Description:

ACNS0122: Endocrine Status Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD9127F7-5FAB-1376-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD9127F7-5FAB-1376-E034-0003BA12F5E7

Keywords:

Brain Neoplasms

Clinical Trial

Treatment Form

Central Nervous System Neoplasms

Uploaded on:

June 21, 2015

DOI:

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License :

Creative Commons BY-NC 3.0 Legacy

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ACNS0122: Endocrine Status Worksheet NCT00047320

Details

No Instruction available.

1 forms

StudyEvent: ACNS0122: Endocrine Status Worksheet
1. No Instruction available.

Header

Name

Study Number

COG Number

Patient Name

Today's date

Date worksheet entered into RDE

Patient status assessment

Date of evaluation

When was the evaluation done?

Prior To Study Entry (Prior to study entry)

On Study (During therapy)

Off Treatment (End of therapy)

Follow-up (During follow up)

Standing height in cm

Weight in kg

BSA

Endocrine Status

Somatomedian C

ng/ml

IGF-BP3

Cortisol

Sodium (8 AM Electrolytes)

mmol/L

Potassium (8 AM Electrolytes)

mmol/L

Bicarbonate (8 AM Electrolytes)

mEq/L

Chloride (8 AM Electrolytes)

mEq/L

Urine Specific Gravity

Free T4

ng/dl

Free T4

ng/dl

FSH

Testosterone

Estradiol

hCG

Was radiographic evaluation for bone age done?

Yes

bone age according to Greulich-Pyle Atlas (If yes,)

Pubertal Status

Breasts

Menarche

Yes

Pubic hair

Genitalia

Testicular volume

Comments

Ccrr Module For Acns0122: Endocrine Status Worksheet

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