ID
8159
Description
RTOG-0522 S1: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Surgery Form Radiation Therapy and Cisplatin With or Without Cetuximab in Treating Patients With Stage III or Stage IV Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F7024665-89F4-412D-E034-0003BA3F9857
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015
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License
Creative Commons BY-NC 3.0 Legacy
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NCT00265941 Treatment - RTOG-0522 S1: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Surgery Form - 2228661v1.0
Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC
- StudyEvent: RTOG-0522 S1: Radiation Therapy Oncology Group Phase III Head and Neck Cancer Surgery Form
Description
Module 2
Description
SurgicalProcedureHeadandNeckMalignantNeoplasmResultStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C12418
- UMLS 2011AA Property
- C0460004
- NCI Thesaurus Property-2
- C9305
- UMLS 2011AA Property-2
- C0006826
- NCI Thesaurus Property-3
- C20200
- UMLS 2011AA Property-3
- C1274040
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
SurgicalProcedureHeadandNeckMalignantNeoplasmResultStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C12418
- UMLS 2011AA Property
- C0460004
- NCI Thesaurus Property-2
- C9305
- UMLS 2011AA Property-2
- C0006826
- NCI Thesaurus Property-3
- C20200
- UMLS 2011AA Property-3
- C1274040
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
PrimarySurgeryDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25251
- UMLS 2011AA ObjectClass
- C0205225
- NCI Thesaurus ObjectClass-2
- C15329
- UMLS 2011AA ObjectClass-2
- C0543467
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
Description
SurgicalProcedureHeadandNeckLymphadenectomyPerformedType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C12418
- UMLS 2011AA Property
- C0460004
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus Property-3
- C15275
- UMLS 2011AA Property-3
- C0024203
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
SurgicalProcedureNoHeadandNeckLymphadenectomyPerformedReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C49487
- UMLS 2011AA Property
- C1298908
- NCI Thesaurus Property-2
- C12418
- UMLS 2011AA Property-2
- C0460004
- NCI Thesaurus Property-3
- C38000
- UMLS 2011AA Property-3
- C0884358
- NCI Thesaurus Property-4
- C15275
- UMLS 2011AA Property-4
- C0024203
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
SurgicalProcedureNoHeadandNeckLymphadenectomyPerformedSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C49487
- UMLS 2011AA Property
- C1298908
- NCI Thesaurus Property-2
- C12418
- UMLS 2011AA Property-2
- C0460004
- NCI Thesaurus Property-3
- C38000
- UMLS 2011AA Property-3
- C0884358
- NCI Thesaurus Property-4
- C15275
- UMLS 2011AA Property-4
- C0024203
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
HeadandNeckRightLymphNodeNeoplasmInvolvementStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25228
- UMLS 2011AA ObjectClass
- C0205090
- NCI Thesaurus ObjectClass-2
- C12418
- UMLS 2011AA ObjectClass-2
- C0460004
- NCI Thesaurus ObjectClass-3
- C12745
- UMLS 2011AA ObjectClass-3
- C0024204
- NCI Thesaurus Property
- C3262
- UMLS 2011AA Property
- C0027651
- NCI Thesaurus Property-2
- C25548
- UMLS 2011AA Property-2
- C1314939
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
HeadandNeckLeftLymphNodeNeoplasmInvolvementStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25229
- UMLS 2011AA ObjectClass
- C0205091
- NCI Thesaurus ObjectClass-2
- C12418
- UMLS 2011AA ObjectClass-2
- C0460004
- NCI Thesaurus ObjectClass-3
- C12745
- UMLS 2011AA ObjectClass-3
- C0024204
- NCI Thesaurus Property
- C3262
- UMLS 2011AA Property
- C0027651
- NCI Thesaurus Property-2
- C25548
- UMLS 2011AA Property-2
- C1314939
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
ResidualDiseaseAnatomicalLocationText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C4809
- UMLS 2011AA ObjectClass
- C0543478
- NCI Metathesaurus Property
- C0923870
Description
ResidualDiseaseAnatomicalLocationText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C4809
- UMLS 2011AA ObjectClass
- C0543478
- NCI Metathesaurus Property
- C0923870
Description
ResidualDiseaseAnatomicalLocationText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C4809
- UMLS 2011AA ObjectClass
- C0543478
- NCI Metathesaurus Property
- C0923870
Description
SurgicalProcedureHeadandNeckLymphadenectomyPerformedDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C12418
- UMLS 2011AA Property
- C0460004
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus Property-3
- C15275
- UMLS 2011AA Property-3
- C0024203
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
SurgicalProcedureHeadandNeckLymphadenectomyPerformedDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C15329
- UMLS 2011AA ObjectClass
- C0543467
- NCI Thesaurus Property
- C12418
- UMLS 2011AA Property
- C0460004
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus Property-3
- C15275
- UMLS 2011AA Property-3
- C0024203
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Neck Nodal Sites (pathologic Assessment)
Description
HeadandNeckLymphNodeAssessmentSite
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C13717
- UMLS 2011AA ValueDomain
- C1515974
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus ObjectClass
- C12418
- UMLS 2011AA ObjectClass
- C0460004
