ID

11192

Descrição

GOG-0219 Surgical Reporting Form NCT00262821 Cisplatin and Radiation Therapy With or Without Tirapazamine in Treating Patients With Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05D7A2BB-BA3D-24FB-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=05D7A2BB-BA3D-24FB-E044-0003BA3F9857

Palavras-chave

D002583

Clinical Trial

Treatment Form

Transferido a

21 juni 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy

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GOG-0219 Surgical Reporting Form NCT00262821

model
Detalhes

No Instruction available.

1 Formulários

StudyEvent: GOG-0219 Surgical Reporting Form
1. No Instruction available.

Name

Tipo

Description | Question | Decode (Coded Value)

Tipo de dados

Alias

HEADER MODULE

Item Group

Header Module

Form Completion Date

Item

Date form originally completed

date

C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)

Amendment date

Item

Date form amended

date

C19464 (NCI Thesaurus ObjectClass)
C0680532 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)

Person Amending Form

Item

Person amending form, last name

text

C25191 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1547383 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)

Patient Initials

Item

Patient Initials

text

C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)

Patient Study ID

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Person Completing Form Last Name

Item

Person completing form, last name

text

C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)

ParticipatingGroupIdentifierCode

Item

Participating group code

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

Study Number Participating Group

Item

Participating group protocol number

text

C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Trial subject ID Participating Group

Item

Participating group patient ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Gynecologic Surgical Procedure

Item Group

Gynecologic Surgical Procedure

GynecologicSurgicalProcedurePerformedType

Item

Gynecologic Surgical Procedure Performed Type

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)

CL.1

Code List

Gynecologic Surgical Procedure Performed Type

CL Item

Bilateral Salpingo-oophorectomy (bilateral salpingo-oophorectomy)

CL Item

Deep Lymphadenectomy (Deep lymphadenectomy)

CL Item

Exenteration (Exenteration)

CL Item

Hemivolvectomy (Hemi volvectomy)

CL Item

Interval Debulking (Interval debulking)

CL Item

Omentectomy (omentectomy)

C0198614 (NCI Metathesaurus)

CL Item

Other, Specify (other specify)

CL Item

Para-aortic Node Sampling/dissection (para-aortic node sampling/dissection)

CL Item

Pelvic Node Sampling/dissection (pelvic node sampling/dissection)

CL Item

Peritoneal Sampling (Peritoneal sampling)

CL Item

Primary Debulking (Primary debulking)

CL Item

Radical Hysterectomy (radical hysterectomy)

CL Item

Radical Trachelectomy (radical trachelectomy)

CL Item

Radical Vulvectomy (Radical vulvectomy)

CL Item

Reassessment Laparotomy (Reassessment laparotomy)

CL Item

Superficial Lymphadenectomy (Superficial lymphadenectomy)

CL Item

Total Abdominal Hysterectomy (Total abdominal hysterectomy)

CL Item

Total Vaginal Hysterectomy (Total vaginal hysterectomy)

CL Item

Unilateral Salpingo-oophorectomy (unilateral salpingo-oophorectomy)

C28012 (NCI Thesaurus)
C0205092 (UMLS 2011AA)
C15323 (NCI Thesaurus-3)
C0036132 (UMLS 2011AA-4)

GynecologicSurgicalProcedurePerformedSpecify

Item

Other, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)

GynecologicTumorGroupingStage

Item

Surgical stage

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C28016 (NCI Thesaurus ObjectClass-2)
C0205480 (UMLS 2011AA ObjectClass-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25523 (NCI Thesaurus Property)
C1522242 (UMLS 2011AA Property)

CL.2

Code List

Surgical stage

CL Item

0 (0)

C0919414 (NCI Metathesaurus)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (1)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (1A)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (1B)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (1C)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (2)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (2A)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (2B)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (2C)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (3)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (3A)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (3B)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (3C)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (4)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (4A)

CL Item

Refer To Figo Staging For Specific Gynecologic Cancer (4B)

CL Item

Persistent (Persistent)

CL Item

Recurrent (Recurrent)

C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)

CL Item

Not Available (Not available)

