ID

3194

Descripción

T2 Radiation Therapy Oncology Group Initial Protocol Treatment 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=A4E2767E-4BDF-2632-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E2767E-4BDF-2632-E034-080020C9C0E0

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 1/6/15 1/6/15 -
  3. 3/6/15 3/6/15 -
Subido en

19 de septiembre de 2012

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer NCT00023829 Treatment - T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form - 2039507v3.0

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
    1. No Instruction available.
Unnamed1
Descripción

Unnamed1

RTOG Study
Descripción

RTOGStudy

Tipo de datos

text

Case #
Descripción

Case#

Tipo de datos

text

Unnamed2
Descripción

Unnamed2

Institution
Descripción

Institution

Tipo de datos

text

Institution No.
Descripción

InstitutionNo.

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient's Name
Descripción

Patient'sName

Tipo de datos

text

Patient's I.D. No.
Descripción

Patient'sI.D.No.

Tipo de datos

text

Option #
Descripción

Option#

Tipo de datos

text

Description
Descripción

DESCRIPTION

Tipo de datos

text

Date RT starts
Descripción

DateRTstarts

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Surgical Stage: T
Descripción

SurgicalStage:T

Tipo de datos

text

Surgical Stage: N
Descripción

SurgicalStage:N

Tipo de datos

text

Surgical Stage: M (or)
Descripción

SurgicalStage:M

Tipo de datos

text

system
Descripción

BodySystem

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
NCI Metathesaurus ValueDomain
C0332307
Primary Site
Descripción

PrimarySite

Tipo de datos

text

ENERGY (Check all that apply)
Descripción

ENERGY

Tipo de datos

text

BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
Descripción

BRACHYTHERAPYIMPLANT/INSERTION/APPLICATION

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
specify source (brachytherapy)
Descripción

specifysource(brachytherapy)

Tipo de datos

text

PLANNED IMPLANT DOSE
Descripción

PLANNEDIMPLANTDOSE

Tipo de datos

double

FIELDS (Check all that apply)
Descripción

FIELDS

Tipo de datos

text

Other, specify (fields)
Descripción

Other,specify(fields)

Tipo de datos

text

ELECTRONS
Descripción

ELECTRONS

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
SITE OF ELECTRON RT
Descripción

SITEOFELECTRONRT

Tipo de datos

text

ALL FIELDS TREATED EACH SESSION
Descripción

ALLFIELDSTREATEDEACHSESSION

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
FRACTIONATION (CHECK ALL THAT APPLY)
Descripción

FRACTIONATION

Tipo de datos

text

Other, specify (fractionation) (FOR FRACTIONATION SCHEDULES OTHER THAN ONCE PER DAY)
Descripción

Other,specify(fractionation)

Tipo de datos

text

SPECIFY TIME INTERVAL BETWEEN FRACTIONS
Descripción

SPECIFYTIMEINTERVALBETWEENFRACTIONS

Tipo de datos

text

POINT OF PRIMARY TREATMENT PRESCRIPTION
Descripción

POINTOFPRIMARYTREATMENTPRESCRIPTION

Tipo de datos

text

Other, specify (points of primary treatment prescription)
Descripción

Other,specify(pointsofprimarytreatmentprescription)

Tipo de datos

text

# OF INSERTIONS
Descripción

#OFINSERTIONS

Tipo de datos

text

Unnamed3
Descripción

Unnamed3

SITE OF PROTOCOL TREATMENT
Descripción

SITEOFPROTOCOLTREATMENT

Tipo de datos

text

NODES
Descripción

NODES

Tipo de datos

text

DAILY DOSE
Descripción

DAILYDOSE

Tipo de datos

double

TOTAL FX
Descripción

TOTALFX

Tipo de datos

double

TOTAL DOSE
Descripción

TotalDoseValue

Tipo de datos

text

PLANNED TOTAL DOSE, TOTAL FX
Descripción

PLANNEDTOTALDOSE,TOTALFX

Tipo de datos

text

PLANNED TOTAL DOSE, TOTAL DOSE
Descripción

PLANNEDTOTALDOSE,TOTALDOSE

Tipo de datos

text

Unnamed4
Descripción

Unnamed4

CRITICAL STRUCTURES
Descripción

RadiationTherapyCriticalAnatomicSite

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus Property
C25467
UMLS 2011AA Property
C1511545
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
MAXIMUM DOSE (GY)
Descripción

