ID
11416
Description
NCT00033631 FF Radiation Therapy Oncology Group Phase III Prostate 3D / IMRT Long Term Follow-up Form Radiation Therapy in Treating Patients With Stage II Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11CEB6D6-9D7B-4CCB-E044-0003BA3F9857
Lien
Mots-clés
Versions (3)
- 19/09/2012 19/09/2012 -
- 09/01/2015 09/01/2015 - Martin Dugas
- 03/07/2015 03/07/2015 -
Téléchargé le
3 juillet 2015
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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NCT00033631 FF Radiation Therapy Oncology Group Phase III Prostate 3D / IMRT Long Term Follow-up Form
Instructions: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated. This form may be used after 5 years provided none of the following events have occurred since the last submitted report: change in disease status; new or continuing toxicity; new therapy for cancer, the patient expired. If any of these events have occurred, submit the standard F1 form.
- StudyEvent: FF Radiation Therapy Oncology Group Phase III Prostate 3D / IMRT Long Term Follow-up Form
Description
Prostate 3D / IMRT Long Term Follow-up
Description
Patient'sVitalStatus
Type de données
text
Description
DeathDate/LastContactDate
Type de données
date
Description
Causeofdeath
Type de données
text
Description
Primary Cause of Death, specify
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass-2
- C25251
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- NCI Thesaurus Property-2
- C25365
- NCI Thesaurus ValueDomain
- C25685
Description
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS 2011AA ValueDomain-2
- C1522602
Description
CancerFollow-upStatusDate
Type de données
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
Follow-upPSAValue(s)
Type de données
text
Description
DateofPSAAssessment(s)
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
HASCLINICALDISEASESTATUSlocal,regional,distantCHANGEDSINCETHELASTREPORT?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
Description
NewCancerDiagnosisAnatomicSite
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C9305
- UMLS 2011AA ObjectClass-2
- C0006826
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
Description
NewPrimaryCancerDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS 2011AA ValueDomain-2
- C1522602
Description
URINARYINCONTINENCE,SeverityGrade
Type de données
text
Description
URINARYINCONTINENCE,Attribution
Type de données
text
Description
Specifyifothercause(urinaryincontinence,attribution)
Type de données
text
Description
URINARYINCONTINENCE,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
URINARYFREQUENCY/URGENCY,SeverityGrade
Type de données
text
Description
URINARYFREQUENCY/URGENCY,Attribution
Type de données
text
Description
Specifyifothercause(urinaryfrequency/urgency,attribution)
Type de données
text
Description
URINARYFREQUENCY/URGENCY,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
ERECTILEIMPOTENCE,SeverityGrade
Type de données
text
Description
ERECTILEIMPOTENCE,Attribution
Type de données
text
Description
Specifyifothercause(erectileimpotence,attribution)
Type de données
text
Description
ERECTILEIMPOTENCE,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS 2011AA ValueDomain-2
- C1522602
Description
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain-2
- C25180
- UMLS 2011AA ValueDomain-2
- C1522602
Description
Comments
Type de données
text
Description
Signature
Type de données
text
Description
Date
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Ccrr Module For Ff Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Long Term Follow-up Form
Similar models
Instructions: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated. This form may be used after 5 years provided none of the following events have occurred since the last submitted report: change in disease status; new or continuing toxicity; new therapy for cancer, the patient expired. If any of these events have occurred, submit the standard F1 form.
- StudyEvent: FF Radiation Therapy Oncology Group Phase III Prostate 3D / IMRT Long Term Follow-up Form
C0237753 (UMLS 2011AA ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0439673 (UMLS 2011AA)
C0007465 (UMLS CUI-1)
C25251 (NCI Thesaurus ObjectClass-2)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1515974 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C0005682 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C0555952 (UMLS 2011AA)
C1522619 (UMLS 2011AA)
C1704242 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0025202 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205448 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C1272460 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain-2)
C1522602 (UMLS 2011AA ValueDomain-2)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
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