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ID

2243

Description

LUNG CARCINOMA RADIATION THERAPY 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=9E343E83-5FEB-119F-E034-080020C9C0E0

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E343E83-5FEB-119F-E034-080020C9C0E0

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 08/05/2015 08/05/2015 - Martin Dugas
Téléchargé le

19 septembre 2012

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer NCT00020709 Registration - LUNG CARCINOMA RADIATION THERAPY FORM - 2031928v3.0

    Anglais

    No Instruction available.

    1 Formulaires  
    1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
      1. No Instruction available.
    Unnamed1
    Description

    Unnamed1

    SWOG Patient ID
    Description

    SWOGPatientID

    Type de données

    text

    SWOG Study No.
    Description

    SWOGStudyNo.

    Type de données

    text

    Registration Step
    Description

    RegistrationStep

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ValueDomain
    C16154
    UMLS 2011AA ValueDomain
    C1704379
    Patient Initials (L, F,M)
    Description

    PatientInitials

    Type de données

    text

    Social Security No.
    Description

    SocialSecurityNo.

    Type de données

    text

    Institution / Affiliate
    Description

    Institution/Affiliate

    Type de données

    text

    Physician
    Description

    Physician

    Type de données

    text

    Hosp. No.
    Description

    Hosp.No.

    Type de données

    text

    Group Name (Groups other than SWOG )
    Description

    GroupName

    Type de données

    text

    Study No. (Groups other than SWOG )
    Description

    StudyNo.

    Type de données

    double

    Pt. ID (Groups other than SWOG )
    Description

    Pt.ID

    Type de données

    text

    Treating Radiation Oncologist
    Description

    TreatingRadiationOncologist

    Type de données

    text

    RT Facility
    Description

    RTFacility

    Type de données

    text

    RT Facility Code
    Description

    RTFacilityCode

    Type de données

    text

    Unnamed2
    Description

    Unnamed2

    Radiation Therapy Start Date
    Description

    RTBeginDate

    Type de données

    date

    RT End Date
    Description

    RTEndDate

    Type de données

    date

    Were there any unscheduled interruptions in radiation therapy?
    Description

    Werethereanyunscheduledinterruptionsinradiationtherapy?

    Type de données

    text

    If Yes, Specify RT Interruptions Reason
    Description

    IfYes,SpecifyRTInterruptionsReason

    Type de données

    text

    Treatment Information
    Description

    Treatment Information

    Total Dose to Isocenter (cGy)
    Description

    TotalDosetoIsocenter

    Type de données

    text

    Total Fractions
    Description

    TotalFractions

    Type de données

    text

    Radiation Source
    Description

    RadiationSource

    Type de données

    text

    Other, specify
    Description

    CytogeneticAnalysis,OtherReason,NoSuccess

    Type de données

    text

    Fractions
    Description

    Fractions

    Type de données

    text

    Number of Days
    Description

    NumberofDays

    Type de données

    text

    Number of Days
    Description

    NumberofDays

    Type de données

    text

    Radiation Energy (MeV)
    Description

    RadiationEnergy

    Type de données

    text

    Maximum Dose to Critical Structures
    Description

    MaximumDosetoCriticalStructures

    Type de données

    text

    Spinal Cord
    Description

    SpinalCord

    Type de données

    text

    Heart
    Description

    Heart

    Type de données

    text

    Esophagus
    Description

    Esophagus

    Type de données

    text

    Other structures
    Description

    TumorExtension,OtherStructures

    Type de données

    text

    Specify
    Description

    Specify

    Type de données

    text

    Specify
    Description

    Specify

    Type de données

    text

    Specify
    Description

    Specify

    Type de données

    text

    Dose (cGy)
    Description

    RadiationTherapyDose

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus Property
    C25256
    UMLS 2011AA Property
    C1265611
    Dose (cGy)
    Description

    RadiationTherapyDose

    Type de données

    text

    Alias
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus Property
    C25256
    UMLS 2011AA Property
    C1265611
    %Of Total Lung Receiving>=2000 cGy
    Description

    %OfTotalLungReceiving>=2000cGy

    Type de données

    text

    %Of Right Lung Receiving>=2000 cGy
    Description

    %OfRightLungReceiving>=2000cGy

    Type de données

    text

    Primary Tumor location
    Description

    PrimaryTumorlocation

    Type de données

    text

    %Of Left Lung Receiving>=2000 cGy
    Description

    %OfLeftLungReceiving>=2000cGy

    Type de données

    text

    Unnamed4
    Description

    Unnamed4

    Form completed by
    Description

    Formcompletedby

    Type de données

    text

    Facility
    Description

    Facility

    Type de données

    text

    Telephone Number
    Description

    TelephoneNumber

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ValueDomain
    C25395
    UMLS 2011AA ValueDomain
    C0039457
    Date
    Description

    Date

    Type de données

    text

    Unnamed5
    Description

    Unnamed5

    Radiation Oncologist's Signature
    Description

    RadiationOncologyPhysicianSignatureText

    Type de données

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus Property
    C25678
    UMLS 2011AA Property
    C1519316
    NCI Thesaurus ObjectClass
    C25741
    UMLS 2011AA ObjectClass
    C0031831
    NCI Thesaurus ObjectClass
    C17833
    UMLS 2011AA ObjectClass
    C1514693
    Notes
    Description

    Notes

    Notes
    Description

    Notes

    Type de données

    text

    Retour au début de la page

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    No Instruction available.

