ID

10570

Description

FIRST SITE(S) OF PROGRESSION OR RELAPSE 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=9E343E83-5F33-119F-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E343E83-5F33-119F-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 -
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June 3, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM NCT00020709

English

No Instruction available.

1 forms  
  1. StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE 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-2
C16154
UMLS 2011AA ValueDomain-2
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

float

Pt. ID (Groups other than SWOG )
Description

Pt.ID

Data type

text

Patient status
Description

Patient status

Date of last contact or death
Description

Dateoflastcontactordeath

Data type

text

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ObjectClass
C47954
UMLS 2011AA ObjectClass
C1705415
NCI Thesaurus ObjectClass-2
C25551
UMLS 2011AA ObjectClass-2
C1517741
Status
Description

Status

Data type

text

Progression/ relapse status
Description

Progression/ relapse status

Date of progression or relapse
Description

Dateofprogressionorrelapse

Data type

text

Local Site(s) of Progression or Relapse at the time progression/relapse was detected (select all that apply)
Description

LocalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Data type

text

Lung parenchyma adjacent to primary tumor
Description

Lungparenchymaadjacenttoprimarytumor

Data type

text

Bronchial stump
Description

Bronchialstump

Data type

text

Regional/Nodal Site(s) of Progression or Relapse at the time progression/relapse was detected
Description

Regional/NodalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Data type

text

Ipsilateral hilar mediastinum (nodal)
Description

Ipsilateralhilarmediastinum(nodal)

Data type

text

Contralateral hilar mediastinum (nodal)
Description

Contralateralhilarmediastinum(nodal)

Data type

text

Ipsilateral pleural effusion
Description

Ipsilateralpleuraleffusion

Data type

text

Contralateral pleural effusion
Description

Contralateralpleuraleffusion

Data type

text

Ipsilateral supraclavicular lymph nodes
Description

Ipsilateralsupraclavicularlymphnodes

Data type

text

Contralateral supraclavicular lymph nodes
Description

Contralateralsupraclavicularlymphnodes

Data type

text

Distant Site(s) of Progression or Relapse at the time progression/relapse was detected
Description

DistantSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Data type

text

Separate lobe of the ipsilateral lung
Description

Separatelobeoftheipsilaterallung

Data type

text

Opposite lung
Description

OppositeLungInd

Data type

text

Pericardial effusion
Description

Pericardialeffusion

Data type

text

Brain
Description

BrainSiteInd

Data type

text

Leptomeninges
Description

Leptomeninges

Data type

text

Liver
Description

LiverSiteInd

Data type

text

Bone
Description

BoneSiteInd

Data type

text

Adrenal glands
Description

Adrenalglands

Data type

text

Kidney
Description

Kidney

Data type

text

Skin or subcutaneous
Description

Skinorsubcutaneous

Data type

text

Other site, specify
Description

Othersite,specify

Data type

text

For Local Progression or Relapse Progression/Relapse site within previous RT field? (select one )
Description

ForLocalProgressionorRelapseProgression/RelapsesitewithinpreviousRTfield?

Data type

text

For Regional Progression or Relapse Progression/Relapse site within previous RT field? (select one)
Description

ForRegionalProgressionorRelapseProgression/RelapsesitewithinpreviousRTfield?

Data type

text

Notes
Description

Notes

Notes
Description

Notes

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE 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-2)
C1704379 (UMLS 2011AA ValueDomain-2)
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 )
float
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
Item Group
Patient status
Dateoflastcontactordeath
Item
Date of last contact or death
text
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C1517741 (UMLS 2011AA ObjectClass-2)
Item
Status
text
CL.1
Code List
Status
CL Item
Alive2005416 (Alive)
CL Item
Dead2005417 (Dead)
Item Group
Progression/ relapse status
Dateofprogressionorrelapse
Item
Date of progression or relapse
text
LocalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Local Site(s) of Progression or Relapse at the time progression/relapse was detected (select all that apply)
text
Lungparenchymaadjacenttoprimarytumor
Item
Lung parenchyma adjacent to primary tumor
text
Bronchialstump
Item
Bronchial stump
text
Regional/NodalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Regional/Nodal Site(s) of Progression or Relapse at the time progression/relapse was detected
text
Ipsilateralhilarmediastinum(nodal)
Item
Ipsilateral hilar mediastinum (nodal)
text
Contralateralhilarmediastinum(nodal)
Item
Contralateral hilar mediastinum (nodal)
text
Ipsilateralpleuraleffusion
Item
Ipsilateral pleural effusion
text
Contralateralpleuraleffusion
Item
Contralateral pleural effusion
text
Ipsilateralsupraclavicularlymphnodes
Item
Ipsilateral supraclavicular lymph nodes
text
Contralateralsupraclavicularlymphnodes
Item
Contralateral supraclavicular lymph nodes
text
DistantSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Distant Site(s) of Progression or Relapse at the time progression/relapse was detected
text
Separatelobeoftheipsilaterallung
Item
Separate lobe of the ipsilateral lung
text
OppositeLungInd
Item
Opposite lung
text
Pericardialeffusion
Item
Pericardial effusion
text
BrainSiteInd
Item
Brain
text
Leptomeninges
Item
Leptomeninges
text
LiverSiteInd
Item
Liver
text
BoneSiteInd
Item
Bone
text
Adrenalglands
Item
Adrenal glands
text
Kidney
Item
Kidney
text
Skinorsubcutaneous
Item
Skin or subcutaneous
text
Othersite,specify
Item
Other site, specify
text
Item
For Local Progression or Relapse Progression/Relapse site within previous RT field? (select one )
text
CL.2
Code List
For Local Progression or Relapse Progression/Relapse site within previous RT field? (select one )
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Not Applicable (Not Applicable)
Item
For Regional Progression or Relapse Progression/Relapse site within previous RT field? (select one)
text
CL.3
Code List
For Regional Progression or Relapse Progression/Relapse site within previous RT field? (select one)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Not Applicable (Not Applicable)
Item Group
Notes
Notes
Item
Notes
text
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