ID

11165

Description

RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Hypopharynx NCT00113399 Combination Chemotherapy With or Without Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer That Cannot Be Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB3979F3-3B1D-2588-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EB3979F3-3B1D-2588-E034-0003BA3F9857

Keywords

Versions (3)
  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

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Hypopharynx NCT00113399

English

No Instruction available.

1 forms  
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Hypopharynx
    1. No Instruction available.
RTOG clinical trial administrative data
Description

RTOG clinical trial administrative data

RTOG Study
Description

Protocol ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Case #
Description

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19778
UMLS 2011AA ObjectClass-2
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C49152
UMLS 2011AA Property-2
C1706256
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution No.
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Participant's Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Participant's ID No.
Description

Trial subject ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
If this is a revised or corrected form, indicate by checking box.
Description

CaseReportFormModifiedInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C40988
UMLS 2011AA ObjectClass
C1516308
NCI Thesaurus Property
C25573
Head and Neck Tumor
Description

Head and Neck Tumor

CHARACTERISTICS OF TUMOR ( all that apply)
Description

HeadandNeckTumorCharacteristicsType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12418
UMLS 2011AA ObjectClass-2
C0460004
NCI Thesaurus Property
C25447
UMLS 2011AA Property
C1521970
LOCATION OF TUMOR ( all that apply)
Description

HeadandNeckTumorSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass-2
C12418
UMLS 2011AA ObjectClass-2
C0460004
SITE OF ORIGIN
Description

HeadandNeckTumorOriginLocationStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C12418
UMLS 2011AA ObjectClass
C0460004
NCI Thesaurus ObjectClass-2
C3077
UMLS 2011AA ObjectClass-2
C0018671
NCI Thesaurus Property
C13717
UMLS 2011AA Property
C1515974
NCI Thesaurus Property-2
C42703
UMLS 2011AA Property-2
C0439659
NCI Metathesaurus ValueDomain
CL052713
SITE(S) ALSO INVOLVED
Description

HeadandNeckTumorInvolvedLocationStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12418
UMLS 2011AA ObjectClass-2
C0460004
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25547
NCI Metathesaurus ValueDomain
CL052713
Signature
Description

Signature

Data type

text

Date
Description

Investigator Signature Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
UMLS CUI-2
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C17089
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1 forms
  1. StudyEvent: RTOG-0421 I6: Radiation Therapy Oncology Group Phase III Recurrent Head and Neck Study Staging Diagrams / Hypopharynx
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
RTOG clinical trial administrative data
Protocol ID RTOG
Item
RTOG Study
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Participant's Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
Participant's ID No.
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Item
If this is a revised or corrected form, indicate by checking box.
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C40988 (NCI Thesaurus ObjectClass)
C1516308 (UMLS 2011AA ObjectClass)
C25573 (NCI Thesaurus Property)
CL.1
Code List
If this is a revised or corrected form, indicate by checking box.
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Head and Neck Tumor
Item
CHARACTERISTICS OF TUMOR ( all that apply)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25447 (NCI Thesaurus Property)
C1521970 (UMLS 2011AA Property)
CL.2
Code List
CHARACTERISTICS OF TUMOR ( all that apply)
CL Item
Deeply Infiltrating (Deeply infiltrating)
CL Item
Invades More Than One Subsite Of Hypopharynx (Invades more than one subsite of hypopharynx)
CL Item
Limited To One Subsite And <= 2cm (Limited to one subsite and <= 2cm)
CL Item
Size >2cm <=4cm (Size >2cm <=4cm)
CL Item
Fixation Of Hemilarynx (Fixation of hemilarynx)
CL Item
Invades Adjacent Structures (Invades adjacent structures)
Item
LOCATION OF TUMOR ( all that apply)
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
CL.3
Code List
LOCATION OF TUMOR ( all that apply)
CL Item
Pyriform Fossa (Pyriform Fossa)
CL Item
Postcricoid Area (Postcricoid Area)
CL Item
Posterior Wall (Posterior Wall)
Item
SITE OF ORIGIN
text
C12418 (NCI Thesaurus ObjectClass)
C0460004 (UMLS 2011AA ObjectClass)
C3077 (NCI Thesaurus ObjectClass-2)
C0018671 (UMLS 2011AA ObjectClass-2)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C42703 (NCI Thesaurus Property-2)
C0439659 (UMLS 2011AA Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
CL.4
Code List
SITE OF ORIGIN
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
Item
SITE(S) ALSO INVOLVED
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property-2)
CL052713 (NCI Metathesaurus ValueDomain)
CL.5
Code List
SITE(S) ALSO INVOLVED
CL Item
Right (RT)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
CL Item
Left (LT)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
Signature
Item
Signature
text
Investigator Signature Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
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