ID

6316

Description

RTOG-0412 S1: Post-Op Immunotherapy/RT Surgery Form Cisplatin and Docetaxel With or Without Radiation Therapy in Treating Patients Who Are Undergoing Surgery for Newly Diagnosed Stage III Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E4C3CDDF-D8AA-1A4C-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E4C3CDDF-D8AA-1A4C-E034-0003BA3F9857

Keywords

Versions (2)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

December 18, 2014

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.

Back to model comments
Itemgroup comments for :

Item comments for :

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

Lung Cancer NCT00113386 Treatment - RTOG-0412 S1: Post-Op Immunotherapy/RT Surgery Form - 2293382v3.0

English

Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

1 forms  
Module 1
Description

Module 1

RTOG Study
Description

ProtocolRTOGIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C19778
UMLS 2011AA Property
C1514695
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Case #
Description

Case#

Data type

text

Institution
Description

InstitutionName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Institution No.
Description

InstitutionIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participant's Initials
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Participant's I.D. No.
Description

PatientCoordinatingIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25462
UMLS 2011AA Property
C0700114
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
AMENDED DATA (INSTRUCTIONS: This form is submitted on all surgically resected patients. Record dates as mm-dd-yyyy unless otherwise specified.)
Description

DataAmendedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
SURGERY DATE
Description

SurgeryDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C15329
UMLS 2011AA ObjectClass
C0543467
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
TYPE OF PRIMARY SURGERY
Description

PrimarySurgeryType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
DURATION OF SURGERY (hour:minutes)
Description

SurgeryDuration

Data type

date

ESTIMATED BLOOD LOSS (cc)
Description

BloodLossAmount

Data type

double

Alias
NCI Thesaurus ObjectClass
C12434
UMLS 2011AA ObjectClass
C0229664
NCI Thesaurus Property
C25559
UMLS 2011AA Property
C1517945
NCI Thesaurus ValueDomain
C25417
INTRAOP AND PERIOP (TRANSFUSIONS OF WHOLE BLOOD OR PACKED CELLS) (units)
Description

WholeBloodTransfusionAdministeredUnitCount

Data type

double

Alias
NCI Metathesaurus ObjectClass
C0370231
NCI Thesaurus ObjectClass
C15408
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ValueDomain
C44278
UMLS 2011AA ValueDomain
C0439148
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
INTRAOP AND PERIOP (TRANSFUSIONS OF OTHER BLOOD PRODUCT) (units)
Description

OtherTransfusionBloodAdministeredCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ObjectClass
C15408
NCI Thesaurus Property
C12434
UMLS 2011AA Property
C0229664
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Surgical Pathological Results
Description

Surgical Pathological Results

R0 (all margins pathologically negative)
Description

SurgicalResectionNegativeFindingMarginPerformedInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C25698
NCI Thesaurus ObjectClass
C15232
UMLS 2011AA ObjectClass
C0728940
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C38757
UMLS 2011AA Property
C1513916
NCI Thesaurus Property
C25563
UMLS 2011AA Property
C0205284
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
R1 (microscopically positive margins or microscopic residual disease)
Description

SurgicalResectionMicroscopicPositiveFindingMarginPerformedInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C25698
NCI Thesaurus ObjectClass
C15232
UMLS 2011AA ObjectClass
C0728940
NCI Thesaurus Property
C25252
UMLS 2011AA Property
C0205288
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C38758
UMLS 2011AA Property
C1514241
NCI Thesaurus Property
C25563
UMLS 2011AA Property
C0205284
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
R2 (macroscopically positive margins or gross residual disease)
Description

SurgicalResectionGrossPositiveFindingMarginPerformedInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C25698
NCI Thesaurus ObjectClass
C15232
UMLS 2011AA ObjectClass
C0728940
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C38758
UMLS 2011AA Property
C1514241
NCI Thesaurus Property
C25563
UMLS 2011AA Property
C0205284
NCI Thesaurus Property
C43566
UMLS 2011AA Property
C0439806
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
N Stage, Pathologic (N0, N1, N2, N3)
Description

LungTumorPathologicNStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C25610
UMLS 2011AA Property
C1521733
NCI Thesaurus Property
C25580
UMLS 2011AA Property
C0456532
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
T Stage, Pathologic (T1, T2, T3, T4)
Description

