccrr Module For Tf Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Hormone Protocol Treatment Summary Form
Ritorna all'inizio della pagina 

Contatto

Si prega di utilizzare questo modulo per feedback, domande e suggerimenti per miglioramenti.

I campi contrassegnati da * sono obbligatori.

Aiuto

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial