Description:

USMCI 8214/Z6091: Pre-Treatment Measurement Form NCT01167725 Standard Therapy With or Without Surgery and Mitomycin C in Treating Patients With Advanced Limited Peritoneal Dissemination of Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8682D50F-4AD8-16A5-E040-BB89AD434CFC

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8682D50F-4AD8-16A5-E040-BB89AD434CFC

Keywords:

Colorectal Neoplasms

Versions (3) ▾

8/27/12
5/28/15
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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USMCI 8214/Z6091: Pre-Treatment Measurement Form NCT01167725

Details

1. Record the target lesions in the same order as recorded at pretreatment (refer to Section 11 of the protocol). 2. Measure target lesions in cm. using longest diameter (one dimension only). 3. Record measurements at scheduled evaluations and progression

StudyEvent: USMCI 8214/Z6091: Pre-Treatment Measurement Form
1. 1. Record the target lesions in the same order as recorded at pretreatment (refer to Section 11 of the protocol). 2. Measure target lesions in cm. using longest diameter (one dimension only). 3. Record measurements at scheduled evaluations and progression

Header

Baseline (Baseline)

Patient ID

Institution Number

Institution

Assessment Date

Tumor marker

Did the patient have measurable disease at baseline

Yes

No

Measurable Disease

Number of Non-Nodal Target Lesions

Non-nodal target lesion site(s)

Method of Evaluation

Physical Exam (Physical exam)

Ct Scan (CT scan)

Pet/ct Scan (PET/CT scan)

Non-Nodal Longest Diameter of Lesion(s)

cm

Sum of Longest Diameters of All Non-Nodal Target Lesions

Nontarget lesion present

Yes

No

Non-measurable Disease

Number of non-measurable peritoneal surface disease lesions

Non-measurable peritoneal surface disease

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