LungTumorPathologicTStage

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ValueDomain
C16899
UMLS 2011AA ValueDomain
C1300072
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Lymph Node Type
Description

LungLymphNodeInvolvedSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25547
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Lymph Node Involvement
Description

LymphNodeInvolvementType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C25547
NUMBER OF DAYS ON VENTILATOR
Description

PatientVentilatorTreatmentDayCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C15368
NCI Thesaurus Property
C38388
UMLS 2011AA Property
C0087153
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
INPATIENT DISCHARGE DATE
Description

InpatientDischargeDate

Data type

date

NUMBER OF POST-OPERATIVE DAYS TO TIME OF DISCHARGE
Description

PatientPost-OperativeHospitalizationDayCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25623
NCI Thesaurus Property
C25179
UMLS 2011AA Property
C0019993
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
SEVERITY GRADE
Description

CommonToxicityCriteriaAdverseEventGrade

Data type

double

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
AE
Description

CommonToxicityCriteriaAdverseEventTermType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus Property
C45559
UMLS 2011AA Property
C1705313
Adverse Event Assessment Date
Description

AdverseEventAssessmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
COMMENTS
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
Signature of surgeon
Description

SurgeonSignatureText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C18071
UMLS 2011AA ObjectClass
C0582175
Name of person completing form
Description

ResponsiblePersonName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Form completion date, original
Description

FormOriginalCompleteDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C25604
UMLS 2011AA Property
C0205313
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
CHECK ATTACHMENTS
Description

CHECKATTACHMENTS

Data type

text

Back to the top of the page

Similar models

Radiation Therapy Oncology Group Phase III Lung Pre-Op Chemotherapy vs. Pre-Op Concurrent Chemoradiation for NSCLC

