ID

42604

Description

RTOG 1010 Initial Evaluation Form (I1) Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=86E3B1E3-58EB-2570-E040-BB89AD433A07

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=86E3B1E3-58EB-2570-E040-BB89AD433A07

Keywords

Versions (3)
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/17/21 9/17/21 -
Uploaded on

September 17, 2021

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Adenocarcinoma of the Gastroesophageal Junction NCT01196390 On-Study - RTOG 1010 Initial Evaluation Form (I1) - 3088432v1.0

English

INSTRUCTIONS: All questions must be answered per code table and/or instructions. Record dates as mm-dd-yyyy unless otherwise specified

1 forms  
Unnamed Module 1
Description

Unnamed Module 1

RTOG Study No.
Description

Protocol ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Case #
Description

RadiationTherapyOncologyGroupPatientCaseIdentifierNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C19778
UMLS 2011AA ObjectClass-2
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C49152
UMLS 2011AA Property-2
C1706256
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Institution Name
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution No.
Description

Institution Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Patient Initials
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
RTOG Patient ID
Description

Trial subject ID RTOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1514695
NCI Thesaurus Property
C19778
NCI Thesaurus Property-2
C25364
Amended Data
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Unnamed Module 1
Description

Unnamed Module 1

Patient Age
Description

PatientAgeValue

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25150
UMLS 2011AA Property
C0001779
Performance Status (Zubrod)
Description

ZubrodPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Weight (kg)
Description

Patient Weight

Data type

float

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Oral alimentation
Description

NutritionalSupportOralRouteofAdministrationAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38288
UMLS 2011AA Property
C1527415
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ObjectClass
C15433
UMLS 2011AA ObjectClass
C0242739
Nasogastric tube feeding
Description

NutritionalSupportNasogastricRouteofAdministrationTubeAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ObjectClass
C15433
UMLS 2011AA ObjectClass
C0242739
NCI Thesaurus Property
C38285
UMLS 2011AA Property
C0694637
NCI Thesaurus Property-2
C41277
UMLS 2011AA Property-2
C1561954
NCI Thesaurus Property-3
C25382
UMLS 2011AA Property-3
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Ostomy feeding
Description

NutritionalSupportOstomyTubeAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ObjectClass
C15433
UMLS 2011AA ObjectClass
C0242739
NCI Thesaurus Property
C41277
UMLS 2011AA Property
C1561954
NCI Thesaurus Property-2
C15290
UMLS 2011AA Property-2
C0029473
NCI Thesaurus Property-3
C25382
UMLS 2011AA Property-3
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Intravenous hyperalimentation
Description

NutritionalSupportIntravenousRouteofAdministrationAdministeredind-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38276
UMLS 2011AA Property
C1522726
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ObjectClass
C15433
UMLS 2011AA ObjectClass
C0242739
Other
Description

NutritionalSupportOtherAdministeredInd-3

Data type

text

Alias
NCI Thesaurus ObjectClass
C37902
UMLS 2011AA ObjectClass
C1521721
NCI Thesaurus ObjectClass-2
C25597
UMLS 2011AA ObjectClass-2
C1521739
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Other Specify
Description

NutritionalSupportAdministeredSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C37902
UMLS 2011AA ObjectClass
C1521721
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ObjectClass-2
C25597
UMLS 2011AA ObjectClass-2
C1521739
Estimate of daily caloric intake
Description

PersonEstimatedDailyCaloricIntakeAssessmentType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25473
UMLS 2011AA Property-2
C0332173
NCI Thesaurus Property-3
C25498
UMLS 2011AA Property-3
C0750572
NCI Thesaurus Property-4
C28135
UMLS 2011AA Property-4
C0006777
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Tumor Location
Description

ClinicalStudyMalignantNeoplasmAnatomicSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C15206
UMLS 2011AA ObjectClass-2
C0008972
Disease Extent
Description

Disease Extent

Clinical T Stage
Description

EsophagealTumorClinicalTStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C37950
UMLS 2011AA ObjectClass-2
C1522619
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25728
UMLS 2011AA Property-2
C0475455
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
Clinical N Stage
Description

EsophagealTumorClinicalNStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C37950
UMLS 2011AA ObjectClass-2
C1522619
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25580
UMLS 2011AA Property-2
C0456532
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
Clinical M Stage
Description

EsophagealTumorClinicalMStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C37950
UMLS 2011AA ObjectClass-2
C1522619
NCI Thesaurus Property
C25398
UMLS 2011AA Property
C0205210
NCI Thesaurus Property-2
C25727
UMLS 2011AA Property-2
C0456533
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus ValueDomain-2
C39315
UMLS 2011AA ValueDomain-2
C1515946
Study Cancer
Description

Study Cancer

Pathologically Confirmed Primary Adenocarcinoma of the Esophagus
Description

EsophagealMalignantNeoplasmPathologicConfirmedInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C37950
UMLS 2011AA ObjectClass
C1522619
NCI Thesaurus ObjectClass-2
C9305
UMLS 2011AA ObjectClass-2
C0006826
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
NCI Thesaurus Property-2
C25610
UMLS 2011AA Property-2
C1521733
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Cervical esophagus
Description

