Description:

ACNS0122 Induction 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=BD8F3A15-A2D2-0385-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD8F3A15-A2D2-0385-E034-0003BA12F5E7

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  6. 7/25/15
Uploaded on:

July 25, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Induction Worksheet Intracranial Germ Cell Tumors NCT00047320

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  1. StudyEvent: ACNS0122 Induction Worksheet
    1. No Instruction available.
Header
Treatment period
Reporting Period
cm
kg
Tumor Evaluation
Type [imaging studies] (Type of imaging studies:)
Disease Status
Was the patient's disease status evaluated during this reporting interval?
Type of response
Evaluations
Was a Neurologic assessment done?
Was endocrinologic evaluation done?
Second Look Surgery
Was second look surgery performed after Induction cycle 6?
why not? [reason second look surgery not performed] (If no,)
Significant Events During This Reporting Period
Were there any dose modifications or additions/omissions to protocol treatment?
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Is patient off protocol therapy?
Reason Treatment Ended
Vital Status
Was patient unable to be contacted for current scheduled follow-up?
Was the patient enrolled on another COG therapeutic study at the end of the reporting period?
Did the patient withdraw consent for follow-up at the end of the reporting period?
Is the patient receiving any non-protocol cancer therapy not previously reported?
Type [non-protocol treatment] (Types of Treatment)
Treatment Plan After This Treatment Period
What is the patient's treatment plan after chemotherapy?
Toxicities
Attribution
Adverse Drug Experience?
Comments