ID
2520
Beskrivning
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
Länk
Nyckelord
Versioner (2)
- 2012-09-19 2012-09-19 -
- 2015-03-21 2015-03-21 - Martin Dugas
Uppladdad den
19 september 2012
DOI
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Licens
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
Beskrivning
Unnamed2
Beskrivning
RTOGStudy
Datatyp
text
Beskrivning
Case#
Datatyp
text
Beskrivning
InstitutionName
Datatyp
text
Beskrivning
InstitutionNo.
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beskrivning
PatientName,Last
Datatyp
text
Beskrivning
PatientName,First
Datatyp
text
Beskrivning
Unnamed3
Beskrivning
Unnamed4
Beskrivning
Patient'sVitalStatus
Datatyp
text
Beskrivning
DeathDate/LastContactDate
Datatyp
date
Beskrivning
Causeofdeath
Datatyp
text
Beskrivning
PrimaryCauseDeathOtherReasonSpecify
Datatyp
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
Beskrivning
HASTHEPATIENTHADADOCUMENTEDCLINICALASSESSMENTFORPROSTATECANCERSINCESUBMISSIONOFTHEPREVIOUSFOLLOWUPFORM?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
CancerFollow-upStatusDate
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beskrivning
PERFORMANCESTATUS
Datatyp
text
Beskrivning
Follow-upPSAValue(s)
Datatyp
text
Beskrivning
DateofPSAAssessment(s)
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
HASTHEPATIENTHADAPROSTATEBIOPSYSINCESUBMISSIONOFTHELASTFOLLOWUPFORM?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
BiopsyDate
Datatyp
date
Beskrivning
HASTHEPATIENTDEVELOPEDAFIRSTPROGRESSIONTHATHASNOTBEENPREVIOUSLYREPORTED?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
ProgressionInd,Biochemical
Datatyp
text
Beskrivning
ProgressionDate,FirstBiochemical
Datatyp
date
Beskrivning
ProgressionPSAValue
Datatyp
double
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTLOCAL-REGIONALRECURRENCESINCESUBMISSIONOFLASTFOLLOW-UPFORM?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
ProgressionDate,FirstLocal-Regional
Datatyp
date
Beskrivning
SITE(S)OFLOCAL/REGIONALPROGRESSION
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINElocal/regionalPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminelocal/regionalprogression)
Datatyp
text
Beskrivning
HASTHEPATIENTBEENDIAGNOSEDWITHFIRSTDISTANTRECURRENCESINCESUBMISSIONOFTHELASTFOLLOW-UPFORM?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
ProgressionDate,FirstDistant
Datatyp
date
Beskrivning
Site(s)ofFirstDistantProgression
Datatyp
text
Beskrivning
WHATWASTHEMETHODUSEDTODETERMINEdistantPROGRESSION
Datatyp
text
Beskrivning
Other,specify(methodusedtodeterminedistantprogression)
Datatyp
text
Beskrivning
Unnamed5
Beskrivning
Unnamed6
Beskrivning
RTOGStudy
Datatyp
text
Beskrivning
Case#
Datatyp
text
Beskrivning
InstitutionName
Datatyp
text
Beskrivning
InstitutionNo.
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beskrivning
PatientName,Last
Datatyp
text
Beskrivning
PatientName,First
Datatyp
text
Beskrivning
Unnamed7
Beskrivning
TOTALDOSETOPROSTATE
Datatyp
double
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
Beskrivning
TOTALDOSETOPELVIS
Datatyp
double
Alias
- NCI Thesaurus ValueDomain
- C25209
- UMLS 2011AA ValueDomain
- C0242485
Beskrivning
RTBeginDate
Datatyp
date
Beskrivning
RTEndDate
Datatyp
date
Beskrivning
RTInterruptionsInd
Datatyp
text
Beskrivning
RadiationTherapyUnscheduledInterruptionSpecify
Datatyp
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
Beskrivning
REASONRADIATIONTHERAPYTREATMENTENDED
Datatyp
text
Beskrivning
Alternativetherapy,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Othercomplicatingdisease,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
Other,specify(reasonradiationtherapyended)
Datatyp
text
Beskrivning
PROTOCOLHORMONESCONTINUING
Datatyp
text
Beskrivning
DIDTHEPATIENTRECEIVEANYNON-PROTOCOLPROSTATECANCERTHERAPYSINCETHELASTFOLLOW-UP
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
Non-ProtocolTherapyAdministeredType
Datatyp
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
Beskrivning
Non-ProtocolTherapyDate,First
Datatyp
date
Beskrivning
Specify(non-protocolprostatecancertherapy)
Datatyp
text
Beskrivning
RENAL/GENITOURINARYTOXICITYADVERSEEVENTREPORTS(AER)
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
URINARYINCONTINENCE,SeverityGrade
Datatyp
text
Beskrivning
URINARYINCONTINENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryincontinence,attribution)
Datatyp
text
Beskrivning
URINARYINCONTINENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
URINARYFREQUENCY/URGENCY,SeverityGrade
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(urinaryfrequency/urgency,attribution)
Datatyp
text
Beskrivning
URINARYFREQUENCY/URGENCY,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
ERECTILEIMPOTENCE,SeverityGrade
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,Attribution
Datatyp
text
Beskrivning
Specifyifothercause(erectileimpotence,attribution)
Datatyp
text
Beskrivning
ERECTILEIMPOTENCE,AERBeginDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Unnamed8
Beskrivning
Unnamed9
Beskrivning
RTOGStudy
Datatyp
text
Beskrivning
Case#
Datatyp
text
Beskrivning
InstitutionName
Datatyp
text
Beskrivning
InstitutionNo.
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS 2011AA ValueDomain
- C0237753
Beskrivning
PatientName,Last
Datatyp
text
Beskrivning
PatientName,First
Datatyp
text
Beskrivning
Unnamed10
Beskrivning
NEWORCONTINUINGTOXICITY(>=SeverityGrade3)SINCETHELASTREPORT?
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Beskrivning
IMTCODEADVERSEEVENTBASEDONCTEPTOXICITYTERM
Datatyp
text
Beskrivning
CTCAdverseEventTerm
Datatyp
text
Beskrivning
COMMONTOXICITYGENERALCATEGORY
Datatyp
text
Beskrivning
CTCADVERSEEVENTGRADE
Datatyp
text
Beskrivning
CTCADVERSEEVENTONSETDATE
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
CTCADVERSEEVENTATTRIBUTIONCODE
Datatyp
text
Beskrivning
Othercause,specify(adverseeventattribution)
Datatyp
text
Beskrivning
Specify(adverseevent)
Datatyp
text
Beskrivning
HQUse
Datatyp
text
Beskrivning
Unnamed11
Beskrivning
NewCancerDiagnosisAnatomicSite
Datatyp
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
Beskrivning
NewPrimaryCancerDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Specify(newprimarysite)
Datatyp
text
Beskrivning
Unnamed12
Beskrivning
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)