Information: Detta är inte den senaste versionen av datamodellen. Du hittar en versionsöversikt till vänster under versioner. Den senaste versionen hittar du här.
Information:
Fel:
ID
2702
Beskrivning
TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary 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=A46E13D3-E2C2-2CC3-E034-080020C9C0E0
Länk
Nyckelord
Versioner (3)
- 2012-09-19 2012-09-19 - Philipp Bruland
- 2015-05-28 2015-05-28 -
- 2015-06-03 2015-06-03 -
Uppladdad den
19 september 2012
DOI
För en begäran logga in.
Licens
Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :
Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.
Itemgroup-kommentar för :
Item-kommentar för :
Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.
NCT00023829 Treatment - TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form - 2040125v3.0
INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form
Similar models
INSTRUCTIONS: Submit this form at the completion of protocol hormone therapy. Use -1 for unknown or not applicable unless otherwise specified in the code table. All dates to be reported mm-dd-yyyy unless otherwise indicated.
- StudyEvent: TF Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Hormone Protocol Treatment Summary Form
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
RTOGStudy
Item
RTOG Study
text
Case#
Item
Case #
text
InstitutionName
Item
Institution Name
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
AmendedData
Item
Amended Data
text
CL Item
Zoladex (Zoladex)
CL Item
Lupron (Lupron)
C0701459 (NCI Metathesaurus)
CL Item
Suprafact (Suprafact)
CL Item
Flutamide (Flutamide)
C509 (NCI Thesaurus)
C0016384 (UMLS 2011AA)
C0016384 (UMLS 2011AA)
CL Item
Casodex (Casodex)
C0591237 (NCI Metathesaurus)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
CL Item
Unknown Or Not Applicable (Unknown or not applicable)
(ifother,specify)(agent)
Item
(if other, specify) (agent)
text
AgentTotalCumulativeDose
Item
Agent total cumulative dose
double
FirstDateaboveagentprotocoltherapywasgiven
Item
First Date above agent protocol therapy was given
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
LastDateaboveagentprotocoltherapywasgiven
Item
Last Date above agent protocol therapy was given
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
CL Item
Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
CL Item
Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
CL Item
Toxicity/side Effects/complications (Toxicity/side effects/complications)
CL Item
Death On Study (Death on study)
CL Item
Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal or refusal after beginning protocol therapy)
CL Item
Patient Withdrawal Or Refusal Prior To Beginning Protocol Therapy (Patient withdrawal or refusal prior to beginning protocol therapy)
CL Item
Alternative Therapy (Alternative therapy, specify below)
CL Item
Other complicating disease, specify below (Other complicating disease, specify below)
CL Item
Other, Specify (Other, specify below)
CL Item
Unknown or not applicable (Unknown or not applicable)
(specify)(reasontreatmentended)
Item
(specify) (reason treatment ended)
text
Comments
Item
Comments
text
Signature
Item
Signature
text
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Ccrr Module For Tf Radiation Therapy Oncology Group Phase Iii Randomized Study Of Adjuvant Therapy For High Risk Pt3no Prostate Cancer Hormone Protocol Treatment Summary Form