FormCompletionDate,Original
Item
Date form originally completed (m d y)
date
FormCompletionDate,Amended
Item
Date form amended (m d y)
date
ResponsiblePersonReportingChangeLastName
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientStudyID
Item
Patient Study ID
text
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
Item
Lesion Number (unnamed)
double
Code List
Lesion Number (unnamed)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Lesion,TumorDiameter
Item
Longest Diameter of Lesion(s) (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Lesion,Diameter,LongestSum
Item
Sum of longest diameters of all target lesions
double
Item
Are there any nontarget lesions?
text
Code List
Are there any nontarget lesions?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Lesion Number (unnamed)
double
Code List
Lesion Number (unnamed)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Item
Follow-Up Status of Lesion(s)
text
Code List
Follow-Up Status of Lesion(s)
CL Item
Present (Present)
CL Item
Unequivocal Progression (Unequivocal Progression)
CL Item
Complete Response (CR)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Stable Disease Or Unchanged (Stable)
Item
Was the appearance of any new lesions documented since the baseline evaluation?
text
Code List
Was the appearance of any new lesions documented since the baseline evaluation?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Lesion Number (unnamed)
double
Code List
Lesion Number (unnamed)
Lesion,AnatomicSite
Item
Site of Lesion
text
AssessmentDate
Item
Date of Evaluation (m d y)
date
Item
Method of Evaluation (coded values)
text
Code List
Method of Evaluation (coded values)
CL Item
Clinical Examination (Clinical examination)
CL Item
Chest X-ray (Chest X-ray)
CL Item
Ct Scan (CT Scan)
CL Item
Spiral Ct Scan (Spiral CT Scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
AssessmentType,Specify
Item
If Other, specify (Method of Eval)
text
Item
Overall response status at this assessment (check one)
text
Code List
Overall response status at this assessment (check one)
CL Item
Complete Response (CR)
CL Item
Progressive Disease (PD)
C35571 (NCI Thesaurus)
C1335499 (UMLS 2011AA)
CL Item
Partial Response (PR)
C18212 (NCI Thesaurus)
CL Item
Stable Disease (SD)
C18213 (NCI Thesaurus)
C0677946 (UMLS 2011AA)
CL Item
Null (Insufficient evaluation to determine response status)
ResponseConfirmedDate
Item
Response confirmed date (m d y)
date
C25755 (NCI Thesaurus ObjectClass)
C0871261 (UMLS 2011AA ObjectClass)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
ParticipatingGroupProtocolNumber
Item
Participating Group Protocol Number
double
PatientParticipatingIdentifierNumber
Item
Participating Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)