EsophagealCarcinomaCervicalEsophagusInvasionInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C12250
UMLS 2011AA Property
C0227186
NCI Thesaurus ObjectClass
C3513
UMLS 2011AA ObjectClass
C0152018
NCI Thesaurus Property-2
C20625
UMLS 2011AA Property-2
C1269955
Invasion into the trachea or major bronchi
Description

EsophagealCarcinomaTracheaBronchusInvasionInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C3513
UMLS 2011AA ObjectClass
C0152018
NCI Thesaurus Property
C12683
UMLS 2011AA Property
C0006255
NCI Thesaurus Property-2
C12428
UMLS 2011AA Property-2
C0040578
NCI Thesaurus Property-3
C20625
UMLS 2011AA Property-3
C1269955
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Is the tumor proximal thoracic (15-24cm)
Description

MalignantNeoplasmProximalChestAnatomicSiteInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C13717
UMLS 2011AA Property
C1515974
NCI Thesaurus Property-2
C25389
UMLS 2011AA Property-2
C0817096
NCI Thesaurus Property-3
C25236
UMLS 2011AA Property-3
C0205107
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Sites of Lymphadenopathy
Description

LymphNodeIncreaseSizeSite

Data type

text

Alias
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C25533
UMLS 2011AA Property
C0442805
NCI Thesaurus Property-2
C25681
UMLS 2011AA Property-2
C0456389
Celiac lymph nodes <= 2 cm (if present)
Description

EsophagealCarcinomaCeliacLymphNodeMetastasisInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C19151
UMLS 2011AA Property
C0027627
NCI Thesaurus ObjectClass
C3513
UMLS 2011AA ObjectClass
C0152018
NCI Thesaurus Property-2
C65166
UMLS 2011AA Property-2
C0229766
Tumor at the level of the carina
Description

CancerInvolvementCarinaInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ValueDomain-2
C25264
UMLS 2011AA ValueDomain-2
C0225594
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25548
UMLS 2011AA Property
C1314939
Evidence of tracheoesophageal fistule
Description

EsophagealCarcinomaTracheoesophagealFistulaInvasionInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C3513
UMLS 2011AA ObjectClass
C0152018
NCI Thesaurus Property
C20625
UMLS 2011AA Property
C1269955
NCI Thesaurus Property-2
C35080
UMLS 2011AA Property-2
C0040588
Involvement of stomach
Description

DiseaseStomachPresentInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C12391
UMLS 2011AA Property-2
C0038351
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Involvement of stomach <= 5 cm (if present)
Description

StomachInvolvedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25547
NCI Metathesaurus ObjectClass
C0038351
Baseline Lab Values (hematologic)
Description

Baseline Lab Values (hematologic)

WBC (mm^3)
Description

Leukocytes (WBC)

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0023508
NCI Thesaurus Property
C12529
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
Date (MM DD YYYY)
Description

Laboratory Procedure Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0022885
NCI Thesaurus Property
C25214
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
Date (MM DD YYYY)
Description

Laboratory Procedure Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0022885
NCI Thesaurus Property
C25214
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
ANC (mm^3)
Description

Neutrophil count

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0200633
NCI Thesaurus Property
C12533
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C25304
NCI Thesaurus ValueDomain-2
C25712
Date (MM DD YYYY)
Description

Neutrophils date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0200633
NCI Thesaurus Property
C12533
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
Platelet count (mm^3)
Description

Platelets

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0005821
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12520
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
Date (MM DD YYYY)
Description

Platelets date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0005821
NCI Thesaurus Property
C20200
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C12520
NCI Thesaurus ObjectClass
C25294
Hemoglobin (g/dL)
Description

Hemoglobin

Data type

float

Measurement units
  • g/dL
Alias
NCI Thesaurus Property
C16676
UMLS CUI-1
C0019046
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
g/dL
Date (MM DD YYYY)
Description

Hemoglobin Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0019046
NCI Thesaurus Property
C16676
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
Serum creatinine (mg/dl)
Description

Creatinine, Serum

Data type

float

Measurement units
  • mg/dL
Alias
NCI Thesaurus Property
C20200
UMLS CUI-1
C0201976
NCI Thesaurus Property-2
C399
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
mg/dL
Creatinine ULN (SERUM mg/dl)
Description

Creatinine, serum ULN

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201976
NCI Thesaurus Property
C20200
UMLS CUI-2
C1519815
NCI Thesaurus Property-2
C399
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
Total Bilirubin (mg/dl)
Description

Bilirubin, Total

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201913
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C38037
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
Date (MM DD YYYY)
Description

LaboratoryProcedureBilirubinOutcomeDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C305
UMLS 2011AA Property-2
C0005437
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Bilirubin ULN (mg/dl)
Description

Bilirubin, Total ULN

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201913
NCI Thesaurus Property
C20200
UMLS CUI-2
C1519815
NCI Thesaurus Property-2
C38037
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
SGOT (AST) (IU/L)
Description

SGOT (AST)

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201899
NCI Thesaurus Property
C25202
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
Date (MM DD YYYY)
Description

LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25202
UMLS 2011AA Property
C0242192
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
SGOT (AST) ULN (IU/L)
Description

LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25202
UMLS 2011AA Property
C0242192
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain-2
C25706
UMLS 2011AA ValueDomain-2
C1519815
LVEF (%)
Description

HeartLVEFTestPercentageValue

Data type

float

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
%
LVEF LLN (% Institutions lower limit of normal)
Description

HeartLVEFTestPercentageLowerLimitofNormalValue

Data type

float

Measurement units
  • %
Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
NCI Thesaurus ValueDomain-3
C25555
UMLS 2011AA ValueDomain-3
C1518030
%
Date LVEF performed (MM DD YYYY)
Description

HeartLVEFTestDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
Diagnosis Work-up
Description

Diagnosis Work-up

History and Physical
Description

PersonalMedicalHistoryPhysicalExaminationPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass-2
C18772
UMLS 2011AA ObjectClass-2
C0262926
CT scan of the chest/abdomen/pelvis
Description

MagneticResonanceImagingComputedTomographyDiagnosticImagingChestAbdominalCavityAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16502
UMLS 2011AA ObjectClass
C0011923
NCI Thesaurus ObjectClass-2
C17204
UMLS 2011AA ObjectClass-2
C0040405
NCI Thesaurus ObjectClass-3
C16809
UMLS 2011AA ObjectClass-3
C0024485
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25389
UMLS 2011AA Property-2
C0817096
NCI Thesaurus Property-3
C12664
UMLS 2011AA Property-3
C0230168
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Endoscopic biopsy of esophageal tumor
Description

EndoscopicBiopsyDiagnosticProcedureEsophagealCarcinomaAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C18020
UMLS 2011AA ObjectClass
C0430022
NCI Thesaurus ObjectClass-2
C15389
UMLS 2011AA ObjectClass-2
C0184980
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3513
UMLS 2011AA Property-2
C0152018
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
EKG
Description

ElectrocardiographyDiagnosticProcedureAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C38053
UMLS 2011AA ObjectClass
C1623258
NCI Thesaurus ObjectClass-2
C18020
UMLS 2011AA ObjectClass-2
C0430022
Bronchoscopy
Description

BronchoscopyPerformedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16366
UMLS 2011AA ObjectClass
C0006290
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
PET/CT (Whole body)
Description

PositronEmissionTomographyComputedTomographyDiagnosticProcedureAssessmentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass-2
C17204
UMLS 2011AA ObjectClass-2
C0040405
NCI Thesaurus ObjectClass-3
C18020
UMLS 2011AA ObjectClass-3
C0430022
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
MUGA Scan
Description

HeartMUGATestInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C38073
UMLS 2011AA Property
C0521317
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
Cardiac ECHO
Description

HeartEchocardiogramTestInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C37945
UMLS 2011AA Property
C2243117
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
Lymphadenopathy by scan (REGIONAL)
Description

LymphadenopathyImageDocumentedInd

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C3206
UMLS 2011AA ObjectClass
C0024228
NCI Thesaurus Property
C19477
UMLS 2011AA Property
C1704254
NCI Thesaurus ValueDomain-2
C25356
UMLS 2011AA ValueDomain-2
C1301725
Examination Date (MM DD YYYY)
Description

ExaminationDate

Data type

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus ObjectClass
C0031809
Was a surgical oncology consultation performed (DOCUMENTATING THAT THE PATIENT WILL BE ABLE TO UNDERGO CURATIVE RESECTION AFTER COMPLETION OF CHEMORADIATION)
Description

SurgicalOncologistConsultationPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C17840
UMLS 2011AA ObjectClass
C1518577
NCI Thesaurus Property-2
C41188
UMLS 2011AA Property-2
C0009818
Was a radiation oncology consultation performed (DOCUMENTING THAT THE DISEASE CAN BE ENCOMPASSED IN A RADIOTHERAPY FIELD)
Description

RadiationOncologistConsultationPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C17833
UMLS 2011AA ObjectClass
C1514693
NCI Thesaurus Property-2
C41188
UMLS 2011AA Property-2
C0009818
Was a medical oncology consultation performed
Description

MedicalOncologistConsultationPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C17838
UMLS 2011AA ObjectClass
C1555767
NCI Thesaurus Property-2
C41188
UMLS 2011AA Property-2
C0009818
Date of Assessment (MM DD YYYY)
Description

Assessment Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Date of Assessment (MM DD YYYY)
Description

Assessment Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Date of Assessment (MM DD YYYY)
Description

Assessment Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985720
NCI Thesaurus ObjectClass
C25367
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C38000
Severe Active Comorbidity
Description

Severe Active Comorbidity

History of Prior Malignancy (invasive)
Description

PriorCancerDiagnosisInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Date eradicated (If yes MM DD YYYY)
Description

CancerAblationDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C20985
UMLS 2011AA Property
C0547070
Prior systemic chemotherapy for current study cancer
Description

ChemotherapyPriorSystemicClinicalStudyMalignantNeoplasmAdministrationInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus Property
C13310
UMLS 2011AA Property
C0205373
NCI Thesaurus Property-2
C9305
UMLS 2011AA Property-2
C0006826
NCI Thesaurus Property-3
C25629
UMLS 2011AA Property-3
C0332152
NCI Thesaurus Property-4
C15206
UMLS 2011AA Property-4
C0008972
NCI Thesaurus Property-5
C48905
UMLS 2011AA Property-5
C0001554
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior radiation therapy for current study cancer
Description

