ID
2275
Description
FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT Interstitial Brachytherapy With or Without External-Beam Radiation Therapy in Treating Patients With Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AA892EFD-56AF-589E-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 3/19/15 3/19/15 - Martin Dugas
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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NCT00063882 Follow-Up - FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT - 2058144v3.0
INSTRUCTIONS: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT
Description
Unnamed2
Description
RTOGStudy
Data type
text
Description
Case#
Data type
text
Description
InstitutionName
Data type
text
Description
NCIInstitutionNumber
Data type
text
Description
PatientName,Last
Data type
text
Description
PatientName,First
Data type
text
Description
Unnamed3
Description
Unnamed4
Description
Patient'sVitalStatus
Data type
text
Description
DeathDate/LastContactDate
Data type
date
Description
DeathReason
Data type
text
Description
PrimaryCauseDeathOtherReasonSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ObjectClass
- C25251
- UMLS 2011AA ObjectClass
- C0205225
- NCI Metathesaurus ObjectClass
- C0007465
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
CancerFollow-upStatusInd
Data type
text
Description
CancerFollow-upStatusDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
PerformanceStatus
Data type
text
Description
Follow-upPSAValue(s)
Data type
text
Description
AssessmentDate
Data type
date
Description
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
BiopsyDate
Data type
date
Description
ProgressionInd
Data type
text
Description
ProgressionInd,Biochemical
Data type
text
Description
ProgressionDate,FirstBiochemical
Data type
date
Description
ProgressionPSAValue
Data type
double
Description
ProgressionInd,FirstLocal-Regional
Data type
text
Description
ProgressionDate,FirstLocal-Regional
Data type
date
Description
ProgressionSite(s),FirstLocal-Regional
Data type
text
Description
ProgressionInd,FirstDistant
Data type
text
Description
ProgressionDate,FirstDistant
Data type
date
Description
ProgressionSite,FirstDistant
Data type
text
Description
AssessmentType
Data type
text
Description
AssessmentType
Data type
text
Description
AssessmentType,Specify
Data type
text
Description
AssessmentType,Specify
Data type
text
Description
Unnamed5
Description
Unnamed6
Description
RTOGStudy
Data type
text
Description
Case#
Data type
text
Description
InstitutionName
Data type
text
Description
NCIInstitutionNumber
Data type
text
Description
PatientName,Last
Data type
text
Description
PatientName,First
Data type
text
Description
Unnamed7
Description
Non-ProtocolTherapyInd
Data type
text
Description
Non-ProtocolTherapyAdministeredType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
Radiationtoothersites,specify(non-protocoltherapytype)
Data type
text
Description
Non-ProtocolTherapyType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS 2011AA ObjectClass
- C1518384
- NCI Thesaurus ObjectClass
- C2167
- UMLS 2011AA ObjectClass
- C1443775
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
SurgicalprocedurerelatedtopreviousRT,specify(non-protocoltherapytype)
Data type
text
Description
ComplementaryAlternativeMedicine,specify(non-protocoltherapytype)
Data type
text
Description
Non-ProtocolTherapyDate,First
Data type
date
Description
Specify(non-protocolprostatecancertherapy)
Data type
text
Description
NewPrimarySite
Data type
text
Description
NewPrimarySite
Data type
text
Description
NewPrimaryCancerDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Specify(newprimarysite)
Data type
text
Description
Unnamed8
Description
Unnamed9
Description
RTOGStudy
Data type
text
Description
Case#
Data type
text
Description
InstitutionName
Data type
text
Description
NCIInstitutionNumber
Data type
text
Description
PatientName,Last
Data type
text
Description
PatientName,First
Data type
text
Description
Unnamed10
Description
NEWORCONTINUINGTOXICITY(>SeverityGrade3)SINCETHELASTREPORT?
Data type
text
Description
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Data type
text
Description
CTCAdverseEventTerm
Data type
text
Description
CTCAdverseEventCategory
Data type
text
Description
CTCAdverseEventGrade
Data type
text
Description
CTCAdverseEventReportBeginDate
Data type
date
Description
CTCAdverseEventAttributionCode
Data type
text
Description
CTCAdverseEventTerm,Other
Data type
text
Description
Specify
Data type
text
Description
Comments
Data type
text
Description
SignatureofPersonCompletingThisForm
Data type
text
Description
FormCompletionDate,Original
Data type
date
Description
Ccrr Module For Fs Radiation Therapy Oncology Group Phase Iii Randomized Study Of Intermediate Risk Prostate Cancer Initial Follow-up Form For Acute Rt
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INSTRUCTIONS: Submit this form at the appropriate followup interval. Use -1 for unknown or not applicable unless otherwise specified in codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: FS Radiation Therapy Oncology Group Phase III Randomized Study of Intermediate Risk Prostate Cancer Initial Follow-up Form for Acute RT
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C0439673 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C0007465 (NCI Metathesaurus ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0332307 (UMLS 2011AA ValueDomain)
C15368 (NCI Thesaurus ObjectClass)
C25590 (NCI Thesaurus ObjectClass)
C1518384 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C0038894 (UMLS 2011AA)
C0392920 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1518384 (UMLS 2011AA ObjectClass)
C2167 (NCI Thesaurus ObjectClass)
C1443775 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)