E3F05 Long-Term Follow-up Form Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder:


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January 8, 2015

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Brain and Central Nervous System Tumors NCT00978458 Follow-Up - E3F05 Long-Term Follow-up Form - 2900961v1.0

INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule). Submit original to the ECOG Coordinating Center. Keep a copy for your files. NOTE: This form is required at the specified report periods regardless of whether new information is available

Vital Status
Section Ii - Reporting Period
Section Iv - Notice Of New Primary
Section Iii - Disease Follow-up Status
Section V - Adverse Events
Section Vi - Non-protocol Therapy Prior To Progression