Surgery Date

Item

Date of surgery

date

C25164 (NCI Thesaurus ValueDomain)
C1628561 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C15329 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)

TumorPercentageRemovedAmount

Item

Percent of gross tumor removed

float

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25417 (NCI Thesaurus ValueDomain)
C25650 (NCI Thesaurus Property)
C0849355 (UMLS 2011AA Property)

GrossTumorResidualRemainingInd-2

Item

Residual gross tumor

boolean

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C43566 (NCI Thesaurus ObjectClass-2)
C0439806 (UMLS 2011AA ObjectClass-2)
C37895 (NCI Thesaurus Property)
C1609982 (UMLS 2011AA Property)
C25649 (NCI Thesaurus Property-2)
C1527428 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)

GynecologicInvolvedSiteName

Item

Summary of operative findings (*)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)

CL.7

Code List

Summary of operative findings (*)

CL Item

Uterus-corpus (Uterus-corpus)

CL Item

Uterus-cervix (Uterus-cervix)

CL Item

Vagina (Vagina)

C12407 (NCI Thesaurus)
C0042232 (UMLS 2011AA)

CL Item

Fallopian Tube - Rt. (Fallopian tube - rt.)

CL Item

Fallopian Tube - Lt. (Fallopian tube - lt.)

CL Item

Ovary - Rt. (Ovary - rt.)

CL Item

Ovary - Lt. (Ovary - lt.)

CL Item

Bladder - Mucosa (Bladder - mucosa)

CL Item

Bladder - Muscularis (Bladder - muscularis)

CL Item

Ureter - Rt. (Ureter - rt.)

CL Item

Ureter - Lt. (Ureter - lt.)

CL Item

Parametrium - Rt. (Parametrium - rt.)

CL Item

Parametrium - Lt. (Parametrium - lt.)

CL Item

Labium Major - Rt. (Labium major - rt.)

CL Item

Labium Major - Lt. (Labium major - lt.)

CL Item

Labium Minor - Rt. (Labium minor - rt.)

CL Item

Labium Minor - Lt. (Labium minor - lt.)

CL Item

Clitoris (Clitoris)

CL Item

Urethra (Urethra)

CL Item

Introitus (Introitus)

CL Item

Perineal Body (Perineal body)

CL Item

Anus (Anus)

C43362 (NCI Thesaurus)
C0003461 (UMLS 2011AA)

CL Item

Pelvic - Rt. (Pelvic - rt.)

CL Item

Pelvic - Lt. (Pelvic - lt.)

CL Item

Pelvic Bladder (Pelvic bladder)

CL Item

Pelvic Cul-de-sac (Pelvic cul-de-sac)

CL Item

Ant. Abdomen (Ant. Abdomen)

CL Item

Gutters - Rt. (Gutters - rt.)

CL Item

Gutters - Lt. (Gutters - lt.)

CL Item

Subdiaphragm - Rt. (subdiaphragm - rt.)

CL Item

Subdiaphragm - Lt. (subdiaphragm - lt.)

CL Item

Stomach (Stomach)

C12391 (NCI Thesaurus)
C0038351 (UMLS 2011AA)

CL Item

Duodenum (Duodenum)

C12263 (NCI Thesaurus)
C0013303 (UMLS 2011AA)

CL Item

Jejunum (Jejunum)

C12388 (NCI Thesaurus)
C0022378 (UMLS 2011AA)

CL Item

Ileum (Ileum)

CL Item

Appendix (Appendix)

C12380 (NCI Thesaurus)
C0003617 (UMLS 2011AA)

CL Item

Ascending Colon (Ascending colon)

C12265 (NCI Thesaurus)
C0227375 (UMLS 2011AA)

CL Item

Transverse Colon (Transverse colon)

C12385 (NCI Thesaurus)
C0227386 (UMLS 2011AA)

CL Item

Descending Colon (Descending colon)

C12268 (NCI Thesaurus)
C0227389 (UMLS 2011AA)

CL Item

Sig. Mucosa (Sig. Mucosa)

CL Item

Sig. Muscularis (Sig. Muscularis)

CL Item

Small Bowel (Small bowel)

CL Item

Large Bowel (Large bowel)

CL Item

Liver Surface (Liver surface)

CL Item

Liver Parenchyma (Liver parenchyma)

CL Item

Spleen (Spleen)

C12432 (NCI Thesaurus)
C0037993 (UMLS 2011AA)

CL Item

Gall Bladder (Gall bladder)

CL Item

Pancreas (Pancreas)

C12393 (NCI Thesaurus)
C0030274 (UMLS 2011AA)

CL Item

Kidney - Rt. (Kidney - rt.)

