USMCI 8214/Z6091: Active Monitoring 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:

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June 3, 2015

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USMCI 8214/Z6091: Active Monitoring Measurement Form NCT01167725

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

Tumor assessment
Overall Response Status at This Assessment
Was progression determined by Symptomatic Deterioration
Weight loss > 10% of body weight
Worsening of tumor-related symptoms
Decline in performance status of >1 level on ECOG Zubrod scale
Was symptomatic or new ascites with peritoneal cytology positive for malignancy found
Was any small bowel obstruction requiring operation with histologically confirmed malignant obstruction found
Did the patient have measurable disease at baseline
Measurable Disease
Nontarget lesion present
Non-Target Lesion Response Status
Non-measurable Disease
Method of Evaluation

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