Description:

ACNS0122 On Study 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=BD40A64A-F8D7-0B76-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD40A64A-F8D7-0B76-E034-0003BA12F5E7

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  1. 8/26/12
  2. 1/9/15
  3. 7/5/15
Uploaded on:

July 5, 2015

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Creative Commons BY-NC 3.0 Legacy
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ACNS0122 On Study Worksheet NCT00047320

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  1. StudyEvent: ACNS0122 On Study Worksheet
    1. No Instruction available.
Header
Miscellaneous Patient Information
XRT associated with this study?
Method of Payment
Pre-study Neurosurgeries
Was surgery performed prior to study enrollment?
Pre-treatment Imaging Studies
Type [imaging studies]
Tumor Location
Were Supratentorial sites involved?
Were there other Supratentorial sites?
Were Infratentorial sites involved?
check all Infratentorial sites involved on T1 post gadolinium MRI (If yes,)
Were there other Infratentorial sites?
Was Spinal Cord involved at diagnosis?
Were there other Spinal Chord sites?
Was Dura involved?
indicate type of involvement [dura] (If yes,)
Was CSF cytological evaluation of lumbar fluid positive?
Were there other sites involved?
Primary Disease
What is the primary disease site?
Comments
Ccrr Module For Acns0122 On Study Worksheet