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Module 1
ProtocolRTOGIdentifierNumber
Item
RTOG Study
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C19778 (NCI Thesaurus Property)
C1514695 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Case#
Item
Case #
text
InstitutionName
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
InstitutionIdentifierNumber
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientInitialsName
Item
Participant's Initials
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientCoordinatingIdentifierNumber
Item
Participant's I.D. No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25462 (NCI Thesaurus Property)
C0700114 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
AMENDED DATA (INSTRUCTIONS: This form is submitted on all surgically resected patients. Record dates as mm-dd-yyyy unless otherwise specified.)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
AMENDED DATA (INSTRUCTIONS: This form is submitted on all surgically resected patients. Record dates as mm-dd-yyyy unless otherwise specified.)
CL Item
Yes (yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SurgeryDate
Item
SURGERY DATE
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C15329 (NCI Thesaurus ObjectClass)
C0543467 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
TYPE OF PRIMARY SURGERY
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
TYPE OF PRIMARY SURGERY
CL Item
Lobectomy (Lobectomy)
C15272 (NCI Thesaurus)
C0023928 (UMLS 2011AA)
CL Item
Bilobectomy (Bilobectomy)
CL Item
Sleeve Resection (Sleeve Resection)
CL Item
Pneumonectomy (Pneumonectomy)
C15305 (NCI Thesaurus)
C0032284 (UMLS 2011AA)
SurgeryDuration
Item
DURATION OF SURGERY (hour:minutes)
date
BloodLossAmount
Item
ESTIMATED BLOOD LOSS (cc)
double
C12434 (NCI Thesaurus ObjectClass)
C0229664 (UMLS 2011AA ObjectClass)
C25559 (NCI Thesaurus Property)
C1517945 (UMLS 2011AA Property)
C25417 (NCI Thesaurus ValueDomain)
WholeBloodTransfusionAdministeredUnitCount
Item
INTRAOP AND PERIOP (TRANSFUSIONS OF WHOLE BLOOD OR PACKED CELLS) (units)
double
C0370231 (NCI Metathesaurus ObjectClass)
C15408 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C44278 (NCI Thesaurus ValueDomain)
C0439148 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
OtherTransfusionBloodAdministeredCount
Item
INTRAOP AND PERIOP (TRANSFUSIONS OF OTHER BLOOD PRODUCT) (units)
double
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C15408 (NCI Thesaurus ObjectClass)
C12434 (NCI Thesaurus Property)
C0229664 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item Group
Surgical Pathological Results
Item
R0 (all margins pathologically negative)
text
C25698 (NCI Thesaurus ObjectClass)
C15232 (NCI Thesaurus ObjectClass)
C0728940 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38757 (NCI Thesaurus Property)
C1513916 (UMLS 2011AA Property)
C25563 (NCI Thesaurus Property)
C0205284 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.3
Code List
R0 (all margins pathologically negative)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
R1 (microscopically positive margins or microscopic residual disease)
text
C25698 (NCI Thesaurus ObjectClass)
C15232 (NCI Thesaurus ObjectClass)
C0728940 (UMLS 2011AA ObjectClass)
C25252 (NCI Thesaurus Property)
C0205288 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38758 (NCI Thesaurus Property)
C1514241 (UMLS 2011AA Property)
C25563 (NCI Thesaurus Property)
C0205284 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.4
Code List
R1 (microscopically positive margins or microscopic residual disease)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
R2 (macroscopically positive margins or gross residual disease)
text
C25698 (NCI Thesaurus ObjectClass)
C15232 (NCI Thesaurus ObjectClass)
C0728940 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C38758 (NCI Thesaurus Property)
C1514241 (UMLS 2011AA Property)
C25563 (NCI Thesaurus Property)
C0205284 (UMLS 2011AA Property)
C43566 (NCI Thesaurus Property)
C0439806 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.5
Code List
R2 (macroscopically positive margins or gross residual disease)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
N Stage, Pathologic (N0, N1, N2, N3)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C25610 (NCI Thesaurus Property)
C1521733 (UMLS 2011AA Property)
C25580 (NCI Thesaurus Property)
C0456532 (UMLS 2011AA Property)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
CL.6
Code List
N Stage, Pathologic (N0, N1, N2, N3)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis To Ipsilateral Peribronchial And/or Ipsilateral Hilar Lymph Nodes, And Intrapulmonary Nodes Including Involvement By Direct Extension Of The Primary Tumor (N1)
CL Item
Metastasis To Ipsilateral Mediastinal And/or Subcarinal Lymph Node(s) (N2)
CL Item
Metastasis To Contralateral Mediastinal, Contralateral Hilar, Ipsilateral Or Contralateral Scalene, Or Supraclavicular Lymph Node(s) (N3)
CL Item
Regional Lymph Nodes Cannot Be Assessed (NX)
Item
T Stage, Pathologic (T1, T2, T3, T4)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C16899 (NCI Thesaurus ValueDomain)
C1300072 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CL.7
Code List
