Southwest Oncology Group S0931 Recurrence Assessment Form (Form #46940) Everolimus in Treating Patients With Kidney Cancer Who Have Undergone Surgery Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 9/20/21 9/20/21 -
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September 20, 2021

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Creative Commons BY-NC 3.0 Legacy
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Kidney Cancer NCT01120249 Response - Southwest Oncology Group S0931 Recurrence Assessment Form (Form #46940) - 2998562v1.0

Instructions: Please submit at protocol specified intervals and at time of recurrence. All dates are MONTH, DAY, YEAR. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across the top of the form

Clinical Assessment
Has the patient had a documented clinical assessment for this cancer? (during this report period)
Symptomatic Deterioration
Notice Of Recurrence
Has the patient been diagnosed with recurrence of disease (during this report period Second primary is not a basis for recurrence. See section 10.1 for acceptable criteria for recurrence)
How was recurrence discovered (If yes - select one)
Site of recurrence (If yes - select all that apply)
Was biopsy performed
Biopsy Result (If yes)

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