RadiationTherapyPriorMalignantNeoplasmAdministeredInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C9305
UMLS 2011AA Property
C0006826
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus Property-3
C25382
UMLS 2011AA Property-3
C1521801
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior radiation therapy (chest)
Description

PatientChestRadiationTherapyPersonalMedicalHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15313
UMLS 2011AA Property
C1522449
NCI Thesaurus Property-2
C25389
UMLS 2011AA Property-2
C0817096
NCI Thesaurus Property-3
C18772
UMLS 2011AA Property-3
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior anthracycline Treatment
Description

PriorAnthracyclineTherapyRegimenInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus ObjectClass-3
C1594
UMLS 2011AA ObjectClass-2
C0003234
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior Taxane Therapy
Description

PriorChemotherapyTaxaneCompoundAdministeredInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property-2
C1490
UMLS 2011AA Property-2
C0796419
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Prior therapy that targeted EGFR pathway
Description

PriorEpidermalGrowthFactorReceptorTherapyPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus ObjectClass-3
C17068
UMLS 2011AA ObjectClass-2
C0034802
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Prior allergic reaction to study agents
Description

ProtocolAgentPriorHypersensitivityInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C3114
UMLS 2011AA Property
C0020517
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus ObjectClass
C41161
UMLS 2011AA ObjectClass
C1521826
History of documented congestive heart failure
Description

CongestiveHeartFailureHistoryInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C3080
UMLS 2011AA ObjectClass
C0018802
NCI Thesaurus Property
C18772
UMLS 2011AA Property
C0262926
Unstable angina in last 6 months
Description

UnstableAnginaDiseasePresentInd-3

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C25594
UMLS 2011AA ObjectClass
C1518422
NCI Thesaurus ObjectClass-2
C30103
UMLS 2011AA ObjectClass-2
C0205360
NCI Thesaurus ObjectClass-3
C2991
UMLS 2011AA ObjectClass-3
C0012634
NCI Thesaurus ObjectClass-4
C51221
UMLS 2011AA ObjectClass-4
C0002962
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
Description

Pre-existingConditionAcuteBacterialInfectionFungalInfectionRegistrationIntravenousRouteofAdministrationAntibioticPresentInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C54056
UMLS 2011AA ObjectClass
C0521987
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property-2
C25646
UMLS 2011AA Property-2
C1514821
NCI Thesaurus Property-3
C3245
UMLS 2011AA Property-3
C0026946
NCI Thesaurus Property-4
C258
UMLS 2011AA Property-4
C0003232
NCI Thesaurus Property-5
C38276
UMLS 2011AA Property-5
C1522726
NCI Thesaurus Property-6
C2890
UMLS 2011AA Property-6
C0004623
NCI Thesaurus Property-7
C14140
UMLS 2011AA Property-7
C0205178
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Acquired Immune Deficiency Syndrome based upon current CDC definition (AIDS)
Description

PatientAcquiredImmunodeficiencySyndromeAssessmentInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C2851
UMLS 2011AA Property-2
C0001175
Transmural MI in last 6 months (myocardial infarction)
Description

TransmuralMyocardialInfarctionConfirmedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25458
UMLS 2011AA Property
C0750484
NCI Thesaurus ObjectClass
C27996
UMLS 2011AA ObjectClass
C0027051
NCI Metathesaurus ObjectClass
CL233186
Medical contraindication to esophagectomy
Description

OtherPatientMedicalContraindicatedInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C37933
UMLS 2011AA Property
C1444657
Is patient a woman of childbearing potential
Description

FemalePatientPotentialPregnancyInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus ObjectClass-2
C16576
UMLS 2011AA ObjectClass-2
C0086287
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
NCI Metathesaurus Property
C0237399
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Negative serum pregnancy test
Description

PatientNegativePregnancyTestInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25247
UMLS 2011AA Property
C0205160
NCI Metathesaurus Property
C0032976
Negative serum pregnancy test date (MM DD YYYY)
Description

PatientNegativePregnancyTestDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25247
UMLS 2011AA Property
C0205160
NCI Metathesaurus Property
C0032976
Footer Module
Description

Footer Module

Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Investigator Signature
Description

Investigator Signature

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
Date
Description

Investigator Signature Date

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
UMLS CUI-2
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C17089
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Similar models

INSTRUCTIONS: All questions must be answered per code table and/or instructions. Record dates as mm-dd-yyyy unless otherwise specified

