Description:

E3F05 Baseline Primary Brain Tumor Disease Evaluation Form NCT00978458 Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C1947D6-6AFF-2C82-E040-BB89AD4371C6

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6C1947D6-6AFF-2C82-E040-BB89AD4371C6

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Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

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Creative Commons BY-NC 3.0 Legacy
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E3F05 Baseline Primary Brain Tumor Disease Evaluation Form NCT00978458

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files.

Header
Report Period
Data amendment
Section I Measurable Lesions
Does patient have radiographically visible disease
Is measurable disease present?
Is enhancing measureable disease present (if yes, complete T2/FLAIR section below and T1/Contrast section p.2)
Is non-enhancing measureable disease present (if yes, complete T2/FLAIR section below)
T2/FLAIR
Tumor Laterality
Site
Does tumor cross midline
T1/Contrast
Section Ii Non-measurable Lesions
Is non-measurable disease present?
Is enhancing non-measureable disease present (if yes, complete T2/FLAIR section below and T1/Contrast section p.3)
Is non-enhancing non-measureable disease present (if yes, complete T2/FLAIR section below)
Nontarget Lesions
Nontarget Lesions
Section Iii
Is the patient receiving corticosteroids?
Name of Medication (If yes)
Comments