ID

10570

Beschreibung

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

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 28.05.15 28.05.15 -
  3. 03.06.15 03.06.15 -
Hochgeladen am

3. Juni 2015

DOI

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FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM NCT00020709

Englisch

No Instruction available.

1 Formulare  
  1. StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM
    1. No Instruction available.
SWOG clinical trial administrative data
Beschreibung

SWOG clinical trial administrative data

SWOG Patient ID
Beschreibung

SWOGPatientID

Datentyp

text

SWOG Study No.
Beschreibung

SWOGStudyNo.

Datentyp

text

Registration Step
Beschreibung

RegistrationStep

Datentyp

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)
Beschreibung

PatientInitials

Datentyp

text

Institution / Affiliate
Beschreibung

Institution/Affiliate

Datentyp

text

Physician
Beschreibung

Physician

Datentyp

text

Group Name (Groups other than SWOG )
Beschreibung

GroupName

Datentyp

text

Study No. (Groups other than SWOG )
Beschreibung

StudyNo.

Datentyp

float

Pt. ID (Groups other than SWOG )
Beschreibung

Pt.ID

Datentyp

text

Patient status
Beschreibung

Patient status

Date of last contact or death
Beschreibung

Dateoflastcontactordeath

Datentyp

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
Beschreibung

Status

Datentyp

text

Progression/ relapse status
Beschreibung

Progression/ relapse status

Date of progression or relapse
Beschreibung

Dateofprogressionorrelapse

Datentyp

text

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

LocalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Datentyp

text

Lung parenchyma adjacent to primary tumor
Beschreibung

Lungparenchymaadjacenttoprimarytumor

Datentyp

text

Bronchial stump
Beschreibung

Bronchialstump

Datentyp

text

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

Regional/NodalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Datentyp

text

Ipsilateral hilar mediastinum (nodal)
Beschreibung

Ipsilateralhilarmediastinum(nodal)

Datentyp

text

Contralateral hilar mediastinum (nodal)
Beschreibung

Contralateralhilarmediastinum(nodal)

Datentyp

text

Ipsilateral pleural effusion
Beschreibung

Ipsilateralpleuraleffusion

Datentyp

text

Contralateral pleural effusion
Beschreibung

Contralateralpleuraleffusion

Datentyp

text

Ipsilateral supraclavicular lymph nodes
Beschreibung

Ipsilateralsupraclavicularlymphnodes

Datentyp

text

Contralateral supraclavicular lymph nodes
Beschreibung

Contralateralsupraclavicularlymphnodes

Datentyp

text

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

DistantSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected

Datentyp

text

Separate lobe of the ipsilateral lung
Beschreibung

Separatelobeoftheipsilaterallung

Datentyp

text

Opposite lung
Beschreibung

OppositeLungInd

Datentyp

text

Pericardial effusion
Beschreibung

Pericardialeffusion

Datentyp

text

Brain
Beschreibung

BrainSiteInd

Datentyp

text

Leptomeninges
Beschreibung

Leptomeninges

Datentyp

text

Liver
Beschreibung

LiverSiteInd

Datentyp

text

Bone
Beschreibung

BoneSiteInd

Datentyp

text

Adrenal glands
Beschreibung

Adrenalglands

Datentyp

text

Kidney
Beschreibung

Kidney

Datentyp

text

Skin or subcutaneous
Beschreibung

Skinorsubcutaneous

Datentyp

text

Other site, specify
Beschreibung

Othersite,specify

Datentyp

text

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

ForLocalProgressionorRelapseProgression/RelapsesitewithinpreviousRTfield?

Datentyp

text

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

ForRegionalProgressionorRelapseProgression/RelapsesitewithinpreviousRTfield?

Datentyp

text

Notes
Beschreibung

Notes

Notes
Beschreibung

Notes

Datentyp

text

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Ähnliche Modelle

No Instruction available.

1 Formulare
  1. StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
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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