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
Description
HeadandNeckLymphNodeRightRemovedSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12418
- UMLS 2011AA ObjectClass
- C0460004
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25228
- UMLS 2011AA Property
- C0205090
- NCI Thesaurus Property-2
- C25650
- UMLS 2011AA Property-2
- C0849355
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
HeadandNeckLymphNodeLeftRemovedSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12418
- UMLS 2011AA ObjectClass
- C0460004
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25229
- UMLS 2011AA Property
- C0205091
- NCI Thesaurus Property-2
- C25650
- UMLS 2011AA Property-2
- C0849355
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
LymphNodePositiveCount
Data type
float
Alias
- NCI Thesaurus Property
- C25246
- UMLS 2011AA Property
- C1446409
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
LymphNodeExaminedCount
Data type
float
Alias
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ObjectClass
- C12745
- UMLS 2011AA ObjectClass
- C0024204
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Description
DiseaseExtracapsularExtensionInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C2991
- UMLS 2011AA ObjectClass
- C0012634
- NCI Thesaurus Property
- C25270
- UMLS 2011AA Property
- C0231448
Description
RightLymphNodePositiveTotalCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25228
- UMLS 2011AA ObjectClass
- C0205090
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25246
- UMLS 2011AA Property
- C1446409
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
RightLymphNodeExaminedTotalCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25228
- UMLS 2011AA ObjectClass
- C0205090
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
LeftLymphNodePositiveTotalCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25229
- UMLS 2011AA ObjectClass
- C0205091
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25246
- UMLS 2011AA Property
- C1446409
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
LeftLymphNodeExaminedTotalCount
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25229
- UMLS 2011AA ObjectClass
- C0205091
- NCI Thesaurus ObjectClass-2
- C12745
- UMLS 2011AA ObjectClass-2
- C0024204
- NCI Thesaurus Property
- C25500
- UMLS 2011AA Property
- C0332128
- NCI Thesaurus ValueDomain
- C25304
- UMLS 2011AA ValueDomain
- C0439810
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS 2011AA ValueDomain-2
- C0750480
Description
HeadandNeckConnectiveTissueNeoplasmWithoutLymphNodePresentIndicator
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C12418
- UMLS 2011AA ObjectClass-2
- C0460004
- NCI Thesaurus ObjectClass-3
- C12374
- UMLS 2011AA ObjectClass-3
- C0009780
- NCI Thesaurus Property
- C25626
- UMLS 2011AA Property
- C0150312
- NCI Thesaurus Property-2
- C12745
- UMLS 2011AA Property-2
- C0024204
- NCI Thesaurus Property-3
- C25718
- UMLS 2011AA Property-3
- C0332288
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
Description
HeadandNeckConnectiveTissueNeoplasmWithoutLymphNodePresentSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3262
- UMLS 2011AA ObjectClass
- C0027651
- NCI Thesaurus ObjectClass-2
- C12418
- UMLS 2011AA ObjectClass-2
- C0460004
- NCI Thesaurus ObjectClass-3
- C12374
- UMLS 2011AA ObjectClass-3
- C0009780
- NCI Thesaurus Property
- C25626
- UMLS 2011AA Property
- C0150312
- NCI Thesaurus Property-2
- C12745
- UMLS 2011AA Property-2
- C0024204
- NCI Thesaurus Property-3
- C25718
- UMLS 2011AA Property-3
- C0332288
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Footer
Description
Responsible Person Signature
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25678
Description
Form Completion Date
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C19464
- UMLS CUI-1
- C1549507
- NCI Thesaurus Property
- C25250
- NCI Thesaurus Property-2
- C25604
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
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C38000 (NCI Thesaurus Property-2)
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C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0205090 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0205091 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
C25246 (NCI Thesaurus Property)
C1446409 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0205091 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
C25500 (NCI Thesaurus Property)
C0332128 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C12374 (NCI Thesaurus ObjectClass-3)
C0009780 (UMLS 2011AA ObjectClass-3)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12745 (NCI Thesaurus Property-2)
C0024204 (UMLS 2011AA Property-2)
C25718 (NCI Thesaurus Property-3)
C0332288 (UMLS 2011AA Property-3)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C1298908 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0027651 (UMLS 2011AA ObjectClass)
C12418 (NCI Thesaurus ObjectClass-2)
C0460004 (UMLS 2011AA ObjectClass-2)
C12374 (NCI Thesaurus ObjectClass-3)
C0009780 (UMLS 2011AA ObjectClass-3)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12745 (NCI Thesaurus Property-2)
C0024204 (UMLS 2011AA Property-2)
C25718 (NCI Thesaurus Property-3)
C0332288 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C25657 (NCI Thesaurus ObjectClass-2)
C25678 (NCI Thesaurus Property)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)