ID

11342

Description

NSABP PROTOCOL R-04 Radiation Therapy Report NCT00058474 Radiation Therapy and Either Capecitabine or Fluorouracil With or Without Oxaliplatin Before Surgery in Treating Patients With Resectable Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B782329A-7D15-2500-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B782329A-7D15-2500-E034-0003BA12F5E7

Mots-clés

Versions (3)
  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
  3. 03/07/2015 03/07/2015 -
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3 juillet 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL R-04 Radiation Therapy Report NCT00058474

Anglais

Mark Circles Like This

1 Formulaires  
  1. StudyEvent: NSABP PROTOCOL R-04 Radiation Therapy Report
    1. Mark Circles Like This
Header module
Description

Header module

Last
Description

Patient Initials Last

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1517741
NCI Thesaurus Property
C25536
NCI Thesaurus Property-2
C25551
First
Description

Patient Initials First

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C0205435
NCI Thesaurus Property
C25536
NCI Thesaurus Property-2
C25509
Middle
Description

PatientMiddleInitialsName

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
NCI Thesaurus Property-2
C25569
UMLS 2011AA Property-2
C0444598
NSABP Patient ID
Description

Patient ID NSABP

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1513905
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C15818
Person Completing Form, Last Name (Person Completing Form, First Name)
Description

Person Completing Form Last Name

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1301584
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25191
Person Completing Form, First Name
Description

Person Completing Form First Name

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1443235
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25509
NCI Thesaurus ValueDomain
C25191
Person Completing Form, Phone
Description

Person Completing Form Phone

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25190
UMLS CUI-2
C1515258
NCI Thesaurus ObjectClass-2
C25657
NCI Thesaurus Property
C25395
Institution Name / Affiliate
Description

Affiliate Name

Type de données

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS CUI-1
C1510825
NCI Thesaurus ObjectClass-2
C25413
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Are data amended
Description

Data amended

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Radiation Therapy Report
Description

Radiation Therapy Report

Has the patient received pre-operative RT? (prior to treatment failure or second primary cancer)
Description

PreoperativeRadiationTherapyAdministeredInd-2

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C54732
UMLS 2011AA ObjectClass-2
C0445204
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Pre-operative RT begin date
Description

PreoperativeRadiationTherapyAdministeredBeginDate

Type de données

date

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C54732
UMLS 2011AA ObjectClass-2
C0445204
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25431
UMLS 2011AA ValueDomain-2
C0439659
Pre-operative RT end date
Description

PreoperativeRadiationTherapyAdministeredEndDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C54732
UMLS 2011AA ObjectClass-2
C0445204
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Was the tumor fixed to surrounding structures?
Description

ColorectalTumorSurroundingStructureFixedInd-2

Type de données

boolean

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C13363
UMLS 2011AA ObjectClass-2
C0555952
NCI Metathesaurus Property
C1185713
NCI Thesaurus Property
C41186
UMLS 2011AA Property
C0678594
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Were there any unscheduled interruptions in radiation therapy?
Description

Unscheduled Interruptions in Radiation Therapy

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C1522449
NCI Thesaurus ObjectClass
C15313
UMLS CUI-2
C1512900
NCI Thesaurus Property
C25542
Reasons (If yes, indicate)
Description

RTUnscheduledInterruptionReason

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25542
UMLS 2011AA Property
C1512900
Specify
Description

RadiationTherapyUnscheduledInterruptionSpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25211
UMLS 2011AA Property-2
C0086960
NCI Thesaurus Property-3
C25542
UMLS 2011AA Property-3
C1512900
Was a Boost given?
Description

RadiationTherapyBoostAdministeredind-2

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property-2
C25438
UMLS 2011AA Property-2
C1511253
If no Boost, indicate reason(s).
Description

RadiationTherapyBoostNotAdministeredReason

Type de données

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C25438
UMLS 2011AA Property-3
C1511253
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
Other,specify
Description

RadiationTherapyBoostNotAdministeredSpecify

Type de données

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25594
UMLS 2011AA Property
C1518422
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C25438
UMLS 2011AA Property-3
C1511253
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
RT Total Dose, Whole Pelvis (prior to boost)
Description

RTTotalDose,Pelvis

Type de données

text

RT Total Dose, Boost (cGY)
Description

RTTotalDose,Boost

Type de données

float

No. of Fractions, Whole Pelvis (prior to boost)
Description

RTTotalFractionsperField

Type de données

float

Alias
NCI Thesaurus ObjectClass
C25507
UMLS 2011AA ObjectClass
C1521738
NCI Thesaurus Property
C25514
UMLS 2011AA Property
C1264633
No. of Fractions, Boost (cGY)
Description

RTTotalFractionBoostCount

Type de données

float

Alias
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus Property-2
C25514
UMLS 2011AA Property-2
C1264633
Beam Energy
Description

