Description:

North Central Cancer Treatment Group Event Monitoring Form Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=10C2A3FE-45CB-664E-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=10C2A3FE-45CB-664E-E044-0003BA3F9857

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Versions (2) ▾
  1. 12/18/14
  2. 1/8/15
Uploaded on:

January 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00377156 Follow-Up - North Central Cancer Treatment Group Event Monitoring Form - 2470178v1.0

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  1. StudyEvent: North Central Cancer Treatment Group Event Monitoring Form
    1. No Instruction available.
Header
Are data amended (If yes, highlight amended areas)
Unnamed Module
Were you able to obtain any information about the patient since the last report (If this is the first event monitoring form check yes, enter assessment date and complete the rest of the form.)
Vital Status
Vital Status
Primary Cause of Death
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (since submission of the last event monitoring form)
Notice Of First Relapse/progression In The Event Monitoring Phase
Has the patient developed a first relapse or progression that has not been previously reported
Site of relapse/progression (scheck all that apply)
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Late Adverse Event
Has the patient experienced (prior to treatment for progression or relapse or a second primary, and prior to non-protocol treatment) any severe (grade >=3) long term toxicity that has not been previously reported?
Description Of Primary Disease
CTC AE Attribution Code

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