MAXIMUMDOSE

Tipo de datos

double

SPECIFY METHOD USED TO RESTRICT DOSE
Descripción

SPECIFYMETHODUSEDTORESTRICTDOSE

Tipo de datos

text

Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
Descripción

Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Unnamed1
RTOGStudy
Item
RTOG Study
text
Case#
Item
Case #
text
Item Group
Unnamed2
Institution
Item
Institution
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
Patient'sI.D.No.
Item
Patient's I.D. No.
text
Option#
Item
Option #
text
DESCRIPTION
Item
Description
text
DateRTstarts
Item
Date RT starts
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
SurgicalStage:T
Item
Surgical Stage: T
text
SurgicalStage:N
Item
Surgical Stage: N
text
SurgicalStage:M
Item
Surgical Stage: M (or)
text
BodySystem
Item
system
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
C0332307 (NCI Metathesaurus ValueDomain)
PrimarySite
Item
Primary Site
text
Item
ENERGY (Check all that apply)
text
CL.1
Code List
ENERGY (Check all that apply)
CL Item
2-4 Mv (2-4 Mv)
CL Item
6-8 Mv (6-8 Mv)
CL Item
> 10 Mv (> 10 Mv)
CL Item
Particle (Particle)
C63850 (NCI Thesaurus)
C0597177 (UMLS 2011AA)
Item
BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.2
Code List
BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
specifysource(brachytherapy)
Item
specify source (brachytherapy)
text
PLANNEDIMPLANTDOSE
Item
PLANNED IMPLANT DOSE
double
Item
FIELDS (Check all that apply)
text
CL.3
Code List
FIELDS (Check all that apply)
CL Item
The Angle Or Type Of Radiation Used Was Ap (AP)
CL Item
The Angle Or Type Of Radiation Used Was Pa (PA)
CL Item
The Angle Or Type Of Radiation Used Was Left Lateral (Left lateral)
CL Item
The Angle Or Type Of Radiation Used Was Right Lateral (Right lateral)
CL Item
The Angle Or Type Of Radiation Used Was Left Oblique (Left oblique)
CL Item
The Angle Or Type Of Radiation Used Was Right Oblique (Right oblique)
CL Item
The Angle Or Type Of Radiation Used Was Left Arc (Left arc)
CL Item
The Angle Or Type Of Radiation Used Was Right Arc (Right arc)
CL Item
The Angle Or Type Of Radiation Used Was 360 Rotation (360 degree rotation)
CL Item
Specify Other Angle Or Type Of Radiation Used (Other, specify)
Other,specify(fields)
Item
Other, specify (fields)
text
Item
ELECTRONS
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.4
Code List
ELECTRONS
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SITEOFELECTRONRT
Item
SITE OF ELECTRON RT
text
Item
ALL FIELDS TREATED EACH SESSION
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.5
Code List
ALL FIELDS TREATED EACH SESSION
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
FRACTIONATION (CHECK ALL THAT APPLY)
text
CL.6
Code List
FRACTIONATION (CHECK ALL THAT APPLY)
CL Item
5 Fx/week; Once Per Day (5 FX/Week; once per day)
CL Item
10 Fx/week; Twice Per Day (10 FX/Week; twice per day)
CL Item
Other, Specify (Other, specify)
Other,specify(fractionation)
Item
Other, specify (fractionation) (FOR FRACTIONATION SCHEDULES OTHER THAN ONCE PER DAY)
text
SPECIFYTIMEINTERVALBETWEENFRACTIONS
Item
SPECIFY TIME INTERVAL BETWEEN FRACTIONS
text
Item
POINT OF PRIMARY TREATMENT PRESCRIPTION
text
CL.7
Code List
POINT OF PRIMARY TREATMENT PRESCRIPTION
CL Item
Midplane Depth (Midplane depth)
CL Item
Intersection Of Multiple Fields (Intersection of multiple fields)
CL Item
Isocenter/center Of Rotation (Isocenter/center of rotation)
CL Item
Other, Specify (Other, specify)
Other,specify(pointsofprimarytreatmentprescription)
Item
