Description:

RTOG 0825 Phase III GBM Initial Evaluation Form (I1) 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=5AE2A23C-8AD1-6A8B-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5AE2A23C-8AD1-6A8B-E044-0003BA3F9857

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

August 4, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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RTOG 0825 Phase III GBM Initial Evaluation Form (I1)

INSTRUCTIONS: Submit this form at protocol entry. Dates are recorded as mm-dd-yyyy unless otherwise specified

Module 1
Assessment
years
Disease Information
Pre-study Scans
cm
cm
Pre-study Scans
cm
cm
Location Of Primary
Baseline Lab Values (hematologic)
/ul
DD.MM.YYYY
1000/uL
DD.MM.YYYY
g/dL
DD.MM.YYYY
/ul
DD.MM.YYYY
DD.MM.YYYY
mg/dL
DD.MM.YYYY
mg/dL
mg/dL
g/24 hours
mg/dL
mg/dL
U/L
U/L
DD.MM.YYYY
U/L
U/L
DD.MM.YYYY
seconds
Non-protocol Therapy To Brain
Severe Active Comorbidity
Footer Module