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Description:

RTOG-0525 TF: Treatment Summary Form NCT00304031 Radiation Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma or Gliosarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE10D5B1-3CDE-10E3-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE10D5B1-3CDE-10E3-E034-0003BA3F9857

Keywords:

Brain Neoplasms

Central Nervous System Neoplasms

Versions (3) ▾

8/26/12
1/9/15
6/26/15

Uploaded on:

June 26, 2015

DOI:

No DOI assigned. To request one please log in.

License:

Creative Commons BY-NC 3.0 Legacy

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RTOG-0525 TF: Treatment Summary Form NCT00304031

English

Details

Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

StudyEvent: RTOG-0525 TF: Treatment Summary Form
1. Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

RTOG clinical trial administrative data

Institution Name

Institution No.

Patient Initials

RTOG Patient ID

Yes

No

Assessment

Kg

cm

Karnofsky Performance Status

Dead (0)

Moribund, Fatal Processes Progressing Rapidly (10)

Normal, No Complaints, No Evidence Of Disease (100)

Very Sick, Hospitalization Indicated. Death Not Imminent (20)

7 more items in the detailed view.

Neurological Function Status

Minor Neurologic Symptoms, Fully Active At Home/work Without Assistance (Minor neurologic symptoms, fully active at home/work without assistance)

Moderate Neurologic Symptoms, Fully Active At Home/work But Requires Assistance (Moderate neurologic symptoms, fully active at home/work but requires assistance)

Moderate Neurologic Symptoms, Less Than Fully Active At Home/work And Requires Assitance (Moderate neurologic symptoms, less than fully active at home/work and requires assistance)

No Neurologic Symptoms, Fully Active At Home/work Without Assistance (No neurologic symptoms, fully active at home/work without assistance)

Severe Neurologic Symptoms, Totally Inactive Requiring Complete Assistance At Home Or Institution, Unable To Work (Severe neurologic symptoms, totally inactive requiring complete assistance at home or institution, unable to work)

Disease Progression

Protocol Temozolomide Agent Administered Course Type

Concurrent Rt And Tmz (42 Days) (Concurrent RT and TMZ (42 days))

Tmz Days 1-21 Of 28 Day Cycle 12 Cycle Maximum (TMZ days 1-21 of 28 day cycle 12 cycle maximum)

Tmz Days 1-5 Of 28 Day Cycle 12 Cycle Maximum (TMZ days 1-5 of 28 day cycle 12 cycle maximum)

Is protocol chemotherapy continuing?

Yes

No

New or continuing adverse events

Yes

No

Assessment of Chemotherapy

Cycle Start Date

Treatment Course End Date

Total Dose of Agents/Drugs for this Cycle

Total No. of Doses

Reason for Treatment Modification

Adverse Event/side Effects/complications (Adverse event/side effects/complications)

Alternative Therapy (Alternative therapy)

Death On Study (Death on study)

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

6 more items in the detailed view.

Reason for Treatment Modification

Adverse Event/side Effects/complications (Adverse event/side effects/complications)

Alternative Therapy (Alternative therapy)

Death On Study (Death on study)

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

6 more items in the detailed view.

Alternative Therapy

Alternative Therapy

Reason Treatment Ended

Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)

Alternative Therapy (Alternative therapy)

Death On Study (Death on study)

Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)

5 more items in the detailed view.

Footer

Signature of Person Completing This Form

Date Form Originally Completed

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Contact

Institute of Medical Informatics
Director: Prof. Dr. Martin Dugas
Albert-Schweitzer-Campus 1, A11
48149 Münster, Germany
Email : imi@uni-muenster.de

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