Description:

RTOG-0522 IM: Local PET/CT Qualitative and Semi-Quantitative Assessment Form NCT00265941 Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F7655132-1754-5B7C-E034-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F7655132-1754-5B7C-E034-0003BA3F9857
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  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/21/15 6/21/15 -
Uploaded on:

June 21, 2015

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Creative Commons BY-NC 3.0 Legacy
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RTOG-0522 IM: Local PET/CT Qualitative and Semi-Quantitative Assessment Form NCT00265941

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  1. StudyEvent: RTOG-0522 IM: Local PET/CT Qualitative and Semi-Quantitative Assessment Form
    1. No Instruction available.
Header
Qualitative and Semi-Quantitative Assessment
Amended data
Timepoint of PET/CT Imaging
Was PET/CT Imaging completed?
If no, provide reason
Image Quality
Reason Image Inadequate
Semi-quantitative Assessment
Primary Tumor Site
Level I (Submandibular) Left
Level II (Upper 1/3 Internal Jugular) Left
Level III (Mid 1/3 Internal Jugular) Left
Level IV (Lower 1/3 Internal Jugular) Left
Level V (Posterior Triangle) Left
Retropharyngeal Left
Other Location Left
Level I (Submandibular) Right
Level II (Upper 1/3 Internal Jugular) Right
Level III (Mid 1/3 Internal Jugular) Right
Level IV (Lower 1/3 Internal Jugular) Right
Level V (Posterior Triangle) Right
Retropharyngeal Right
Other location Right
Indicate Any Lymphadenopathy
Were there any distant metastases with PET findings?
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