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed Module 1
Protocol ID RTOG
Item
RTOG Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
RadiationTherapyOncologyGroupPatientCaseIdentifierNumber
Item
Case #
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus ObjectClass-2)
C1514695 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49152 (NCI Thesaurus Property-2)
C1706256 (UMLS 2011AA Property-2)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Institution Name
Item
Institution Name
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Trial subject ID RTOG
Item
RTOG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1514695 (UMLS CUI-2)
C19778 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Data amended
Item
Amended Data
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Unnamed Module 1
PatientAgeValue
Item
Patient Age
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS 2011AA Property)
Item
Performance Status (Zubrod)
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.2
Code List
Performance Status (Zubrod)
CL Item
Normal Activity (0)
CL Item
Symptoms, But Nearly Fully Ambulatory (1)
CL Item
Some Bed Time, But Needs To Be In Bed <50% Of Normal Daytime (2)
CL Item
Needs To Be In Bed > 50% Of Normal Daytime (3)
CL Item
Unable To Get Out Of Bed (4)
Patient Weight
Item
Weight (kg)
float
C25209 (NCI Thesaurus ValueDomain)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
Item
Oral alimentation
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38288 (NCI Thesaurus Property)
C1527415 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C15433 (NCI Thesaurus ObjectClass)
C0242739 (UMLS 2011AA ObjectClass)
CL.3
Code List
Oral alimentation
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Nasogastric tube feeding
text
C15433 (NCI Thesaurus ObjectClass)
C0242739 (UMLS 2011AA ObjectClass)
C38285 (NCI Thesaurus Property)
C0694637 (UMLS 2011AA Property)
C41277 (NCI Thesaurus Property-2)
C1561954 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.4
Code List
Nasogastric tube feeding
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Ostomy feeding
text
C15433 (NCI Thesaurus ObjectClass)
C0242739 (UMLS 2011AA ObjectClass)
C41277 (NCI Thesaurus Property)
C1561954 (UMLS 2011AA Property)
C15290 (NCI Thesaurus Property-2)
C0029473 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.5
Code List
Ostomy feeding
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Intravenous hyperalimentation
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38276 (NCI Thesaurus Property)
C1522726 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C15433 (NCI Thesaurus ObjectClass)
C0242739 (UMLS 2011AA ObjectClass)
CL.6
Code List
Intravenous hyperalimentation
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Other
text
C37902 (NCI Thesaurus ObjectClass)
C1521721 (UMLS 2011AA ObjectClass)
C25597 (NCI Thesaurus ObjectClass-2)
C1521739 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.7
Code List
Other
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
NutritionalSupportAdministeredSpecify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C37902 (NCI Thesaurus ObjectClass)
C1521721 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25597 (NCI Thesaurus ObjectClass-2)
C1521739 (UMLS 2011AA ObjectClass-2)
Item
Estimate of daily caloric intake
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25473 (NCI Thesaurus Property-2)
C0332173 (UMLS 2011AA Property-2)
C25498 (NCI Thesaurus Property-3)
C0750572 (UMLS 2011AA Property-3)
C28135 (NCI Thesaurus Property-4)
C0006777 (UMLS 2011AA Property-4)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.8
Code List
Estimate of daily caloric intake
CL Item
< 1500 Cal/day (< 1500 cal/day)
CL Item
>= 1500 Cal/day (>= 1500 cal/day)
Item
Tumor Location
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C15206 (NCI Thesaurus ObjectClass-2)
C0008972 (UMLS 2011AA ObjectClass-2)
CL.9
Code List
Tumor Location
CL Item
Mid Esophagus (Mid esophagus)
CL Item
Distal Esophagus (Distal Esophagus)
CL Item
Esophagogastric Junction (Esophagogastric Junction)
Item Group
Disease Extent
Item
Clinical T Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C37950 (NCI Thesaurus ObjectClass-2)
C1522619 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25728 (NCI Thesaurus Property-2)
C0475455 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.10
Code List
Clinical T Stage
CL Item
Tumor Invades Lamina Propria, Muscularis Mucosae, Or Submucosa (T1)
CL Item
Tumor Invades Muscularis Propria (T2)
CL Item
Tumor Invades Adventitia (T3)
Item
Clinical N Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C37950 (NCI Thesaurus ObjectClass-2)
C1522619 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property-2)
C0456532 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.11
Code List
Clinical N Stage
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Regional Lymph Node Metastases Involving 1 To 2 Nodes (N1)
CL Item
Regional Lymph Node Metastases Involving 3 To 6 Nodes (N2)
Item
Clinical M Stage
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C37950 (NCI Thesaurus ObjectClass-2)
C1522619 (UMLS 2011AA ObjectClass-2)
C25398 (NCI Thesaurus Property)
C0205210 (UMLS 2011AA Property)
C25727 (NCI Thesaurus Property-2)
C0456533 (UMLS 2011AA Property-2)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C39315 (NCI Thesaurus ValueDomain-2)
C1515946 (UMLS 2011AA ValueDomain-2)
CL.12
Code List
Clinical M Stage
CL Item
No Distant Metastasis (M0)
CL Item
Distant Metastasis (M1)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
Item Group
Study Cancer
EsophagealMalignantNeoplasmPathologicConfirmedInd-3
Item
Pathologically Confirmed Primary Adenocarcinoma of the Esophagus
boolean
C37950 (NCI Thesaurus ObjectClass)
C1522619 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass-2)
C0006826 (UMLS 2011AA ObjectClass-2)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
C25610 (NCI Thesaurus Property-2)
C1521733 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
EsophagealCarcinomaCervicalEsophagusInvasionInd-2
Item
Cervical esophagus
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C12250 (NCI Thesaurus Property)
C0227186 (UMLS 2011AA Property)
C3513 (NCI Thesaurus ObjectClass)
C0152018 (UMLS 2011AA ObjectClass)
C20625 (NCI Thesaurus Property-2)
C1269955 (UMLS 2011AA Property-2)
EsophagealCarcinomaTracheaBronchusInvasionInd-2
Item
Invasion into the trachea or major bronchi
boolean
C3513 (NCI Thesaurus ObjectClass)
C0152018 (UMLS 2011AA ObjectClass)
C12683 (NCI Thesaurus Property)
C0006255 (UMLS 2011AA Property)
C12428 (NCI Thesaurus Property-2)
C0040578 (UMLS 2011AA Property-2)
C20625 (NCI Thesaurus Property-3)
C1269955 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
MalignantNeoplasmProximalChestAnatomicSiteInd-2
Item
Is the tumor proximal thoracic (15-24cm)
boolean
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C13717 (NCI Thesaurus Property)
C1515974 (UMLS 2011AA Property)
C25389 (NCI Thesaurus Property-2)
C0817096 (UMLS 2011AA Property-2)
C25236 (NCI Thesaurus Property-3)
C0205107 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Item
Sites of Lymphadenopathy
text
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25533 (NCI Thesaurus Property)
C0442805 (UMLS 2011AA Property)
C25681 (NCI Thesaurus Property-2)
C0456389 (UMLS 2011AA Property-2)
CL.17
Code List
Sites of Lymphadenopathy
CL Item
Para-esophageal (Para-Esophageal)
CL Item
Gastric (Gastric)
CL Item
Gastrohepatic (Gastrohepatic)
CL Item
Celiac (Celiac)
EsophagealCarcinomaCeliacLymphNodeMetastasisInd-2
Item
Celiac lymph nodes <= 2 cm (if present)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C19151 (NCI Thesaurus Property)
C0027627 (UMLS 2011AA Property)
C3513 (NCI Thesaurus ObjectClass)
C0152018 (UMLS 2011AA ObjectClass)
C65166 (NCI Thesaurus Property-2)
C0229766 (UMLS 2011AA Property-2)
CancerInvolvementCarinaInd-3
Item
Tumor at the level of the carina
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25264 (NCI Thesaurus ValueDomain-2)
C0225594 (UMLS 2011AA ValueDomain-2)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property)
C1314939 (UMLS 2011AA Property)
EsophagealCarcinomaTracheoesophagealFistulaInvasionInd-2
Item
Evidence of tracheoesophageal fistule
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C3513 (NCI Thesaurus ObjectClass)
C0152018 (UMLS 2011AA ObjectClass)
C20625 (NCI Thesaurus Property)
C1269955 (UMLS 2011AA Property)
C35080 (NCI Thesaurus Property-2)
C0040588 (UMLS 2011AA Property-2)
DiseaseStomachPresentInd-3
Item
Involvement of stomach
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12391 (NCI Thesaurus Property-2)
C0038351 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
StomachInvolvedInd-3
Item
Involvement of stomach <= 5 cm (if present)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25547 (NCI Thesaurus Property)
C0038351 (NCI Metathesaurus ObjectClass)
Item Group
Baseline Lab Values (hematologic)
Leukocytes (WBC)
Item
WBC (mm^3)
float
C25294 (NCI Thesaurus ObjectClass)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
Laboratory Procedure Date
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0022885 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Laboratory Procedure Date
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0022885 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Neutrophil count
Item
ANC (mm^3)
float
C25294 (NCI Thesaurus ObjectClass)
C0200633 (UMLS CUI-1)
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25304 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
Neutrophils date
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0200633 (UMLS CUI-1)
C12533 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Platelets
Item
Platelet count (mm^3)
float
C25294 (NCI Thesaurus ObjectClass)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C12520 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
Platelets date
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Hemoglobin
Item
Hemoglobin (g/dL)
float
C16676 (NCI Thesaurus Property)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Hemoglobin Date
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0019046 (UMLS CUI-1)
C16676 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Creatinine, Serum
Item
Serum creatinine (mg/dl)
float
C20200 (NCI Thesaurus Property)
C0201976 (UMLS CUI-1)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Creatinine, serum ULN
Item
Creatinine ULN (SERUM mg/dl)
float
C25294 (NCI Thesaurus ObjectClass)
C0201976 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1519815 (UMLS CUI-2)
C399 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
Bilirubin, Total
Item
Total Bilirubin (mg/dl)
float
C25294 (NCI Thesaurus ObjectClass)
C0201913 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C38037 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
LaboratoryProcedureBilirubinOutcomeDate
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property-2)
