Description:

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: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6FC737FA-1C8D-FBF0-E040-BB89AD4367A6

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6FC737FA-1C8D-FBF0-E040-BB89AD4367A6
Keywords:
  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 -
Uploaded on:

September 20, 2021

DOI:
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.

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

Header
Report Period
Patient demographics
Performance Status
cm
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)
Ascites
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
Comments

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial