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6762

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CALGB: 30610 Treatment and Response Form Three Different Radiation Therapy Regimens in Treating Patients With Limited-Stage Small Cell Lung Cancer Receiving Cisplatin and Etoposide Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3C3834F7-372A-2795-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3C3834F7-372A-2795-E044-0003BA3F9857

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-08 2015-01-08 - Martin Dugas
Uppladdad den

8 januari 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer NCT00632853 Treatment - CALGB: 30610 Treatment and Response Form - 2688627v1.0

    Engelsk

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted.

    1 Formulär  
    Ccrr Module For Calgb 90202: Skeletal Survey Form
    Beskrivning

    Ccrr Module For Calgb 90202: Skeletal Survey Form

    CALGB Form (C-1244)
    Beskrivning

    Form ID CALGB

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3262252
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass-2
    C25442
    CALGB Study No.
    Beskrivning

    Protocol ID CALGB

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    CALGB Patient ID
    Beskrivning

    Trial subject ID CALGB

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1516238
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25442
    Reporting Period Start Date
    Beskrivning

    Reporting Period Start Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25616
    UMLS CUI-1
    C2361257
    NCI Thesaurus Property-2
    C25651
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Reporting Period End Date
    Beskrivning

    Reporting Period End Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2361259
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25651
    Are data amended
    Beskrivning

    Data amended

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Patient Initials (Last, First Middle)
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Hospital No.
    Beskrivning

    Medical Record Number

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301894
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25261
    NCI Thesaurus Property-2
    C25198
    Institution/Affiliate
    Beskrivning

    Institution Name

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Participating Group
    Beskrivning

    Participating Group

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2347449
    NCI Thesaurus ObjectClass
    C25608
    NCI Thesaurus ObjectClass-2
    C17005
    NCI Thesaurus Property
    C25364
    Participating Group Study No.
    Beskrivning

    Study Number Participating Group

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Beskrivning

    Trial subject ID Participating Group

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Survival Date
    Beskrivning

    Survival Date

    Vital Status (Mark one with an X.)
    Beskrivning

    Patient Status

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C3846084
    NCI Thesaurus ValueDomain
    C18003
    NCI Thesaurus ValueDomain-2
    C25688
    NCI Thesaurus Property
    C25717
    Date of Last Contact or Death
    Beskrivning

    Date last contact

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-1
    C0805839
    NCI Thesaurus Property
    C25461
    NCI Thesaurus Property-2
    C25551
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Treatment Data
    Beskrivning

    Treatment Data

    Reporting Period
    Beskrivning

    Clinical Trial Period

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2347804
    NCI Thesaurus ObjectClass
    C25214
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass-2
    C25651
    BSA
    Beskrivning

    Body Surface Area

    Datatyp

    float

    Måttenheter
    • m2
    Alias
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-1
    C0005902
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus Property
    C25157
    m2
    Number of cycles given (this reporting period)
    Beskrivning

    TherapyCourseAdministeredCount

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus Property
    C25379
    UMLS 2011AA Property
    C0750729
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    Total dose of cisplatin administered this reporting period (mg)
    Beskrivning

    CisplatinAgentDuringReportingPeriodAdministeredDose

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C376
    UMLS 2011AA ObjectClass
    C0008838
    NCI Thesaurus ObjectClass-2
    C1708
    UMLS 2011AA ObjectClass-2
    C0450442
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25651
    UMLS 2011AA Property-2
    C0700287
    NCI Thesaurus Property-3
    C25382
    UMLS 2011AA Property-3
    C1521801
    NCI Thesaurus Property-4
    C25490
    UMLS 2011AA Property-4
    C0347984
    NCI Thesaurus ValueDomain
    C25488
    UMLS 2011AA ValueDomain
    C0178602
    Total dose of etoposide administered this reporting period (mg)
    Beskrivning

    EtoposideAgentDuringReportingPeriodAdministeredDose

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus ObjectClass-2
    C491
    UMLS 2011AA ObjectClass-2
    C0015133
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25651
    UMLS 2011AA Property-2
    C0700287
    NCI Thesaurus Property-3
    C25382
    UMLS 2011AA Property-3
    C1521801
    NCI Thesaurus Property-4
    C25490
    UMLS 2011AA Property-4
    C0347984
    NCI Thesaurus ValueDomain
    C25488
    UMLS 2011AA ValueDomain
    C0178602
    Total dose of radiation therapy administered during this reporting period
    Beskrivning

    RadiationTherapyReportPeriodAdministeredDose

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus Property-2
    C25375
    UMLS 2011AA Property-2
    C0684224
    NCI Thesaurus Property-3
    C25382
    UMLS 2011AA Property-3
    C1521801
    NCI Thesaurus ValueDomain
    C25488
    UMLS 2011AA ValueDomain
    C0178602
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    Beskrivning

