Description:

NCT01196390 RTOG 1010 Concurrent Treatment Summary Form (TF) Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=870670E5-419D-C79B-E040-BB89AD431B2F

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=870670E5-419D-C79B-E040-BB89AD431B2F

Keywords:
Versions (5) ▾
  1. 8/26/12
  2. 1/9/15
  3. 1/9/15
  4. 1/9/15
  5. 7/8/15
Uploaded on:

July 8, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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NCT01196390 RTOG 1010 Concurrent Treatment Summary Form (TF)

INSTRUCTIONS: Form is submitted 1 week after completion or termination of systemic treatment. All 6 pages of the form must be submitted. Dates are mm-dd-yyyy unless specified otherwise

RTOG clinical trial administrative data
Amended Data
Assessment
cm
Kg
m2
Assigned Treatment Arm
Treatment Summary
Dose Modification (Change)
Reason Treatment Ended
Therapy Modification
Toxicities
Grade 3 or 4 Restrictive Cardiomyopathy
Incipient CHF (Defined as asymptomatic >20% decrease in LVEF or a decrease of LVEF >10% below the institutions lower limit of normal who are judged to require treatment according to institutional guidelines)
Protocol Specific Adverse Event Evaluation
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Protocol Specific Adverse Event Evaluation
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Protocol Specific Adverse Event Evaluation
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Protocol Specific Adverse Event Evaluation
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Protocol Specific Adverse Event Evaluation
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Protocol Specific Adverse Event Evaluation
Any adverse events
CTC AE Grade
CTC AE Attribution Code
SAE report submitted
Comments