C0005437 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Bilirubin, Total ULN
Item
Bilirubin ULN (mg/dl)
float
C25294 (NCI Thesaurus ObjectClass)
C0201913 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1519815 (UMLS CUI-2)
C38037 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
SGOT (AST)
Item
SGOT (AST) (IU/L)
float
C25294 (NCI Thesaurus ObjectClass)
C0201899 (UMLS CUI-1)
C25202 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultDate
Item
Date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue
Item
SGOT (AST) ULN (IU/L)
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
HeartLVEFTestPercentageValue
Item
LVEF (%)
float
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
HeartLVEFTestPercentageLowerLimitofNormalValue
Item
LVEF LLN (% Institutions lower limit of normal)
float
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C25555 (NCI Thesaurus ValueDomain-3)
C1518030 (UMLS 2011AA ValueDomain-3)
HeartLVEFTestDate
Item
Date LVEF performed (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
Item Group
Diagnosis Work-up
PersonalMedicalHistoryPhysicalExaminationPerformedInd-2
Item
History and Physical
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C18772 (NCI Thesaurus ObjectClass-2)
C0262926 (UMLS 2011AA ObjectClass-2)
MagneticResonanceImagingComputedTomographyDiagnosticImagingChestAbdominalCavityAssessmentInd-2
Item
CT scan of the chest/abdomen/pelvis
boolean
C16502 (NCI Thesaurus ObjectClass)
C0011923 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C0040405 (UMLS 2011AA ObjectClass-2)
C16809 (NCI Thesaurus ObjectClass-3)
C0024485 (UMLS 2011AA ObjectClass-3)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25389 (NCI Thesaurus Property-2)
C0817096 (UMLS 2011AA Property-2)
C12664 (NCI Thesaurus Property-3)
C0230168 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
EndoscopicBiopsyDiagnosticProcedureEsophagealCarcinomaAssessmentInd-2
Item
Endoscopic biopsy of esophageal tumor
boolean
C18020 (NCI Thesaurus ObjectClass)
C0430022 (UMLS 2011AA ObjectClass)
C15389 (NCI Thesaurus ObjectClass-2)
C0184980 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3513 (NCI Thesaurus Property-2)
C0152018 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
ElectrocardiographyDiagnosticProcedureAssessmentInd-2
Item
EKG
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C38053 (NCI Thesaurus ObjectClass)
C1623258 (UMLS 2011AA ObjectClass)
C18020 (NCI Thesaurus ObjectClass-2)
C0430022 (UMLS 2011AA ObjectClass-2)
BronchoscopyPerformedInd-2
Item
Bronchoscopy
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16366 (NCI Thesaurus ObjectClass)
C0006290 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
PositronEmissionTomographyComputedTomographyDiagnosticProcedureAssessmentInd-2
Item
PET/CT (Whole body)
boolean
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C0040405 (UMLS 2011AA ObjectClass-2)
C18020 (NCI Thesaurus ObjectClass-3)
C0430022 (UMLS 2011AA ObjectClass-3)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
HeartMUGATestInd-3
Item
MUGA Scan
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C38073 (NCI Thesaurus Property)
C0521317 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
HeartEchocardiogramTestInd-3
Item
Cardiac ECHO
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C37945 (NCI Thesaurus Property)
C2243117 (UMLS 2011AA Property)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
LymphadenopathyImageDocumentedInd
Item
Lymphadenopathy by scan (REGIONAL)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C3206 (NCI Thesaurus ObjectClass)
C0024228 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C25356 (NCI Thesaurus ValueDomain-2)
C1301725 (UMLS 2011AA ValueDomain-2)
ExaminationDate
Item
Examination Date (MM DD YYYY)
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0031809 (NCI Metathesaurus ObjectClass)
SurgicalOncologistConsultationPerformedInd-3
Item
Was a surgical oncology consultation performed (DOCUMENTATING THAT THE PATIENT WILL BE ABLE TO UNDERGO CURATIVE RESECTION AFTER COMPLETION OF CHEMORADIATION)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C17840 (NCI Thesaurus ObjectClass)
C1518577 (UMLS 2011AA ObjectClass)
C41188 (NCI Thesaurus Property-2)
C0009818 (UMLS 2011AA Property-2)
RadiationOncologistConsultationPerformedInd-3
Item
Was a radiation oncology consultation performed (DOCUMENTING THAT THE DISEASE CAN BE ENCOMPASSED IN A RADIOTHERAPY FIELD)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C17833 (NCI Thesaurus ObjectClass)
C1514693 (UMLS 2011AA ObjectClass)
C41188 (NCI Thesaurus Property-2)
C0009818 (UMLS 2011AA Property-2)
MedicalOncologistConsultationPerformedInd-3
Item
Was a medical oncology consultation performed
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C17838 (NCI Thesaurus ObjectClass)
C1555767 (UMLS 2011AA ObjectClass)
C41188 (NCI Thesaurus Property-2)
C0009818 (UMLS 2011AA Property-2)
Assessment Date
Item
Date of Assessment (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Assessment Date
Item
Date of Assessment (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Assessment Date
Item
Date of Assessment (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
Item Group
Severe Active Comorbidity
PriorCancerDiagnosisInd-3
Item
History of Prior Malignancy (invasive)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
CancerAblationDate
Item
Date eradicated (If yes MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C20985 (NCI Thesaurus Property)