    1 Formulaires
    1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    Alias
    Item Group
    Unnamed1
    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)
    PatientInitials
    Item
    Patient Initials (L, F,M)
    text
    SocialSecurityNo.
    Item
    Social Security No.
    text
    Institution/Affiliate
    Item
    Institution / Affiliate
    text
    Physician
    Item
    Physician
    text
    Hosp.No.
    Item
    Hosp. No.
    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
    TreatingRadiationOncologist
    Item
    Treating Radiation Oncologist
    text
    RTFacility
    Item
    RT Facility
    text
    RTFacilityCode
    Item
    RT Facility Code
    text
    Item Group
    Unnamed2
    RTBeginDate
    Item
    Radiation Therapy Start Date
    date
    RTEndDate
    Item
    RT End Date
    date
    Item
    Were there any unscheduled interruptions in radiation therapy?
    text
    CL.1
    Code List
    Were there any unscheduled interruptions in radiation therapy?
    CL Item
    Yes (Yes)
    CL Item
    No (No)
    IfYes,SpecifyRTInterruptionsReason
    Item
    If Yes, Specify RT Interruptions Reason
    text
    Item Group
    Treatment Information
    TotalDosetoIsocenter
    Item
    Total Dose to Isocenter (cGy)
    text
    TotalFractions
    Item
    Total Fractions
    text
    Item
    Radiation Source
    text
    CL.2
    Code List
    Radiation Source
    CL Item
    Co_60_2005542 (Co 60)
    CL Item
    Megavoltage_2005543 (Megavoltage)
    CL Item
    Electron_2005544 (Electron)
    CL Item
    Combination_2005545 (Combination)
    CL Item
    Other_specify_2005546 (Other, specify)
    CytogeneticAnalysis,OtherReason,NoSuccess
    Item
    Other, specify
    text
    Fractions
    Item
    Fractions
    text
    NumberofDays
    Item
    Number of Days
    text
    NumberofDays
    Item
    Number of Days
    text
    Item
    Radiation Energy (MeV)
    text
    CL.4
    Code List
    Radiation Energy (MeV)
    CL Item
    P98not_applicable2005561 (98=not applicable)
    MaximumDosetoCriticalStructures
    Item
    Maximum Dose to Critical Structures
    text
    SpinalCord
    Item
    Spinal Cord
    text
    Heart
    Item
    Heart
    text
    Esophagus
    Item
    Esophagus
    text
    TumorExtension,OtherStructures
    Item
    Other structures
    text
    Specify
    Item
    Specify
    text
    Specify
    Item
    Specify
    text
    Specify
    Item
    Specify
    text
    RadiationTherapyDose
    Item
    Dose (cGy)
    text
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25256 (NCI Thesaurus Property)
    C1265611 (UMLS 2011AA Property)
    RadiationTherapyDose
    Item
    Dose (cGy)
    text
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25256 (NCI Thesaurus Property)
    C1265611 (UMLS 2011AA Property)
    %OfTotalLungReceiving>=2000cGy
    Item
    %Of Total Lung Receiving>=2000 cGy
    text
    %OfRightLungReceiving>=2000cGy
    Item
    %Of Right Lung Receiving>=2000 cGy
    text
    Item
    Primary Tumor location
    text
    CL.5
    Code List
    Primary Tumor location
    CL Item
    Left_lung2005574 (Left lung)
    CL Item
    Right_lung2005575 (Right lung)
    %OfLeftLungReceiving>=2000cGy
    Item
    %Of Left Lung Receiving>=2000 cGy
    text
    Item Group
    Unnamed4
    Formcompletedby
    Item
    Form completed by
    text
    Facility
    Item
    Facility
    text
    TelephoneNumber
    Item
    Telephone Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25395 (NCI Thesaurus ValueDomain)
    C0039457 (UMLS 2011AA ValueDomain)
    Date
    Item
    Date
    text
    Item Group
    Unnamed5
    RadiationOncologyPhysicianSignatureText
    Item
    Radiation Oncologist's Signature
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C25678 (NCI Thesaurus Property)
    C1519316 (UMLS 2011AA Property)
    C25741 (NCI Thesaurus ObjectClass)
    C0031831 (UMLS 2011AA ObjectClass)
    C17833 (NCI Thesaurus ObjectClass)
    C1514693 (UMLS 2011AA ObjectClass)
    Item Group
    Notes
    Notes
    Item
    Notes
    text
    Retour au début de la page 

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