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ID
2192
Beschreibung
BASELINE TUMOR ASSESSMENT FORM S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-4831-361C-E034-080020C9C0E0
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Versionen (3)
- 19.09.12 19.09.12 -
- 28.05.15 28.05.15 -
- 03.06.15 03.06.15 -
Hochgeladen am
19. September 2012
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Lung Cancer NCT00020709 On-Study - BASELINE TUMOR ASSESSMENT FORM - 2030740v3.0
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- StudyEvent: BASELINE TUMOR ASSESSMENT FORM
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- StudyEvent: BASELINE TUMOR ASSESSMENT FORM
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain)
C1704379 (UMLS 2011AA ValueDomain)
PatientInitials
Item
Patient Initials (L, F,M)
text
Institution/Affiliate
Item
Institution / Affiliate
text
Physician
Item
Physician
text
GroupName
Item
Group Name (Groups other than SWOG )
text
StudyNo.
Item
Study No. (Groups other than SWOG )
double
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
CL Item
L1 (L1)
CL Item
L2 (L2)
CL Item
L3 (L3)
CL Item
L4 (L4)
CL Item
L5 (L5)
CL Item
L6 (L6)
CL Item
L7 (L7)
CL Item
L8 (L8)
CL Item
L9 (L9)
CL Item
L10 (L10)
TargetLesionSite
Item
Target Lesion Site
text
RTNoProg.
Item
RT No Prog.
text
LongestDiameter
Item
Longest Diameter (cm )
text
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
CA-125 assay (CA-125 assay)
CL Item
Endoscopy (Endoscopy)
CL Item
PSA (PSA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
CT scan (CT scan)
CL Item
MRI scan (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
CL Item
PET scan (PET scan)
CL Item
Histologic confirmation (Histologic confirmation)
CL Item
Cytologic confirmation (Cytologic confirmation)
CL Item
Other (Other)
TargetLesionAssessmentDate
Item
Target Lesion Assessment Date
text
CL Item
S1 (S1)
CL Item
S2 (S2)
CL Item
S3 (S3)
CL Item
S4 (S4)
CL Item
S5 (S5)
Non-TargetLesionSite
Item
Non-Target Lesion Site
text
Extent
Item
Extent
text
CL Item
Palpation (Palpation)
CL Item
Visualization (Visualization)
CL Item
Colposcopy (Colposcopy)
CL Item
CA-125 assay (CA-125 assay)
CL Item
Endoscopy (Endoscopy)
CL Item
PSA (PSA)
CL Item
Plain film/X-ray without contrast (Plain film/X-ray without contrast)
CL Item
Plain film/X-ray with contrast (Plain film/X-ray with contrast)
CL Item
CT scan (CT scan)
CL Item
MRI scan (MRI scan)
CL Item
Radioisotope scan (Radioisotope scan)
CL Item
Ultrasound (Ultrasound)
CL Item
PET scan (PET scan)
CL Item
Histologic confirmation (Histologic confirmation)
CL Item
Cytologic confirmation (Cytologic confirmation)
CL Item
Other (Other)
Non-TargetLesionAssessmentDate
Item
Non-Target Lesion Assessment Date
text
Tests/studies
Item
Tests/studies
text
AssessmentDate
Item
Assessment Date
date
Notes
Item
Notes
text