Lung Cancer - Localized Disease Follow-Up Form Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 9/17/21 9/17/21 -
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September 17, 2021

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Creative Commons BY-NC 3.0 Legacy
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Follow-Up - Lung Cancer - Localized Disease Follow-Up Form - 2019386v2.31

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  1. StudyEvent: Lung Cancer - Localized Disease Follow-Up Form
    1. No Instruction available.
Crf Header
Vital Status
Primary Cause of Death
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Information On Progression Or Relapse Of Localized Lung Cancer (both Nsclc And Sclc Trials)
Has the patient developed a first progression (or relapse) that has not been previously reported?
CNS (excluding Brain)
Opposite Lung
Regional Lymph Nodes
Distant Lymph Nodes
Distant Skin/subcutaneous Tissue
Disease Progression Site was within Radiation Portal (use only for protocols with radiation therapy)
Disease Progression Site was outside Radiation Portal
Is the patient receiving any non-protocol cancer therapy not previously reported?
Non-Protocol Hormonal Therapy?
Non-Protocol Chemotherapy
Non-Protocol Immunotherapy?
Non-Protocol Biologic Response Modifier?
Non-Protocol High Dose Chemotherapy/Autologous Stem Cell Transplant
Non-Protocol Radiation Therapy?
Non-Protocol Surgery?
Other Non-Protocol Therapy
Has a new primary cancer or MDS been diagnosed that has not been previously reported? (myelodysplastic syndrome)
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity that has not been previously reported
Allows Documentation Of Any Additional Cooments

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