Description:

KS Evaluation and Clinical Benefit Form: RK1 NCT00310128 Combination Chemotherapy Followed by Rituximab and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin's Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0059EF25-C95F-0C32-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0059EF25-C95F-0C32-E044-0003BA3F9857

Keywords:
Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 6/21/15
Uploaded on:

June 21, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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KS Evaluation and Clinical Benefit Form: RK1 NCT00310128

No Instruction available.

  1. StudyEvent: KS Evaluation and Clinical Benefit Form: RK1
    1. No Instruction available.
Patient demographics
Time period
History And Symptoms
Are there any GI lesions present at this evaluation
Does the patient have other related pulmonary symptoms
Patient symptoms of oral cavity lesions
Does the patient have other related oral cavity symptoms
GI Symptoms
Patient symptoms
Is the patient experiencing tumor-related pain
Is the patient on analgesics
What was the average pain experienced by the patient over the last 24 hours
Pain
Patient symptoms of edema
Patient symptoms of periorbital edema
Patient symptoms of scrotal/genital swelling
Patient symptoms of foot KS
Evaluation Of Cutaneous Lesions
Representative Area
At entry, does the patient have >=50 lesions
Character of cutaneous Lesions
Evaluation Of Marker Lesions
Site Code
Evaluation Of Foot Ks
Compared to previous evaluation
Foot KS
Photos taken
Physical findings
Evaluation Of Oral Cavity
%
Are there lesions which are not countable or measurable
Are there any GI lesions present at this evaluation
Sites
Evaluation method
Evaluation method
Pleural effusion
Are there any oral cavity lesions present at this evaluation
Are oral symptoms related to Kaposi's Sarcoma
Kaposi's Sarcoma Present
Photos taken
Oral lesions
Are there any GI symptoms related to Kaposi's Sarcoma
Performed
Are there any pulmonary KS lesions present at this evaluation
Indicate if the lesions are measurable or evaluable
Are there any pulmonary symptoms related to Kaposi's Sarcoma
Performed
Lesions Measurements
cm
cm
Bronchoscopy Performed
Any other tests peformed
Edema Evaluation
Compared to previous evaluation
Is there any tumor-associated edema at this evaluation
Edema Site
Edema present
Edema Evaluation
Evaluation Of Extremity Edema
Status of edema
Evaluation Of Periorbital Edema
Photos taken
Physical findings
Evaluation Of Scrotal/genital Swelling
Photos taken
Physical findings
Evaluation Of Visceral Disease
Has a visceral disease evaluation been done since the last KS evaluation
Procedure
Has an evaluation for visceral disease been done
Site of Lesion
KS involvement
Visceral Evaluation
Interventions (in Addition To Study Drug Therapy)
Antiemetics
Blood transfusions
Steroids
Analgesics
Analgesics
Analgesics
Local anesthetic/analgesic
Local interventions to KS lesions
Others
Others
Oxygen
Bronchodilators
Cough suppressant
Others
Diuretics
Others
Local Therapy
Others
Others
Uses cane, wheelchair
Others
Overall Assessment
Best overall response attained since Entry/Baseline
During this reporting period, did a complete response occur
During this reporting period, did a partial response occur
During this reporting period, did progression with no response occur
What is the present status of the best response
During this reporting period, did a clinical complete response occur