Description:

RTOG 0825 Phase III GBM Follow-Up Form (F1) NCT00884741 Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A7D0D0E-5E03-3FE7-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A7D0D0E-5E03-3FE7-E044-0003BA3F9857

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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RTOG 0825 Phase III GBM Follow-Up Form (F1) NCT00884741

No Instruction available.

  1. StudyEvent: RTOG 0825 Phase III GBM Follow-Up Form (F1)
    1. No Instruction available.
RTOG clinical trial administrative data
Amended Data (INSTRUCTIONS: Submit this form as indicated in the protocol. All dates need to be recorded as mm-dd-yyyy unless otherwise specified)
Patient status assessment
Patient Vital Status
Primary Cause of Death
Karnofsky Performance Status (0-100)
Neurologic function
Recurrence Or Progression
Recurrent disease
Non-protocol Therapy To Brain
Non-Protocol Therapy
Extent of Resection
Was there gross evidence of tumor?
Was RT necrosis present
Non-Protocol Radiation Therapy
Non-Protocol Radiosurgery?
Non-Protocol brachytherapy
Non-Protocol Chemotherapy (I.E. GLIADEL WAFER)
Non-Protocol Systemic Treatment
Corticosteroids
Anticonvulsants
Has the patient taken anticoagulant agents?
seconds
seconds
seconds
Agents with proarrhythmic potential
Herbal Products
Protocol Specific Adverse Event Evaluation
Were there any hemorrhage events during this report period
CTC AE Attribution Code
SAE report submitted
seconds
seconds
1000/uL
Protocol Specific Adverse Event Evaluation
Were there any study-specific adverse events during this report period
Comments