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7621

Beschreibung

ACOSOG-Z4099 Active Monitoring RECIST Measurement Form (Arm 2) Surgery With or Without Internal Radiation Therapy Compared With Stereotactic Body Radiation Therapy in Treating Patients With High-Risk Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9815654D-3AFA-EB3D-E040-BB89AD437C70

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9815654D-3AFA-EB3D-E040-BB89AD437C70

Stichworte

Versionen (2)
  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
Hochgeladen am

9. Januar 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer NCT01336894 Response - ACOSOG-Z4099 Active Monitoring RECIST Measurement Form (Arm 2) - 3178204v1.0

    Englisch

    ALL ITEMS MUST BE COMPLETED

    1 Formulare  
    1. StudyEvent: ACOSOG-Z4099 Active Monitoring RECIST Measurement Form (Arm 2)
      1. ALL ITEMS MUST BE COMPLETED
    Header Module
    Beschreibung

    Header Module

    Protocol Number
    Beschreibung

    Protocol ID ACOSOG

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1515944
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C19712
    Patient ID
    Beschreibung

    Patient Study ID

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Patient Initials (L F M)
    Beschreibung

    Patient Initials

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution Number
    Beschreibung

    Institution Number

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Institution
    Beschreibung

    Institution Name

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Are data amended (check one if data amended, please circle in red when using paper forms)
    Beschreibung

    Data amended

    Datentyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Visit
    Beschreibung

    Visit

    Visit (check one)
    Beschreibung

    AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus ObjectClass
    C19712
    UMLS 2011AA ObjectClass
    C1515944
    NCI Thesaurus ObjectClass-2
    C25716
    UMLS 2011AA ObjectClass-2
    C0545082
    Overall Response Status
    Beschreibung

    Overall Response Status

    Overall Response Status at This Assessment (check one)
    Beschreibung

    OverallTumorResponseType

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C25605
    UMLS 2011AA ObjectClass-2
    C1561607
    NCI Thesaurus Property
    C25755
    UMLS 2011AA Property
    C0871261
    Was the appearance of any new lesions documented (If PD: check one NOTE: If PD is selected for Overall Response Status, and Yes is selected for "Was the appearance of any new lesions documented" end form)
    Beschreibung

    NewLesionAppearanceInd-2

    Datentyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus ObjectClass-2
    C25586
    UMLS 2011AA ObjectClass-2
    C0205314
    NCI Thesaurus Property
    C25377
    UMLS 2011AA Property
    C0700364
    Overall Response Status
    Beschreibung

    Overall Response Status

    Assessment date (dd MMM yyyy Assessment date is the date reflecting type of assessment, not the physician interpretation date. If tumor measurements are not required this cycle per Section 4.0, Assessment Date is the date the patient was evaluated )
    Beschreibung

    Assessment Date

    Datentyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985720
    NCI Thesaurus ObjectClass
    C25367
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C38000
    Non-nodal target lesion site(s) (Primary Tumor)
    Beschreibung

    NonNodalTargetLesionPresentSite

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus ObjectClass-2
    C25594
    UMLS 2011AA ObjectClass-2
    C1518422
    NCI Thesaurus ObjectClass-3
    C25323
    UMLS 2011AA ObjectClass-3
    C0443268
    NCI Thesaurus ObjectClass-4
    C25702
    UMLS 2011AA ObjectClass-4
    C1521840
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    Method of Evaluation
    Beschreibung

    Evaluation method

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2911685
    NCI Thesaurus ObjectClass
    C20989
    NCI Thesaurus Property
    C16847
    Non-Nodal Longest Diameter of Lesion(s) (Primary Tumor cm)
    Beschreibung

    NegationNodalTargetLesionLongestDiameterMeasurement

    Datentyp

    float

    Maßeinheiten
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus ObjectClass-2
    C25594
    UMLS 2011AA ObjectClass-2
    C1518422
    NCI Thesaurus ObjectClass-3
    C25323
    UMLS 2011AA ObjectClass-3
    C0443268
    NCI Thesaurus ObjectClass-4
    C25702
    UMLS 2011AA ObjectClass-4
    C1521840
    NCI Thesaurus Property
    C25285
    UMLS 2011AA Property
    C1301886
    NCI Thesaurus Property-2
    C25558
    UMLS 2011AA Property-2
    C1522425
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ValueDomain-2
    C25285
    UMLS 2011AA ValueDomain-2
    C1301886
    cm
    Zum Seitenanfang zurückkehren

