ID

10569

Description

BASELINE TUMOR ASSESSMENT FORM NCT00020709 S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4831-361C-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4831-361C-E034-080020C9C0E0

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 5/28/15 5/28/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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BASELINE TUMOR ASSESSMENT FORM NCT00020709

English

No Instruction available.

1 forms  
  1. StudyEvent: BASELINE TUMOR ASSESSMENT FORM
    1. No Instruction available.
SWOG clinical trial administrative data
Description

SWOG clinical trial administrative data

SWOG Patient ID
Description

SWOGPatientID

Data type

text

SWOG Study No.
Description

SWOGStudyNo.

Data type

text

Registration Step
Description

RegistrationStep

Data type

text

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

PatientInitials

Data type

text

Institution / Affiliate
Description

Institution/Affiliate

Data type

text

Physician
Description

Physician

Data type

text

Group Name (Groups other than SWOG )
Description

GroupName

Data type

text

Study No. (Groups other than SWOG )
Description

StudyNo.

Data type

double

Pt. ID (Groups other than SWOG )
Description

Pt.ID

Data type

text

Target lesion status
Description

Target lesion status

Target Lesion Site Number
Description

TargetLesionSiteNumber

Data type

text

Target Lesion Site
Description

TargetLesionSite

Data type

text

RT No Prog.
Description

RTNoProg.

Data type

text

Longest Diameter (cm )
Description

LongestDiameter

Data type

text

Target Lesion Assessment Type
Description

TargetLesionAssessmentType

Data type

text

Target Lesion Assessment Date
Description

TargetLesionAssessmentDate

Data type

text

Non-Target Lesion Site Number
Description

Non-TargetLesionSiteNumber

Data type

text

Non-Target Lesion Site
Description

Non-TargetLesionSite

Data type

text

Extent
Description

Extent

Data type

text

Non-Target Lesion Assessment Type
Description

Non-TargetLesionAssessmentType

Data type

text

Non-Target Lesion Assessment Date
Description

Non-TargetLesionAssessmentDate

Data type

text

Tests
Description

Tests

Tests/studies
Description

Tests/studies

Data type

text

Assessment Date
Description

AssessmentDate

Data type

date

Notes
Description

Notes

Notes
Description

Notes

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: BASELINE TUMOR ASSESSMENT FORM
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
SWOG clinical trial administrative data
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)
C1704379 (UMLS 2011AA ValueDomain)
PatientInitials
Item
Patient Initials (L, F,M)
text
Institution/Affiliate
Item
Institution / Affiliate
text
Physician
Item
Physician
text
GroupName
Item
Group Name (Groups other than SWOG )
text
StudyNo.
Item
Study No. (Groups other than SWOG )
double
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
Item Group
Target lesion status
Item
Target Lesion Site Number
text
CL.1
Code List
Target Lesion Site Number
CL Item
L1 (L1)
CL Item
L2 (L2)
CL Item
L3 (L3)
CL Item
L4 (L4)
CL Item
L5 (L5)
CL Item
L6 (L6)
CL Item
L7 (L7)
CL Item
L8 (L8)
CL Item
L9 (L9)
CL Item
L10 (L10)
TargetLesionSite
Item
Target Lesion Site
text
RTNoProg.
Item
RT No Prog.
text
LongestDiameter
Item
Longest Diameter (cm )
text
Item
Target Lesion Assessment Type
text
CL.2
Code List
Target Lesion Assessment Type
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
CA-125 assay (CA-125 assay)
CL Item
Endoscopy (Endoscopy)
CL Item
PSA (PSA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
CT scan (CT scan)
CL Item
MRI scan (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
CL Item
PET scan (PET scan)
CL Item
Histologic confirmation (Histologic confirmation)
CL Item
Cytologic confirmation (Cytologic confirmation)
CL Item
Other (Other)
TargetLesionAssessmentDate
Item
Target Lesion Assessment Date
text
Item
Non-Target Lesion Site Number
text
CL.3
Code List
Non-Target Lesion Site Number
CL Item
S1 (S1)
CL Item
S2 (S2)
CL Item
S3 (S3)
CL Item
S4 (S4)
CL Item
S5 (S5)
Non-TargetLesionSite
Item
Non-Target Lesion Site
text
Extent
Item
Extent
text
Item
Non-Target Lesion Assessment Type
text
CL.4
Code List
Non-Target Lesion Assessment Type
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
CA-125 assay (CA-125 assay)
CL Item
Endoscopy (Endoscopy)
CL Item
PSA (PSA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
CT scan (CT scan)
CL Item
MRI scan (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
CL Item
PET scan (PET scan)
CL Item
Histologic confirmation (Histologic confirmation)
CL Item
Cytologic confirmation (Cytologic confirmation)
CL Item
Other (Other)
Non-TargetLesionAssessmentDate
Item
Non-Target Lesion Assessment Date
text
Item Group
Tests
Tests/studies
Item
Tests/studies
text
AssessmentDate
Item
Assessment Date
date
Item Group
Notes
Notes
Item
Notes
text
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