E1208 Hepatic On-Study Form NCT01004978 Chemoembolization With or Without Sorafenib Tosylate in Treating Patients With Liver Cancer That Cannot Be Removed By Surgery Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/16/15 6/16/15 -
  4. 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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E1208 Hepatic On-Study Form NCT01004978

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files

Report Period
Patient demographics
Performance Status
Data amendment
History Of Disease
Description Of Current Disease
Pre-registration Evaluation
Is macrovascular invasion present
Is disease limited to intrahepatic vessels (If Yes:)
Is portal lymphadenopathy present
Has disease been deemed unresectable by a qualified surgeon
What is the patient's hepatitis B status
What is the patient's hepatitis C status
Has the patient received antineoplastic therapy for non-malignant disease
Prior RFA treatment
Prior transplant
Child Pugh Classification
Encephalopathy status (per CTCA v4.0)
Albumin (g/dl)
Prothrombin time (seconds over control)
Bilirubin (mg/dl)
Child Pugh Classification (Grade A, B, C Refer to table above)
Baseline Abnormalities
CTC Adverse Event Term
CTC Adverse Event Grade

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