Other, specify (points of primary treatment prescription)
text
#OFINSERTIONS
Item
# OF INSERTIONS
text
Item Group
Unnamed3
Item
SITE OF PROTOCOL TREATMENT
text
CL.8
Code List
SITE OF PROTOCOL TREATMENT
CL Item
Initial Field (INITIAL FIELD)
CL Item
Boost Field #1 (BOOST FIELD #1)
CL Item
Boost Field #2 (BOOST FIELD #2)
CL Item
Additional Site (ADDITIONAL SITE)
CL Item
Nodes (NODES)
Item
NODES
text
CL.9
Code List
NODES
CL Item
Head & Neck, Ant To Cord (HEAD & NECK, Ant to cord)
CL Item
Head & Neck, Post To Cord (HEAD & NECK, Post to cord)
CL Item
Head & Neck, S'clav (HEAD & NECK, S'clav)
CL Item
Lung (upper/mid Lobes), Ipsil Hilar/subcar (LUNG (UPPER/MID LOBES), Ipsil hilar/subcar)
CL Item
Lung (upper/mid Lobes), Contra Hilar (LUNG (UPPER/MID LOBES), Contra hilar)
CL Item
Lung (upper/mid Lobes), S'clav (LUNG (UPPER/MID LOBES), S'clav)
CL Item
Lung (lower Lobes), Ipsil Hilar/subcar (LUNG (LOWER LOBES), Ipsil hilar/subcar)
CL Item
Lung (lower Lobes), Contra Hilar (LUNG (LOWER LOBES), Contra hilar)
CL Item
Lung (lower Lobes), Inf Mediastinal (LUNG (LOWER LOBES), Inf mediastinal)
CL Item
Esophagus, Mediastinal (ESOPHAGUS, Mediastinal)
CL Item
Esophagus, S'clav (ESOPHAGUS, S'clav)
CL Item
Pelvic Primaries, Int/ext Iliac (PELVIC PRIMARIES, Int/ext iliac)
CL Item
Pelvic Primaries, Common Iliac (PELVIC PRIMARIES, Common iliac)
CL Item
Pelvic Primaries, Para-aortic (PELVIC PRIMARIES, Para-aortic)
CL Item
Breast, Int Mammary (BREAST, Int mammary)
CL Item
Breast, Axillary (BREAST, Axillary)
CL Item
Breast, S'clav (BREAST, S'clav)
CL Item
Abdomen, Mesenteric (ABDOMEN, Mesenteric)
DAILYDOSE
Item
DAILY DOSE
double
TOTALFX
Item
TOTAL FX
double
TotalDoseValue
Item
TOTAL DOSE
text
PLANNEDTOTALDOSE,TOTALFX
Item
PLANNED TOTAL DOSE, TOTAL FX
text
PLANNEDTOTALDOSE,TOTALDOSE
Item
PLANNED TOTAL DOSE, TOTAL DOSE
text
Item Group
Unnamed4
Item
CRITICAL STRUCTURES
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C25467 (NCI Thesaurus Property)
C1511545 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.10
Code List
CRITICAL STRUCTURES
CL Item
HEAD & NECK, Spinal cord (HEAD & NECK, Spinal cord)
CL Item
LUNG (UPPER / MID LOBES), Spinal cord (LUNG (UPPER / MID LOBES), Spinal cord)
CL Item
LUNG (UPPER / MID LOBES), Heart (LUNG (UPPER / MID LOBES), Heart)
CL Item
LUNG (UPPER / MID LOBES), Contra lung (LUNG (UPPER / MID LOBES), Contra lung)
CL Item
LUNG (LOWER LOBES), Spinal cord (LUNG (LOWER LOBES), Spinal cord)
CL Item
LUNG (LOWER LOBES), Heart (LUNG (LOWER LOBES), Heart)
CL Item
LUNG (LOWER LOBES), Contra lung (LUNG (LOWER LOBES), Contra lung)
CL Item
ESOPHAGUS, Spinal cord (ESOPHAGUS, Spinal cord)
CL Item
ESOPHAGUS, Heart (ESOPHAGUS, Heart)
CL Item
ESOPHAGUS, Lung (ESOPHAGUS, Lung)
CL Item
PELVIC PRIMARIES, Bladder (PELVIC PRIMARIES, Bladder)
CL Item
PELVIC PRIMARIES, Rectum (PELVIC PRIMARIES, Rectum)
CL Item
PELVIC PRIMARIES, Small bowel (PELVIC PRIMARIES, Small bowel)
CL Item
BRAIN, Lens (right) (BRAIN, Lens (right))
CL Item
BRAIN, Lens (left) (BRAIN, Lens (left))
CL Item
BRAIN, Spinal cord (BRAIN, Spinal cord)
CL Item
ABDOMEN, Kidney (ABDOMEN, Kidney)
CL Item
ABDOMEN, Liver (ABDOMEN, Liver)
CL Item
ABDOMEN, Spinal cord (ABDOMEN, Spinal cord)
CL Item
ABDOMEN, Small intestine (ABDOMEN, Small intestine)
MAXIMUMDOSE
Item
MAXIMUM DOSE (GY)
double
SPECIFYMETHODUSEDTORESTRICTDOSE
Item
SPECIFY METHOD USED TO RESTRICT DOSE
text
Item Group
Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
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