Description:

NSABP PROTOCOL C-09: Treatment Form for Group 2 Patients NCT00268463 Oxaliplatin and Capecitabine With or Without an Hepatic Arterial Infusion With Floxuridine in Treating Patients Who Are Undergoing Surgery and/or Ablation for Liver Metastases Due to Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBE35C9-1452-58D9-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBE35C9-1452-58D9-E034-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/8/15
  3. 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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NSABP PROTOCOL C-09: Treatment Form for Group 2 Patients NCT00268463

Details

Submit this form when protocol treatment has ended in a Group 2 patient, or when it is certain patient will not receive protocol therapy

Header module
Are data amended (Check box if yes, and circle amended items)
cm
Assessment of Chemotherapy
Kg
Was less than full dose administered because of toxicity?
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Why did treatment end or not begin (CAPECITABINE Select primary reason)
Treatment Group 2. Complications Related To Hai Catheter Or Pump
Were there any complications related to the HAI catheter or pump (complete table per specifications)
Pump Malfunction (if yes, complete this row)
Catheter Occlusion (if yes, complete this row)
Misperfusion (if yes, complete this row)
Bleeding (if yes, complete this row)
Infection (if yes, complete this row)
Other (if yes, complete this row)
Cycle Number (Mark all that apply)
Management of Complication (Mark all that apply)
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