T Stage, Pathologic (T1, T2, T3, T4)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Tumor 3 Cm Or Less In Greatest Dimension, Surrounded By Lung Or Visceral Pleura, Invasion More Proximal Than The Lobar Bronchus, (i.e., Not In The Main Bronchus) (T1)
CL Item
Tumor Of Any Size That Directly Invades Any Of The Following: Chest Wall (including Superior Sulcus Tumors), Diaphragm, Mediastinal Pleura, Parietal Pericardium; Or Tumor In The Main Bronchus Less Than 2 Cm Distal To The Carina, But Without Involvement O* (T3)
CL Item
Tumor Of Any Size That Invades Any Of The Following: Mediastinum, Heart, Great Vessels, Trachea, Esophagus, Vertebral Body, Carina; Or Separate Tumor Nodules In The Same Lobe; Or Tumor With A Malignant Pleural Effusion (T4)
CL Item
Tumor With Any Of The Following Features Of Size Or Extent: More Than 3cm In Greatest Dimension; Invades The Visceral Pleura; Associated With Atelectasis Or Obstructive Pneumonitis That Extends To The Hilar Region But Does Not Involve The Entire Lung (T2)
Item
Lymph Node Type
text
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.8
Code List
Lymph Node Type
CL Item
Highest Mediastinal (Highest Mediastinal)
CL Item
Right Upper Paratracheal Node (Right upper paratracheal)
CL Item
Left Upper Paratracheal Node (Left upper paratracheal)
CL Item
Pre And Retro Paratracheal Node (Pre and retro paratracheal)
CL Item
Right Lower Paratracheal Node (Right lower paratracheal)
CL Item
Left Lower Paratracheal Node (Left lower paratracheal)
CL Item
Subaortic Node (Subaortic)
CL Item
Para-aortic Node (Para-aortic)
CL Item
Subcarinal Node (Subcarinal)
CL Item
Paraesophageal Node (Paraesophageal)
CL Item
Pulmonary Ligament (Pulmonary ligament)
C0225794 (NCI Metathesaurus)
CL Item
Right Hilar Node (Right hilar)
CL Item
Left Hilar Node (Left hilar)
CL Item
Interlobar Node (Interlobar)
CL Item
Right Lobar Node (Right lobar)
CL Item
Left Lobar Node (Left lobar)
CL Item
Right Segmental Node (Right segmental)
CL Item
Left Segmental Node (Left segmental)
CL Item
Right Subsegmental Node (Right subsegmental)
CL Item
Left Subsegmental Node (Left subsegmental)
Item
Lymph Node Involvement
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
CL.9
Code List
Lymph Node Involvement
CL Item
Not Evaluated (not evaluated)
CL Item
Positive (positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Negative (negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Equivocal (equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientVentilatorTreatmentDayCount
Item
NUMBER OF DAYS ON VENTILATOR
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C38388 (NCI Thesaurus Property)
C0087153 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
InpatientDischargeDate
Item
INPATIENT DISCHARGE DATE
date
PatientPost-OperativeHospitalizationDayCount
Item
NUMBER OF POST-OPERATIVE DAYS TO TIME OF DISCHARGE
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25623 (NCI Thesaurus Property)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventGrade
Item
SEVERITY GRADE
double
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item
AE
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C45559 (NCI Thesaurus Property)
C1705313 (UMLS 2011AA Property)
CL.10
Code List
AE
CL Item
Prolonged Chest Tube Drainage Or Air Leak After Pulmonary Resection (Prolonged chest tube drainage or air leak after pulmonary resection)
CL Item
Pneumonitis Nos (PNEUMONITIS/PULMONARY INFILTRATES)
CL Item
Culture Wound Positive (INFECTION (WOUND))
C0476436 (NCI Metathesaurus)
CL Item
Atelectasis (ATELECTASIS)
C2888 (NCI Thesaurus)
C0004144 (UMLS 2011AA)
CL Item
Pneumothorax Nos (PNEUMOTHORAX)
C0032326 (NCI Metathesaurus)
CL Item
Chylothorax (CHYLOTHORAX)
C0008733 (NCI Metathesaurus)
CL Item
Myocardial Ischaemia (CARDIAC ISCHEMIA/INFARCTION)
C0151744 (NCI Metathesaurus)
CL Item
Thrombosis Nos (THROMBOSIS/EMBOLISM (PULMONARY))
CL Item
Supraventricular Arrhythmia Nos (SUPRAVENTRICULAR ARRHYTHMIA (ATRIAL))
CL Item
Post-operative Haemorrhage (HEMORRHAGE (POST-OPERATIVE))
CL Item
Fistula, Pulmonary/upper Respiratory (FISTULA PULMONARY/UPPER RESPIRATORY)
CL Item
Pleural Effusion (PLEURAL EFFUSION)
C3331 (NCI Thesaurus)
C0021071 (UMLS 2011AA)
CL Item
Death Not Associated With Ctcae Term (DEATH)
AdverseEventAssessmentDate
Item
Adverse Event Assessment Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
ResearchCommentsText
Item
COMMENTS
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
SurgeonSignatureText
Item
Signature of surgeon
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C18071 (NCI Thesaurus ObjectClass)
C0582175 (UMLS 2011AA ObjectClass)
ResponsiblePersonName
Item
Name of person completing form
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormOriginalCompleteDate
Item
Form completion date, original
date
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
Item
CHECK ATTACHMENTS
text
CL.11
Code List
CHECK ATTACHMENTS
CL Item
SURGICAL REPORT(S2) (SURGICAL REPORT(S2))
CL Item
RESECTION PATHOLOGY REPORT(S5) (RESECTION PATHOLOGY REPORT(S5))
Back to the top of the page 

Contact

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

Fields marked with * are required.

Help

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