ID

2243

Descripción

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

Link

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

Palabras clave

  1. 19/9/12 19/9/12 -
  2. 8/5/15 8/5/15 - Martin Dugas
Subido en

19 de septiembre de 2012

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0 Legacy

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Lung Cancer NCT00020709 Registration - LUNG CARCINOMA RADIATION THERAPY FORM - 2031928v3.0

No Instruction available.

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

Unnamed1

SWOG Patient ID
Descripción

SWOGPatientID

Tipo de datos

text

SWOG Study No.
Descripción

SWOGStudyNo.

Tipo de datos

text

Registration Step
Descripción

RegistrationStep

Tipo de datos

text

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

PatientInitials

Tipo de datos

text

Social Security No.
Descripción

SocialSecurityNo.

Tipo de datos

text

Institution / Affiliate
Descripción

Institution/Affiliate

Tipo de datos

text

Physician
Descripción

Physician

Tipo de datos

text

Hosp. No.
Descripción

Hosp.No.

Tipo de datos

text

Group Name (Groups other than SWOG )
Descripción

GroupName

Tipo de datos

text

Study No. (Groups other than SWOG )
Descripción

StudyNo.

Tipo de datos

double

Pt. ID (Groups other than SWOG )
Descripción

Pt.ID

Tipo de datos

text

Treating Radiation Oncologist
Descripción

TreatingRadiationOncologist

Tipo de datos

text

RT Facility
Descripción

RTFacility

Tipo de datos

text

RT Facility Code
Descripción

RTFacilityCode

Tipo de datos

text

Unnamed2
Descripción

Unnamed2

Radiation Therapy Start Date
Descripción

RTBeginDate

Tipo de datos

date

RT End Date
Descripción

RTEndDate

Tipo de datos

date

Were there any unscheduled interruptions in radiation therapy?
Descripción

Werethereanyunscheduledinterruptionsinradiationtherapy?

Tipo de datos

text

If Yes, Specify RT Interruptions Reason
Descripción

IfYes,SpecifyRTInterruptionsReason

Tipo de datos

text

Treatment Information
Descripción

Treatment Information

Total Dose to Isocenter (cGy)
Descripción

TotalDosetoIsocenter

Tipo de datos

text

Total Fractions
Descripción

TotalFractions

Tipo de datos

text

Radiation Source
Descripción

RadiationSource

Tipo de datos

text

Other, specify
Descripción

CytogeneticAnalysis,OtherReason,NoSuccess

Tipo de datos

text

Fractions
Descripción

Fractions

Tipo de datos

text

Number of Days
Descripción

NumberofDays

Tipo de datos

text

Number of Days
Descripción

NumberofDays

Tipo de datos

text

Radiation Energy (MeV)
Descripción

RadiationEnergy

Tipo de datos

text

Maximum Dose to Critical Structures
Descripción

MaximumDosetoCriticalStructures

Tipo de datos

text

Spinal Cord
Descripción

SpinalCord

Tipo de datos

text

Heart
Descripción

Heart

Tipo de datos

text

Esophagus
Descripción

Esophagus

Tipo de datos

text

Other structures
Descripción

TumorExtension,OtherStructures

Tipo de datos

text

Specify
Descripción

Specify

Tipo de datos

text

Specify
Descripción

Specify

Tipo de datos

text

Specify
Descripción

Specify

Tipo de datos

text

Dose (cGy)
Descripción

RadiationTherapyDose

Tipo de datos

text

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

RadiationTherapyDose

Tipo de datos

text

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

%OfTotalLungReceiving>=2000cGy

Tipo de datos

text

%Of Right Lung Receiving>=2000 cGy
Descripción

%OfRightLungReceiving>=2000cGy

Tipo de datos

text

Primary Tumor location
Descripción

PrimaryTumorlocation

Tipo de datos

text

%Of Left Lung Receiving>=2000 cGy
Descripción

%OfLeftLungReceiving>=2000cGy

Tipo de datos

text

Unnamed4
Descripción

Unnamed4

Form completed by
Descripción

Formcompletedby

Tipo de datos

text

Facility
Descripción

Facility

Tipo de datos

text

Telephone Number
Descripción

TelephoneNumber

Tipo de datos

text

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

Date

Tipo de datos

text

Unnamed5
Descripción

Unnamed5

Radiation Oncologist's Signature
Descripción

RadiationOncologyPhysicianSignatureText

Tipo de datos

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
Descripción

Notes

Notes
Descripción

Notes

Tipo de datos

text

Similar models

No Instruction available.

  1. StudyEvent: LUNG CARCINOMA RADIATION THERAPY FORM
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
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
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
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
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

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