Description:

North Central Cancer Treatment Group Evaluation/Observation Form NCT00377156 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=109FB871-880B-538E-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=109FB871-880B-538E-E044-0003BA3F9857

Keywords:
Versions (4) ▾
  1. 8/26/12
  2. 1/8/15
  3. 6/8/15
  4. 9/20/21
Uploaded on:

September 20, 2021

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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North Central Cancer Treatment Group Evaluation/Observation Form NCT00377156

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  1. StudyEvent: North Central Cancer Treatment Group Evaluation/Observation Form
    1. No Instruction available.
Header
Are data amended (If yes, highlight amended areas)
Patient status assessment
Kg
ECOG Performance Status (check one)
Neurologic Examination
Cranial nerves (check one)
Sensation (check one)
Motor (check one)
Cerebellar (check one)
Observation
End of observation
Observation
Has the patient been assessed for systemic disease (e.g., disease outside of brain)
Status of systemic disease (If yes,)
Notice Of First Recurrence
Has the patient been diagnosed with a first local-regional recurrence of the treated brain lesion(s) (that has not been previously reported? Note: If marked "yes" below, submit reports to document the recurrence.)
Has the patient been diagnosed with a first distant recurrence of the treated brain lesion(s) (that has not been previously reported? Note: If marked "yes" below, submit reports to document the recurrence.)
Treatment Of Any Recurrence
Has the patient been treated for any recurrence of the central nervous system disease (CNS)
Therapy administered (If yes,)
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?

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