    Ähnliche Modelle

    ALL ITEMS MUST BE COMPLETED

    1 Formulare
    1. StudyEvent: ACOSOG-Z4099 Active Monitoring RECIST Measurement Form (Arm 2)
      1. ALL ITEMS MUST BE COMPLETED
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    Header Module
    Protocol ID ACOSOG
    Item
    Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1515944 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C19712 (NCI Thesaurus Property-2)
    Patient Study ID
    Item
    Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    Patient Initials (L F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Data amended
    Item
    Are data amended (check one if data amended, please circle in red when using paper forms)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Visit
    Item
    Visit (check one)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C19712 (NCI Thesaurus ObjectClass)
    C1515944 (UMLS 2011AA ObjectClass)
    C25716 (NCI Thesaurus ObjectClass-2)
    C0545082 (UMLS 2011AA ObjectClass-2)
    CL.2
    Code List
    Visit (check one)
    CL Item
    4 Weeks After Surgery/completion Of Stereotactic Body Radiation Therapy (4 weeks after surgery/completion of SBRT)
    CL Item
    3 Months After Completion Of Stereotactic Body Radiation Therapy (3 months after completion of SBRT)
    CL Item
    6 Months After Completion Of Stereotactic Body Radiation Therapy (6 months after completion of SBRT)
    CL Item
    9 Months After Completion Of Stereotactic Body Radiation Therapy (9 months after completion of SBRT)
    CL Item
    12 Months After Completion Of Stereotactic Body Radiation Therapy (12 months after completion of SBRT)
    Item Group
    Overall Response Status
    Item
    Overall Response Status at This Assessment (check one)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C25605 (NCI Thesaurus ObjectClass-2)
    C1561607 (UMLS 2011AA ObjectClass-2)
    C25755 (NCI Thesaurus Property)
    C0871261 (UMLS 2011AA Property)
    CL.3
    Code List
    Overall Response Status at This Assessment (check one)
    CL Item
    Not Evaluated (Not evaluated)
    CL Item
    Complete Response (CR)
    CL Item
    Partial Response (PR)
    C18212 (NCI Thesaurus)
    CL Item
    Stable Disease (SD)
    C18213 (NCI Thesaurus)
    C0677946 (UMLS 2011AA)
    CL Item
    Progressive Disease (PD)
    C35571 (NCI Thesaurus)
    C1335499 (UMLS 2011AA)
    NewLesionAppearanceInd-2
    Item
    Was the appearance of any new lesions documented (If PD: check one NOTE: If PD is selected for Overall Response Status, and Yes is selected for "Was the appearance of any new lesions documented" end form)
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25586 (NCI Thesaurus ObjectClass-2)
    C0205314 (UMLS 2011AA ObjectClass-2)
    C25377 (NCI Thesaurus Property)
    C0700364 (UMLS 2011AA Property)
    Item Group
    Overall Response Status
    Assessment Date
    Item
    Assessment date (dd MMM yyyy Assessment date is the date reflecting type of assessment, not the physician interpretation date. If tumor measurements are not required this cycle per Section 4.0, Assessment Date is the date the patient was evaluated )
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985720 (UMLS CUI-1)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C38000 (NCI Thesaurus Property)
    NonNodalTargetLesionPresentSite
    Item
    Non-nodal target lesion site(s) (Primary Tumor)
    text
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus ObjectClass-2)
    C1518422 (UMLS 2011AA ObjectClass-2)
    C25323 (NCI Thesaurus ObjectClass-3)
    C0443268 (UMLS 2011AA ObjectClass-3)
    C25702 (NCI Thesaurus ObjectClass-4)
    C1521840 (UMLS 2011AA ObjectClass-4)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    Item
    Method of Evaluation
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2911685 (UMLS CUI-1)
    C20989 (NCI Thesaurus ObjectClass)
    C16847 (NCI Thesaurus Property)
    CL.5
    Code List
    Method of Evaluation
    CL Item
    Ct Scan (CT scan)
    CL Item
    Pet/ct Scan (PET/CT scan)
    NegationNodalTargetLesionLongestDiameterMeasurement
    Item
    Non-Nodal Longest Diameter of Lesion(s) (Primary Tumor cm)
    float
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus ObjectClass-2)
    C1518422 (UMLS 2011AA ObjectClass-2)
    C25323 (NCI Thesaurus ObjectClass-3)
    C0443268 (UMLS 2011AA ObjectClass-3)
    C25702 (NCI Thesaurus ObjectClass-4)
    C1521840 (UMLS 2011AA ObjectClass-4)
    C25285 (NCI Thesaurus Property)
    C1301886 (UMLS 2011AA Property)
    C25558 (NCI Thesaurus Property-2)
    C1522425 (UMLS 2011AA Property-2)
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C25285 (NCI Thesaurus ValueDomain-2)
    C1301886 (UMLS 2011AA ValueDomain-2)
    Zum Seitenanfang zurückkehren 

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