CL Item

Kidney - Lt. (Kidney - lt.)

CL Item

Adb. Ureter - Rt. (Adb. Ureter - rt.)

CL Item

Adb. Ureter - Lt. (Adb. Ureter - lt.)

CL Item

Omentum - Gastrocolic (Omentum - gastrocolic)

CL Item

Omentum - Infracolic (Omentum - infracolic)

CL Item

Abdominal Organs (Abdominal organs)

CL Item

Left Scalene (Left scalene)

CL Item

Para-aortic - Rt. (Para-aortic - rt.)

CL Item

Para-aortic - Lt. (Para-aortic - lt.)

CL Item

Common Iliac - Rt. (Common iliac - rt.)

CL Item

Common Iliac - Lt. (Common iliac - lt.)

CL Item

External Iliac - Rt. (External iliac - rt.)

CL Item

External Iliac - Lt. (External iliac - lt.)

CL Item

Obturator - Rt. (Obturator - rt.)

CL Item

Obturator - Lt. (Obturator - lt.)

CL Item

Internal - Rt. (Internal - rt.)

CL Item

Internal - Lt. (Internal - lt.)

CL Item

Superficial Gr. - Rt. (Superficial gr. - rt.)

CL Item

Superficial Gr. - Lt. (Superficial gr. - lt.)

CL Item

Deep Groin - Rt. (Deep groin - rt.)

CL Item

Deep Groin - Lt. (Deep groin - lt.)

GynecologicExaminedSite

Item

Exam

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)

CL.8

Code List

Exam

CL Item

Tumor Present (Tumor present)

CL Item

No Tumor (No tumor)

CL Item

Suspicious (Suspicious)

C0750493 (NCI Metathesaurus)

CL Item

Organ Absent (Organ absent)

CL Item

Not Examined (Not examined)

GynecologicProcedureSite

Item

Proc

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus Property)
C28016 (NCI Thesaurus ObjectClass)
C0205480 (UMLS 2011AA ObjectClass)

CL.9

Code List

Proc

CL Item

Removed Partially (Removed partially)

CL Item

Removed Completely (Removed completely)

CL Item

Biopsy Only (Biopsy only)

CL Item

Left Intact (Left intact)

CL Item

Not Applicable (Not applicable)

C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)

Miscellaneous Patient Assessment

Item Group

Miscellaneous Patient Assessment

LargestMalignantNeoplasmLongestDiameterMeasurement

Item

Greatest diameter of largest residual gross tumor mass

float

C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25550 (NCI Thesaurus ObjectClass-2)
C0443228 (UMLS 2011AA ObjectClass-2)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25558 (NCI Thesaurus Property-2)
C1522425 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)

MicroscopicDiseasePresentInd-2

Item

Microscopic disease only

boolean

C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

AscitesPresentInd-3

Item

Ascites

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2885 (NCI Thesaurus ObjectClass)
C0003962 (UMLS 2011AA ObjectClass)

FluidCytologyResultType

Item

Cytology of peritoneal or ascitic fluids

text

C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16491 (NCI Thesaurus ObjectClass)
C0010819 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)

CL.6

Code List

Cytology of peritoneal or ascitic fluids

CL Item

Positive (Positive)

C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)

CL Item

Suspicious (Suspicious)

C0750493 (NCI Metathesaurus)

CL Item

Negative (Negative)

C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)

CL Item

Not Done (Not done)

CL281691 (NCI Metathesaurus)

CL Item

Unavailable (Unavailable)

Comments

Item Group

Comments

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

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GOG-0219 Surgical Reporting Form NCT00262821

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