    Dose Modification

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25256
    NCI Thesaurus Property
    C25572
    NCI Thesaurus ValueDomain-2
    C25572
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    Beskrivning

    Dose Modification

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25256
    NCI Thesaurus Property
    C25572
    NCI Thesaurus ValueDomain-2
    C25572
    Reason Treatment Ended
    Beskrivning

    Off Treatment Reason

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1518544
    NCI Thesaurus ObjectClass
    C25601
    UMLS CUI-2
    C0566251
    NCI Thesaurus Property
    C25365
    Alternative Therapy
    Beskrivning

    Off-treatmentAlternativeReasonSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C25601
    UMLS 2011AA ObjectClass
    C1518544
    NCI Thesaurus Property
    C25415
    UMLS 2011AA Property
    C1523987
    NCI Thesaurus Property-2
    C25365
    UMLS 2011AA Property-2
    C0678257
    Other specify
    Beskrivning

    Off Treatment Reason, specify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1518544
    NCI Thesaurus ObjectClass
    C25601
    UMLS CUI-2
    C0566251
    NCI Thesaurus Property
    C25365
    UMLS CUI-3
    C1521902
    Response Data
    Beskrivning

    Response Data

    Date of Last Clinical Assessment
    Beskrivning

    Follow-Up Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS CUI-1
    C3694716
    NCI Thesaurus Property
    C16033
    NCI Thesaurus Property-2
    C25365
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Best Overall Response to date
    Beskrivning

    Best Overall Response

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS CUI-1
    C2986560
    NCI Thesaurus ObjectClass-2
    C25605
    NCI Thesaurus ObjectClass-3
    C25432
    NCI Thesaurus Property
    C25755
    NCI Thesaurus ValueDomain
    C25284
    Complete Response (CR) First Observed Date
    Beskrivning

    Complete Response First Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS CUI-1
    C0677874
    NCI Thesaurus ObjectClass-2
    C25250
    UMLS CUI-2
    C1115465
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Partial Response (PR) First Observed Date
    Beskrivning

    Partial Response First Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS CUI-1
    C1521726
    NCI Thesaurus ObjectClass-2
    C25378
    UMLS CUI-2
    C1115465
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Progressive Disease (PD) Observed Date
    Beskrivning

    Progressive Disease Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1335499
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus Property
    C25599
    UMLS CUI-2
    C0011008
    Sites of Progression
    Beskrivning

    Progression Site

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS CUI-1
    C0242656
    NCI Thesaurus Property
    C25341
    UMLS CUI-2
    C1515974
    NCI Thesaurus ObjectClass
    C25331
    Other specify
    Beskrivning

    Progression Site, specify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C0242656
    NCI Thesaurus Property
    C25341
    UMLS CUI-2
    C1515974
    NCI Thesaurus ObjectClass
    C25331
    Site of progression with regard to RT fields
    Beskrivning

    RadiationFieldCancerProgressionAnatomicSite

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    NCI Thesaurus ObjectClass
    C54648
    UMLS 2011AA ObjectClass
    C1882536
    NCI Thesaurus Property
    C19987
    UMLS 2011AA Property
    C0242656
    Footer
    Beskrivning

    Footer

    Completed by (Last name, First name)
    Beskrivning

    Person Completing Form

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1550483
    NCI Thesaurus ObjectClass
    C25657
    NCI Thesaurus Property
    C25364
    Date Form Originally Completed
    Beskrivning

    Form Completion Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Tillbaka till toppen

    Similar models

    INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted.

