Description:

NCT00980954 RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Concurrent Systemic Treatment Summary Form (TF) Chemotherapy and Pelvic Radiation Therapy With or Without Additional Chemotherapy in Treating Patients With High-Risk Early-Stage Cervical Cancer After Radical Hysterectomy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5FE95381-CD25-390D-E040-BB89AD436907

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5FE95381-CD25-390D-E040-BB89AD436907

Keywords:
Versions (6) ▾
  1. 8/27/12
  2. 1/9/15
  3. 1/9/15
  4. 1/9/15
  5. 7/8/15
  6. 9/20/21
Uploaded on:

September 20, 2021

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

NCT00980954 RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Concurrent Systemic Treatment Summary Form (TF)

INSTRUCTIONS: Submit this form at the completion of each cycle of salvage treatment. Dates are to be recorded as mm-dd-yyyy unless otherwise specified

  1. StudyEvent: RTOG 0724 Phase III Cervix Chemo RT (+)/(-) Adjuvant Chemotherapy: Concurrent Systemic Treatment Summary Form (TF)
    1. INSTRUCTIONS: Submit this form at the completion of each cycle of salvage treatment. Dates are to be recorded as mm-dd-yyyy unless otherwise specified
RTOG clinical trial administrative data
Amended Data (INSTRUCTIONS: Complete form on web to unblind the protocol treatment arm)
Assessment
cm
Kg
m2
Treatment Summary
Dose Modification (Change)
Reason Treatment Ended
Protocol Specific Adverse Event Evaluation
Any adverse events
CTC Adverse Event Term
Attribution
SAE report submitted
Lab results
Units
g/dL
%
1000/uL
%
mmol/L
mmol/L
mEq/L
mg/dL
1000/uL
U/L
U/L
mg/dL
mg/dL
mmol/L
Footer Module

Similar models