ID

7176

Description

Bone Sarcoma - On-Study Form Recurrent Treatment Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E20A02D1-D3E7-176A-E034-0003BA12F5E7

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E20A02D1-D3E7-176A-E034-0003BA12F5E7

Mots-clés

19/09/2012 19/09/2012 -
09/01/2015 09/01/2015 - Martin Dugas
09/01/2015 09/01/2015 - Martin Dugas

Téléchargé le

9 janvier 2015

DOI

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Licence

Creative Commons BY-NC 3.0 Legacy

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On-Study - Bone Sarcoma - On-Study Form Recurrent Treatment - 2290047v3.0

model
Détails

No Instruction available.

1 Formulaires

StudyEvent: Bone Sarcoma - On-Study Form Recurrent Treatment
1. No Instruction available.

Name

Type

Description | Question | Decode (Coded Value)

Type de données

Alias

CRF Header

Item Group

Crf Header

Protocol ID Coordinating Group

Item

Coordinating Group Protocol No.

text

C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)

Coordinating Group Code

Item

Coordinating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)

Protocol Title

Item

Protocol Title

text

C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)

Patient Study ID

Item

Patient Study ID

text

C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (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)

Trial subject ID Participating Group

Item

Other 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)

ParticipatingGroupIdentifierCode

Item

Participating Group Code

text

C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

PatientName

Item

Patient Name (initials acceptable)

text

C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)

Sarcoma: Form Administration

Item Group

Sarcoma: Form Administration

Person Completing Form

Item

Person Completing Form

text

C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)

Data amended

Item

Are data amended (If data are amended, please circle in red when using paper form)

boolean

C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)

Bone Sarcoma: Recurrent Disease Description

Item Group

Bone Sarcoma: Recurrent Disease Description

CancerInitialDiagnosisDate

Item

Date of Initial Pathologic Diagnosis (not relapse)

date

C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)

DiseaseRecurrenceDate

Item

Recurrence date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C3352 (NCI Thesaurus Property)
C0034897 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

BiopsyProcedure

Item

Biopsy Type (at time of relapse)

text

C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus Property)
C25218 (NCI Thesaurus ValueDomain)
C1948041 (UMLS 2011AA ValueDomain)

CL.2

Code List

Biopsy Type (at time of relapse)

CL Item

Incisional (Incisional)

CL Item

Excisional (Excisional)

CL Item

Trucut Needle (TruCut needle)

CL Item

Fine Needle Aspirate (Fine needle aspirate)

CL Item

Large Bore Needle (Large bore needle)

CL Item

Other, Specify (Other specify)

BiopsyDescriptionSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

BoneSarcomaPrimarySite

Item

Primary Site

text

C12366 (NCI Thesaurus ObjectClass)
C0262950 (UMLS 2011AA ObjectClass)
C9118 (NCI Thesaurus ObjectClass-2)
C1261473 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)

CL.3

Code List

Primary Site

CL Item

Skull (Skull)

C12789 (NCI Thesaurus)
C0037303 (UMLS 2011AA)

CL Item

Vertebra (Vertebra)

C12933 (NCI Thesaurus)
C0549207 (UMLS 2011AA)

CL Item

Mandible (Mandible)

C12290 (NCI Thesaurus)
C0024687 (UMLS 2011AA)

CL Item

Maxilla (Maxilla)

C26470 (NCI Thesaurus)
C0024947 (UMLS 2011AA)

CL Item

Sternum (Sternum)

C12793 (NCI Thesaurus)
C0038293 (UMLS 2011AA)

CL Item

Ribs (Ribs)

C12782 (NCI Thesaurus)
C0035561 (UMLS 2011AA)

CL Item

Scapula (Scapula)

C12783 (NCI Thesaurus)
C0036277 (UMLS 2011AA)

CL Item

Clavicle (Clavicle)

C12695 (NCI Thesaurus)
C0008913 (UMLS 2011AA)

CL Item

Humerus (Humerus)

C12731 (NCI Thesaurus)
C0020164 (UMLS 2011AA)

CL Item

Radius (Radius)

C63921 (NCI Thesaurus)
C1306504 (UMLS 2011AA)

CL Item

Ulna (Ulna)

CL Item

Femur (Femur)

C12717 (NCI Thesaurus)
C0015811 (UMLS 2011AA)

CL Item

Tibia (Tibia)