    1 Formulär
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Ccrr Module For Calgb 90202: Skeletal Survey Form
    Form ID CALGB
    Item
    CALGB Form (C-1244)
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3262252 (UMLS CUI-1)
    C19464 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus ObjectClass-2)
    Protocol ID CALGB
    Item
    CALGB Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Trial subject ID CALGB
    Item
    CALGB Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1516238 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25442 (NCI Thesaurus Property-2)
    Reporting Period Start Date
    Item
    Reporting Period Start Date
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C2361257 (UMLS CUI-1)
    C25651 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Reporting Period End Date
    Item
    Reporting Period End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2361259 (UMLS CUI-1)
    C25616 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25651 (NCI Thesaurus Property-2)
    Data amended
    Item
    Are data amended
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials (Last, First Middle)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Medical Record Number
    Item
    Patient Hospital No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301894 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25261 (NCI Thesaurus Property)
    C25198 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Participating Group
    Item
    Participating Group
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2347449 (UMLS CUI-1)
    C25608 (NCI Thesaurus ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Study Number Participating Group
    Item
    Participating Group Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Item Group
    Survival Date
    Item
    Vital Status (Mark one with an X.)
    text
    C16960 (NCI Thesaurus ObjectClass)
    C3846084 (UMLS CUI-1)
    C18003 (NCI Thesaurus ValueDomain)
    C25688 (NCI Thesaurus ValueDomain-2)
    C25717 (NCI Thesaurus Property)
    CL.2
    Code List
    Vital Status (Mark one with an X.)
    CL Item
    Alive (Alive)
    CL Item
    Dead (Dead)
    Date last contact
    Item
    Date of Last Contact or Death
    date
    C16960 (NCI Thesaurus ObjectClass)
    C0805839 (UMLS CUI-1)
    C25461 (NCI Thesaurus Property)
    C25551 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Treatment Data
    Item
    Reporting Period
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2347804 (UMLS CUI-1)
    C25214 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C25651 (NCI Thesaurus ObjectClass-2)
    CL.3
    Code List
    Reporting Period
    CL Item
    Cycles 1 & 2 (Cycles 1 & 2)
    CL Item
    Cycles 3 & 4 (Cycles 3 & 4)
    Body Surface Area
    Item
    BSA
    float
    C25190 (NCI Thesaurus ObjectClass)
    C0005902 (UMLS CUI-1)
    C25712 (NCI Thesaurus ValueDomain)
    C25157 (NCI Thesaurus Property)
    TherapyCourseAdministeredCount
    Item
    Number of cycles given (this reporting period)
    float
    C15368 (NCI Thesaurus ObjectClass)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C25379 (NCI Thesaurus Property)
    C0750729 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    CisplatinAgentDuringReportingPeriodAdministeredDose
    Item
    Total dose of cisplatin administered this reporting period (mg)
    float
    C376 (NCI Thesaurus ObjectClass)
    C0008838 (UMLS 2011AA ObjectClass)
    C1708 (NCI Thesaurus ObjectClass-2)
    C0450442 (UMLS 2011AA ObjectClass-2)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25651 (NCI Thesaurus Property-2)
    C0700287 (UMLS 2011AA Property-2)
    C25382 (NCI Thesaurus Property-3)
    C1521801 (UMLS 2011AA Property-3)
    C25490 (NCI Thesaurus Property-4)
    C0347984 (UMLS 2011AA Property-4)
    C25488 (NCI Thesaurus ValueDomain)
    C0178602 (UMLS 2011AA ValueDomain)
    EtoposideAgentDuringReportingPeriodAdministeredDose
    Item
    Total dose of etoposide administered this reporting period (mg)
    float
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C491 (NCI Thesaurus ObjectClass-2)
    C0015133 (UMLS 2011AA ObjectClass-2)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25651 (NCI Thesaurus Property-2)
    C0700287 (UMLS 2011AA Property-2)
    C25382 (NCI Thesaurus Property-3)
    C1521801 (UMLS 2011AA Property-3)
    C25490 (NCI Thesaurus Property-4)
    C0347984 (UMLS 2011AA Property-4)
    C25488 (NCI Thesaurus ValueDomain)
    C0178602 (UMLS 2011AA ValueDomain)
    RadiationTherapyReportPeriodAdministeredDose
    Item
    Total dose of radiation therapy administered during this reporting period
    float
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C25375 (NCI Thesaurus Property-2)
    C0684224 (UMLS 2011AA Property-2)
    C25382 (NCI Thesaurus Property-3)
    C1521801 (UMLS 2011AA Property-3)
    C25488 (NCI Thesaurus ValueDomain)
    C0178602 (UMLS 2011AA ValueDomain)
    Item
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25256 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C25572 (NCI Thesaurus ValueDomain-2)
    CL.5
    Code List
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
    CL Item
    Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
    Item
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25256 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C25572 (NCI Thesaurus ValueDomain-2)
    CL.5
    Code List
    Were there any dose modifications or additions/omissions to protocol treatment? (Radiation therapy)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
    CL Item
    Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
    Item
    Reason Treatment Ended