BeamEnergy

Type de données

text

Energy Type
Description

EnergyType

Type de données

text

Field Size (Anterior cm)
Description

FieldSize

Type de données

text

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Similar models

Mark Circles Like This

1 Formulaires
  1. StudyEvent: NSABP PROTOCOL R-04 Radiation Therapy Report
    1. Mark Circles Like This
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Header module
Patient Initials Last
Item
Last
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1517741 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
Patient Initials First
Item
First
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C0205435 (UMLS CUI-2)
C25536 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
PatientMiddleInitialsName
Item
Middle
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C25569 (NCI Thesaurus Property-2)
C0444598 (UMLS 2011AA Property-2)
Patient ID NSABP
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1513905 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C15818 (NCI Thesaurus Property-2)
Person Completing Form Last Name
Item
Person Completing Form, Last Name (Person Completing Form, First 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)
Person Completing Form First Name
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1443235 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25509 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Person Completing Form Phone
Item
Person Completing Form, Phone
text
C25337 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
Affiliate Name
Item
Institution Name / Affiliate
text
C21541 (NCI Thesaurus ObjectClass)
C1510825 (UMLS CUI-1)
C25413 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Radiation Therapy Report
PreoperativeRadiationTherapyAdministeredInd-2
Item
Has the patient received pre-operative RT? (prior to treatment failure or second primary cancer)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C54732 (NCI Thesaurus ObjectClass-2)
C0445204 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
PreoperativeRadiationTherapyAdministeredBeginDate
Item
Pre-operative RT begin date
date
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C54732 (NCI Thesaurus ObjectClass-2)
C0445204 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
PreoperativeRadiationTherapyAdministeredEndDate
Item
Pre-operative RT end date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C54732 (NCI Thesaurus ObjectClass-2)
C0445204 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
ColorectalTumorSurroundingStructureFixedInd-2
Item
Was the tumor fixed to surrounding structures?
boolean
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C13363 (NCI Thesaurus ObjectClass-2)
C0555952 (UMLS 2011AA ObjectClass-2)
C1185713 (NCI Metathesaurus Property)
C41186 (NCI Thesaurus Property)
C0678594 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Unscheduled Interruptions in Radiation Therapy
Item
Were there any unscheduled interruptions in radiation therapy?
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C1512900 (UMLS CUI-2)
C25542 (NCI Thesaurus Property)
Item
Reasons (If yes, indicate)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25542 (NCI Thesaurus Property)
C1512900 (UMLS 2011AA Property)
CL.5
Code List
Reasons (If yes, indicate)
CL Item
Chemotherapy-related Adverse Event (Chemotherapy-related AE)
CL Item
Non-medical Reason (Non-medical reason)
CL Item
Other Medical Reason (Other medical reason)
CL Item
Radiation Reaction: Gastrointestinal Adverse Event (Radiation reaction: gastrointestinal AE)
CL Item
Radiation Reaction: Other Adverse Event (Radiation reaction: Other AE)
CL Item
Radiation Reaction: Skin Adverse Event (Radiation reaction: skin AE)
RadiationTherapyUnscheduledInterruptionSpecify
Item
Specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25211 (NCI Thesaurus Property-2)
C0086960 (UMLS 2011AA Property-2)
C25542 (NCI Thesaurus Property-3)
C1512900 (UMLS 2011AA Property-3)
RadiationTherapyBoostAdministeredind-2
Item
Was a Boost given?
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25438 (NCI Thesaurus Property-2)
C1511253 (UMLS 2011AA Property-2)
Item
If no Boost, indicate reason(s).
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25438 (NCI Thesaurus Property-3)
C1511253 (UMLS 2011AA Property-3)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
CL.7
Code List
If no Boost, indicate reason(s).
CL Item
Small Bowel In Field (Small Bowel in Field)
CL Item
Toxicity (Toxicity)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Patient Refusal (Patient Refusal)
CL Item
Other,specify (Other,specify)
RadiationTherapyBoostNotAdministeredSpecify
Item
Other,specify
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25438 (NCI Thesaurus Property-3)
C1511253 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
RTTotalDose,Pelvis
Item
RT Total Dose, Whole Pelvis (prior to boost)
text
RTTotalDose,Boost
Item
RT Total Dose, Boost (cGY)
float
RTTotalFractionsperField
Item
No. of Fractions, Whole Pelvis (prior to boost)
float
C25507 (NCI Thesaurus ObjectClass)
C1521738 (UMLS 2011AA ObjectClass)
C25514 (NCI Thesaurus Property)
C1264633 (UMLS 2011AA Property)
RTTotalFractionBoostCount
Item
No. of Fractions, Boost (cGY)
float
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25514 (NCI Thesaurus Property-2)
C1264633 (UMLS 2011AA Property-2)
BeamEnergy
Item
Beam Energy
text
Item
Energy Type
text
CL.8
Code List
Energy Type
CL Item
Whole Pelvis, X-ray or Photon (Whole Pelvis, X-ray or Photon)
CL Item
Whole Pelvis, Electron (Whole Pelvis, Electron)
CL Item
Boost, X-ray or Photon (Boost, X-ray or Photon)
CL Item
Boost, Electron (Boost, Electron)
FieldSize
Item
Field Size (Anterior cm)
text
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