C0547070 (UMLS 2011AA Property)
ChemotherapyPriorSystemicClinicalStudyMalignantNeoplasmAdministrationInd-2
Item
Prior systemic chemotherapy for current study cancer
boolean
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C13310 (NCI Thesaurus Property)
C0205373 (UMLS 2011AA Property)
C9305 (NCI Thesaurus Property-2)
C0006826 (UMLS 2011AA Property-2)
C25629 (NCI Thesaurus Property-3)
C0332152 (UMLS 2011AA Property-3)
C15206 (NCI Thesaurus Property-4)
C0008972 (UMLS 2011AA Property-4)
C48905 (NCI Thesaurus Property-5)
C0001554 (UMLS 2011AA Property-5)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
RadiationTherapyPriorMalignantNeoplasmAdministeredInd-2
Item
Prior radiation therapy for current study cancer
boolean
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus Property)
C0006826 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientChestRadiationTherapyPersonalMedicalHistoryInd-2
Item
Prior radiation therapy (chest)
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15313 (NCI Thesaurus Property)
C1522449 (UMLS 2011AA Property)
C25389 (NCI Thesaurus Property-2)
C0817096 (UMLS 2011AA Property-2)
C18772 (NCI Thesaurus Property-3)
C0262926 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PriorAnthracyclineTherapyRegimenInd-2
Item
Prior anthracycline Treatment
boolean
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C1594 (NCI Thesaurus ObjectClass-3)
C0003234 (UMLS 2011AA ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PriorChemotherapyTaxaneCompoundAdministeredInd-2
Item
Prior Taxane Therapy
boolean
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1490 (NCI Thesaurus Property-2)
C0796419 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PriorEpidermalGrowthFactorReceptorTherapyPerformedInd-3
Item
Prior therapy that targeted EGFR pathway
boolean
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17068 (NCI Thesaurus ObjectClass-3)
C0034802 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
ProtocolAgentPriorHypersensitivityInd-3
Item
Prior allergic reaction to study agents
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C3114 (NCI Thesaurus Property)
C0020517 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C41161 (NCI Thesaurus ObjectClass)
C1521826 (UMLS 2011AA ObjectClass)
CongestiveHeartFailureHistoryInd-2
Item
History of documented congestive heart failure
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C3080 (NCI Thesaurus ObjectClass)
C0018802 (UMLS 2011AA ObjectClass)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
UnstableAnginaDiseasePresentInd-3
Item
Unstable angina in last 6 months
boolean
C25594 (NCI Thesaurus ObjectClass)
C1518422 (UMLS 2011AA ObjectClass)
C30103 (NCI Thesaurus ObjectClass-2)
C0205360 (UMLS 2011AA ObjectClass-2)
C2991 (NCI Thesaurus ObjectClass-3)
C0012634 (UMLS 2011AA ObjectClass-3)
C51221 (NCI Thesaurus ObjectClass-4)
C0002962 (UMLS 2011AA ObjectClass-4)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Pre-existingConditionAcuteBacterialInfectionFungalInfectionRegistrationIntravenousRouteofAdministrationAntibioticPresentInd-2
Item
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
boolean
C54056 (NCI Thesaurus ObjectClass)
C0521987 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25646 (NCI Thesaurus Property-2)
C1514821 (UMLS 2011AA Property-2)
C3245 (NCI Thesaurus Property-3)
C0026946 (UMLS 2011AA Property-3)
C258 (NCI Thesaurus Property-4)
C0003232 (UMLS 2011AA Property-4)
C38276 (NCI Thesaurus Property-5)
C1522726 (UMLS 2011AA Property-5)
C2890 (NCI Thesaurus Property-6)
C0004623 (UMLS 2011AA Property-6)
C14140 (NCI Thesaurus Property-7)
C0205178 (UMLS 2011AA Property-7)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientAcquiredImmunodeficiencySyndromeAssessmentInd-3
Item
Acquired Immune Deficiency Syndrome based upon current CDC definition (AIDS)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C2851 (NCI Thesaurus Property-2)
C0001175 (UMLS 2011AA Property-2)
TransmuralMyocardialInfarctionConfirmedInd-2
Item
Transmural MI in last 6 months (myocardial infarction)
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25458 (NCI Thesaurus Property)
C0750484 (UMLS 2011AA Property)
C27996 (NCI Thesaurus ObjectClass)
C0027051 (UMLS 2011AA ObjectClass)
CL233186 (NCI Metathesaurus ObjectClass)
OtherPatientMedicalContraindicatedInd-2
Item
Medical contraindication to esophagectomy
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C37933 (NCI Thesaurus Property)
C1444657 (UMLS 2011AA Property)
FemalePatientPotentialPregnancyInd-2
Item
Is patient a woman of childbearing potential
boolean
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C16576 (NCI Thesaurus ObjectClass-2)
C0086287 (UMLS 2011AA ObjectClass-2)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C0237399 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientNegativePregnancyTestInd-2
Item
Negative serum pregnancy test
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25247 (NCI Thesaurus Property)
C0205160 (UMLS 2011AA Property)
C0032976 (NCI Metathesaurus Property)
PatientNegativePregnancyTestDate
Item
Negative serum pregnancy test date (MM DD YYYY)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25247 (NCI Thesaurus Property)
C0205160 (UMLS 2011AA Property)
C0032976 (NCI Metathesaurus Property)
Item Group
Footer Module
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Investigator Signature
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
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