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI-1)
    C25601 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property)
    CL.6
    Code List
    Reason Treatment Ended
    CL Item
    Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)
    CL Item
    Alternative Therapy (Alternative therapy)
    CL Item
    Death On Study (Death on study)
    CL Item
    Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    CL Item
    Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)
    CL Item
    Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal/refusal after beginning protocol therapy)
    CL Item
    Patient Withdrawal Or Refusal Before Beginning Protocol Therapy (Patient withdrawal/refusal prior to beginning protocol therapy)
    Off-treatmentAlternativeReasonSpecify
    Item
    Alternative Therapy
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C25601 (NCI Thesaurus ObjectClass)
    C1518544 (UMLS 2011AA ObjectClass)
    C25415 (NCI Thesaurus Property)
    C1523987 (UMLS 2011AA Property)
    C25365 (NCI Thesaurus Property-2)
    C0678257 (UMLS 2011AA Property-2)
    Off Treatment Reason, specify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI-1)
    C25601 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property)
    C1521902 (UMLS CUI-3)
    Item Group
    Response Data
    Follow-Up Date
    Item
    Date of Last Clinical Assessment
    date
    C9305 (NCI Thesaurus ObjectClass)
    C3694716 (UMLS CUI-1)
    C16033 (NCI Thesaurus Property)
    C25365 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item
    Best Overall Response to date
    text
    C3262 (NCI Thesaurus ObjectClass)
    C2986560 (UMLS CUI-1)
    C25605 (NCI Thesaurus ObjectClass-2)
    C25432 (NCI Thesaurus ObjectClass-3)
    C25755 (NCI Thesaurus Property)
    C25284 (NCI Thesaurus ValueDomain)
    CL.7
    Code List
    Best Overall Response to date
    CL Item
    Complete Response (CR)
    CL Item
    Partial Response (PR)
    C18212 (NCI Thesaurus)
    CL Item
    Stable Disease (SD)
    C18213 (NCI Thesaurus)
    C0677946 (UMLS 2011AA)
    CL Item
    Progressive Disease (PD)
    C35571 (NCI Thesaurus)
    C1335499 (UMLS 2011AA)
    CL Item
    Insufficient Evaluation (Insufficient evaluation to determine response status)
    Complete Response First Observed Date
    Item
    Complete Response (CR) First Observed Date
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0677874 (UMLS CUI-1)
    C25250 (NCI Thesaurus ObjectClass-2)
    C1115465 (UMLS CUI-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Partial Response First Observed Date
    Item
    Partial Response (PR) First Observed Date
    date
    C25755 (NCI Thesaurus ObjectClass)
    C1521726 (UMLS CUI-1)
    C25378 (NCI Thesaurus ObjectClass-2)
    C1115465 (UMLS CUI-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Progressive Disease Observed Date
    Item
    Progressive Disease (PD) Observed Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1335499 (UMLS CUI-1)
    C25367 (NCI Thesaurus ValueDomain-2)
    C25331 (NCI Thesaurus ObjectClass)
    C25599 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    Item
    Sites of Progression
    text
    C13717 (NCI Thesaurus ValueDomain)
    C0242656 (UMLS CUI-1)
    C25341 (NCI Thesaurus Property)
    C1515974 (UMLS CUI-2)
    C25331 (NCI Thesaurus ObjectClass)
    CL.8
    Code List
    Sites of Progression
    CL Item
    Bone (Bone)
    C12366 (NCI Thesaurus)
    C0262950 (UMLS 2011AA)
    CL Item
    Brain (Brain)
    C12439 (NCI Thesaurus)
    C0006104 (UMLS 2011AA)
    CL Item
    Hilar Lymph Node (Hilar lymph nodes)
    C1305372 (NCI Metathesaurus)
    CL Item
    Liver (Liver)
    C12392 (NCI Thesaurus)
    C0023884 (UMLS 2011AA)
    CL Item
    Lung, Nos (Lung)
    C12468 (NCI Thesaurus)
    C0024109 (UMLS 2011AA)
    CL Item
    Mediastinal Lymph Node (Mediastinal lymph nodes)
    C33073 (NCI Thesaurus)
    C0588055 (UMLS 2011AA)
    CL Item
    Contralateral Lung (Opposite lung)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    C17649 (NCI Thesaurus-3)
    C0205394 (UMLS 2011AA-4)
    CL Item
    Pleura (Pleura)
    C12469 (NCI Thesaurus)
    C0032225 (UMLS 2011AA)
    Progression Site, specify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C0242656 (UMLS CUI-1)
    C25341 (NCI Thesaurus Property)
    C1515974 (UMLS CUI-2)
    C25331 (NCI Thesaurus ObjectClass)
    Item
    Site of progression with regard to RT fields
    text
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    C54648 (NCI Thesaurus ObjectClass)
    C1882536 (UMLS 2011AA ObjectClass)
    C19987 (NCI Thesaurus Property)
    C0242656 (UMLS 2011AA Property)
    CL.9
    Code List
    Site of progression with regard to RT fields
    CL Item
    Outside The Rt Field And Outside The Initial (pre-chemotherapy) Tumor Volume (Outside the RT field and outside the initial (pre-chemotherapy) tumor volume)
    CL Item
    Outside The Rt Field And Within The Initial (pre-chemotherapy) Tumor Volume (Outside the RT field and within the initial (pre-chemotherapy) tumor volume)
    CL Item
    Within Delivered/intended Low Dose Volume (Within delivered/intended low dose volume)
    CL Item
    Within The Delivered/intended High Dose Volume (Within the delivered/intended high dose volume)
    Item Group
    Footer
    Person Completing Form
    Item
    Completed by (Last name, First name)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1550483 (UMLS CUI-1)
    C25657 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Form Completion Date
    Item
    Date Form Originally Completed
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
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