ID
2520
Description
FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A56DC7B3-8145-10C4-E034-080020C9C0E0
Lien
Mots-clés
Versions (2)
- 19/09/2012 19/09/2012 -
- 21/03/2015 21/03/2015 - Martin Dugas
Téléchargé le
19 septembre 2012
DOI
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Licence
Creative Commons BY-NC 3.0 Legacy
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NCT00023829 Follow-Up - FS Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form - 2041294v3.0
INSTRUCTIONS: Submit this form at patient's entry on study. 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 Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
Description
Unnamed2
Description
RTOGStudy
Type de données
text
Description
Case#
Type de données
text
Description
InstitutionName
Type de données
text
Description
InstitutionNo.
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
PatientName,Last
Type de données
text
Description
PatientName,First
Type de données
text
Description
Unnamed3
Description
Unnamed4
Description
Patient'sVitalStatus
Type de données
text
Description
DeathDate/LastContactDate
Type de données
date
Description
Causeofdeath
Type de données
text
Description
PrimaryCauseDeathOtherReasonSpecify
Type de données
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
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
CancerFollow-upStatusDate
Type de données
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Description
PERFORMANCESTATUS
Type de données
text
Description
Follow-upPSAValue(s)
Type de données
text
Description
DateofPSAAssessment(s)
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
BiopsyDate
Type de données
date
Description
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
ProgressionInd,Biochemical
Type de données
text
Description
ProgressionDate,FirstBiochemical
Type de données
date
Description
ProgressionPSAValue
Type de données
double
Description
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
ProgressionDate,FirstLocal-Regional
Type de données
date
Description
SITE(S)OFLOCAL/REGIONALPROGRESSION
Type de données
text
Description
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Type de données
text
Description
Other,specify(methodusedtodeterminelocal/regionalprogression)
Type de données
text
Description
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
ProgressionDate,FirstDistant
Type de données
date
Description
Site(s)ofFirstDistantProgression
Type de données
text
Description
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Type de données
text
Description
Other,specify(methodusedtodeterminedistantprogression)
Type de données
text
Description
Unnamed5
Description
Unnamed6
Description
RTOGStudy
Type de données
text
Description
Case#
Type de données
text
Description
InstitutionName
Type de données
text
Description
InstitutionNo.
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
PatientName,Last
Type de données
text
Description
PatientName,First
Type de données
text
Description
Unnamed7
Description
TOTALDOSETOPROSTATE
Type de données
double
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
Description
TOTALDOSETOPELVIS
Type de données
double
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
Description
RTBeginDate
Type de données
date
Description
RTEndDate
Type de données
date
Description
RTInterruptionsInd
Type de données
text
Description
RadiationTherapyUnscheduledInterruptionSpecify
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C15313
- UMLS 2011AA ObjectClass
- C1522449
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property
- C25211
- UMLS 2011AA Property
- C0086960
- NCI Thesaurus Property
- C25542
- UMLS 2011AA Property
- C1512900
Description
REASONRADIATIONTHERAPYTREATMENTENDED
Type de données
text
Description
Alternativetherapy,specify(reasonradiationtherapyended)
Type de données
text
Description
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Type de données
text
Description
Other,specify(reasonradiationtherapyended)
Type de données
text
Description
PROTOCOLHORMONESCONTINUING
Type de données
text
Description
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
Non-ProtocolTherapyAdministeredType
Type de données
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
Non-ProtocolTherapyDate,First
Type de données
date
Description
Specify(non-protocolprostatecancertherapy)
Type de données
text
Description
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
URINARYINCONTINENCE,SeverityGrade
Type de données
text
Description
URINARYINCONTINENCE,Attribution
Type de données
text
Description
Specifyifothercause(urinaryincontinence,attribution)
Type de données
text
Description
URINARYINCONTINENCE,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
URINARYFREQUENCY/URGENCY,SeverityGrade
Type de données
text
Description
URINARYFREQUENCY/URGENCY,Attribution
Type de données
text
Description
Specifyifothercause(urinaryfrequency/urgency,attribution)
Type de données
text
Description
URINARYFREQUENCY/URGENCY,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
ERECTILEIMPOTENCE,SeverityGrade
Type de données
text
Description
ERECTILEIMPOTENCE,Attribution
Type de données
text
Description
Specifyifothercause(erectileimpotence,attribution)
Type de données
text
Description
ERECTILEIMPOTENCE,AERBeginDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Unnamed8
Description
Unnamed9
Description
RTOGStudy
Type de données
text
Description
Case#
Type de données
text
Description
InstitutionName
Type de données
text
Description
InstitutionNo.
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Description
PatientName,Last
Type de données
text
Description
PatientName,First
Type de données
text
Description
Unnamed10
Description
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Type de données
text
Description
CTCAdverseEventTerm
Type de données
text
Description
COMMONTOXICITYGENERALCATEGORY
Type de données
text
Description
CTCADVERSEEVENTGRADE
Type de données
text
Description
CTCADVERSEEVENTONSETDATE
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
CTCADVERSEEVENTATTRIBUTIONCODE
Type de données
text
Description
Othercause,specify(adverseeventattribution)
Type de données
text
Description
Specify(adverseevent)
Type de données
text
Description
HQUse
Type de données
text
Description
Unnamed11
Description
NewCancerDiagnosisAnatomicSite
Type de données
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property
- C15220
- UMLS 2011AA Property
- C0011900
Description
NewPrimaryCancerDate
Type de données
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Specify(newprimarysite)
Type de données
text
Description
Unnamed12
Description
Ccrr Module For Fs Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Initial Follow-up Form
Similar models
INSTRUCTIONS: Submit this form at patient's entry on study. 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 Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Follow-up Form
C0237753 (UMLS 2011AA ValueDomain)
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)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0012634 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0205448 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
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)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521733 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1521733 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1521902 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C25211 (NCI Thesaurus Property)
C0086960 (UMLS 2011AA Property)
C25542 (NCI Thesaurus Property)
C1512900 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
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)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0205448 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0005778 (UMLS 2011AA)
C0521362 (UMLS 2011AA)
C0019080 (UMLS 2011AA)
C0205054 (UMLS 2011AA)
C0497254 (UMLS 2011AA)
C0027855 (UMLS 2011AA)
C0030193 (UMLS 2011AA)
C2709248 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0439673 (UMLS 2011AA)
C1515974 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C0005682 (UMLS 2011AA)
C0006104 (UMLS 2011AA)
C0555952 (UMLS 2011AA)
C1522619 (UMLS 2011AA)
C1704242 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0025202 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)