ID

10618

Beschreibung

NSABP Protocol B-35 Radiation Therapy Report NCT00053898 Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01A1AE7-8AF7-36F3-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01A1AE7-8AF7-36F3-E034-080020C9C0E0

Stichworte

Versionen (3)
  1. 26.08.12 26.08.12 -
  2. 22.05.15 22.05.15 -
  3. 03.06.15 03.06.15 -
Hochgeladen am

3. Juni 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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NSABP Protocol B-35 Radiation Therapy Report NCT00053898

Englisch

Form E1 (04-30-2002) Breast radiation is required on this protocol. Submit form when radiation therapy has ended. If breast radiation was not done, submit form within 90 days of randomization.

1 Formulare  
Header Module
Beschreibung

Header Module

First Three Letters of Patient's Last Name
Beschreibung

FirstThreeLettersofPatient'sLastName

Datentyp

text

Patient Study ID
Beschreibung

PatientStudyID

Datentyp

text

Institution Name
Beschreibung

InstitutionName

Datentyp

text

Affiliate Name
Beschreibung

AffiliateName

Datentyp

text

Person Completing Form Last Name
Beschreibung

PersonCompletingForm,LastName

Datentyp

text

Person Completing Form First Name
Beschreibung

PersonCompletingForm,FirstName

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Person Completing Form Phone
Beschreibung

PersonCompletingForm,Phone

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Are data amended? (If Yes, circle the amended items in red.)
Beschreibung

AmendedDataInd

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
adjuvante radiatio status
Beschreibung

adjuvante radiatio status

Has the patient received adjuvant RT? (prior to treatment failure or second primary cancer)
Beschreibung

AdjuvantRTInd

Datentyp

boolean

Adjuvant RT Begin Date (month day year)
Beschreibung

AdjuvantRTBeginDate

Datentyp

date

Adjuvant RT End Date (month day year)
Beschreibung

AdjuvantRTEndDate

Datentyp

date

Was the patient enrolled in NSABP Protocol B-39/RTOG 0413?
Beschreibung

NationalSurgicalAdjuvantBreastandBowelProjectBreastRadiationTherapyPriorReceivedInd-2

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C15818
UMLS 2011AA ObjectClass-2
C1513905
NCI Thesaurus ObjectClass-3
C12971
UMLS 2011AA ObjectClass-3
C0006141
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C25639
UMLS 2011AA Property-2
C1514756
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NSABP Patient ID
Beschreibung

PatientNationalSurgicalAdjuvantBreastProjectIdentifierNumber

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C15818
UMLS 2011AA Property-2
C1513905
Breast
Beschreibung

Breast

Breast Irradiated
Beschreibung

RadiationTherapyBreastLocationSideAnatomicSite

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C12971
UMLS 2011AA Property-2
C0006141
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ValueDomain-2
C25306
UMLS 2011AA ValueDomain-2
C0441987
RT Total Dose (cGY)
Beschreibung

RTTotalDose

Datentyp

float

No. of Fractions (if applicable)
Beschreibung

RTTotalFractionCount

Datentyp

float

Beam Energy (Kev if applicable)
Beschreibung

BeamEnergy

Datentyp

text

Energy Type (if applicable)
Beschreibung

EnergyType

Datentyp

text

Operative Area Boost
Beschreibung

Operative Area Boost

Operative Area Boost
Beschreibung

OperativeAreaBoost

Datentyp

text

Zum Seitenanfang zurückkehren

Ähnliche Modelle

Form E1 (04-30-2002) Breast radiation is required on this protocol. Submit form when radiation therapy has ended. If breast radiation was not done, submit form within 90 days of randomization.

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header Module
FirstThreeLettersofPatient'sLastName
Item
First Three Letters of Patient's Last Name
text
PatientStudyID
Item
Patient Study ID
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PersonCompletingForm,LastName
Item
Person Completing Form Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PersonCompletingForm,Phone
Item
Person Completing Form Phone
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
AmendedDataInd
Item
Are data amended? (If Yes, circle the amended items in red.)
boolean
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Item Group
adjuvante radiatio status
AdjuvantRTInd
Item
Has the patient received adjuvant RT? (prior to treatment failure or second primary cancer)
boolean
AdjuvantRTBeginDate
Item
Adjuvant RT Begin Date (month day year)
date
AdjuvantRTEndDate
Item
Adjuvant RT End Date (month day year)
date
NationalSurgicalAdjuvantBreastandBowelProjectBreastRadiationTherapyPriorReceivedInd-2
Item
Was the patient enrolled in NSABP Protocol B-39/RTOG 0413?
boolean
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C15818 (NCI Thesaurus ObjectClass-2)
C1513905 (UMLS 2011AA ObjectClass-2)
C12971 (NCI Thesaurus ObjectClass-3)
C0006141 (UMLS 2011AA ObjectClass-3)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25639 (NCI Thesaurus Property-2)
C1514756 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientNationalSurgicalAdjuvantBreastProjectIdentifierNumber
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C15818 (NCI Thesaurus Property-2)
C1513905 (UMLS 2011AA Property-2)
Item Group
Breast
Item
Breast Irradiated
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12971 (NCI Thesaurus Property-2)
C0006141 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25306 (NCI Thesaurus ValueDomain-2)
C0441987 (UMLS 2011AA ValueDomain-2)
CL.4
Code List
Breast Irradiated
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
RTTotalDose
Item
RT Total Dose (cGY)
float
RTTotalFractionCount
Item
No. of Fractions (if applicable)
float
BeamEnergy
Item
Beam Energy (Kev if applicable)
text
Item
Energy Type (if applicable)
text
CL.7
Code List
Energy Type (if applicable)
CL Item
X-ray Or Photon (X-ray or Photon)
CL Item
Electron (Electron)
C40428 (NCI Thesaurus)
C0005166 (UMLS 2011AA)
Item Group
Operative Area Boost
Item
Operative Area Boost
text
CL.6
Code List
Operative Area Boost
CL Item
By Brachytherapy (By brachytherapy)
CL Item
By Other Method (By other method)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
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