E3201 Long-Term Follow-up Form NCT00068692 Comparison of Adjuvant Chemotherapy Regimens in Treating Patients With Stage II or Stage III Rectal Cancer Who Are Receiving Radiation Therapy and Fluorouracil Before or After Surgery Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 6/8/15 6/8/15 -
Uploaded on:

June 8, 2015

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Creative Commons BY-NC 3.0 Legacy
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E3201 Long-Term Follow-up Form NCT00068692

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  1. StudyEvent: E3201 Long-Term Follow-up Form
    1. No Instruction available.
ECOG clinical trial administrative data
Off protocol treatment
Off Treatment Time Period
Are data amended? (If yes, please circle amended items in red)
Vital Status
Patient's Vital Status
Primary Cause of Death (if applicable)
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)?
Notice Of Progression
Has the patient developed a first progression that has not been previously reported?
Did a physician make a formal diagnosis of progressive disease?
Site(s) of progression
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >= 3) long term toxicity that has not been previously reported?
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first progression (not previously reported)?
Ccrr Module For E3201 Long-term Follow-up Form

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