C12800 (NCI Thesaurus)
C0040184 (UMLS 2011AA)

CL Item

Fibula (Fibula)

C12718 (NCI Thesaurus)
C0016068 (UMLS 2011AA)

CL Item

Ilium (Ilium)

C32765 (NCI Thesaurus)
C0020889 (UMLS 2011AA)

CL Item

Ischium (Ischium)

CL Item

Pubis (Pubis)

CL Item

Other, Specify (Other specify)

Primary Disease Site

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
C25341 (NCI Thesaurus Property)
C25251 (NCI Thesaurus ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)

SarcomaTumorOrganSideType

Item

Tumor Location, Side

text

C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C9118 (NCI Thesaurus ObjectClass-2)
C1261473 (UMLS 2011AA ObjectClass-2)
C13018 (NCI Thesaurus Property)
C0178784 (UMLS 2011AA Property)
C25306 (NCI Thesaurus Property-2)
C0441987 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.4

Code List

Tumor Location, Side

CL Item

Left (Left)

C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)

CL Item

Right (Right)

C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)

CL Item

Both (Both)

C49636 (NCI Thesaurus)
C1706086 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

BoneSarcomaAreaTumorType

Item

Area (If long bone,)

text

C12366 (NCI Thesaurus ObjectClass)
C0262950 (UMLS 2011AA ObjectClass)
C9118 (NCI Thesaurus ObjectClass-2)
C1261473 (UMLS 2011AA ObjectClass-2)
CL053268 (NCI Metathesaurus Property)
C25244 (NCI Thesaurus Property)
C0205146 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)

CL.5

Code List

Area (If long bone,)

CL Item

Metaphysis (Metaphysis)

CL Item

Epiphysis (Epiphysis)

CL Item

Diaphysis (Diaphysis)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

DiseaseSite

Item

Site(s) of Disease (at Study Entry)

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

CL.6

Code List

Site(s) of Disease (at Study Entry)

CL Item

Bone (Bone)

C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)

CL Item

Bone Marrow (Bone marrow)

C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)

CL Item

Soft Tissue (Soft tissue)

C12471 (NCI Thesaurus)
C0225317 (UMLS 2011AA)

CL Item

Cns/brain (CNS/brain)

CL Item

Lung (Lung)

C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)

CL Item

Chest Wall/ribs (Chest wall/ribs)

CL Item

Mediastinum (Mediastinum)

C12748 (NCI Thesaurus)
C0025066 (UMLS 2011AA)

CL Item

Pleura (Pleura)

C12469 (NCI Thesaurus)
C0032225 (UMLS 2011AA)

CL Item

Pericardium (Pericardium)

C13005 (NCI Thesaurus)
C0031050 (UMLS 2011AA)

CL Item

Liver (Liver)

C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)

CL Item

Abdominal Organs (Abdominal organs)

CL Item

Ascites (Ascites)

C2885 (NCI Thesaurus)
C0003962 (UMLS 2011AA)

CL Item

Peritoneum (Peritoneum)

C12770 (NCI Thesaurus)
C0031153 (UMLS 2011AA)

CL Item

Retroperitoneum (Retroperitoneum)

C12298 (NCI Thesaurus)
C0035359 (UMLS 2011AA)

CL Item

Skin (Skin)

C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)

CL Item

Lymph Nodes, Specify (Lymph nodes specify)

CL Item

Other, Specify (Other specify)

LymphNodeInvolvementSiteSpecify

Item

Lymph Nodes Specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)

DiseaseInvolvedSiteSpecify

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)

RegionalLymphNodeInvolvedInd-3

Item

Regional lymph nodes

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25643 (NCI Thesaurus ObjectClass-2)
C0205147 (UMLS 2011AA ObjectClass-2)
C25547 (NCI Thesaurus Property)

CL.7

Code List

Regional lymph nodes

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

DistantLymphNodeInvolvedInd-3

Item

Distant lymph nodes

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25321 (NCI Thesaurus ObjectClass-2)
C0443203 (UMLS 2011AA ObjectClass-2)
C25547 (NCI Thesaurus Property)

CL.8

Code List

Distant lymph nodes

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

SarcomaMalignantNeoplasmMetastaticInvolvementSite

Item

Metastatic Site (s - check all that apply)

text

C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9118 (NCI Thesaurus ObjectClass-2)
C1261473 (UMLS 2011AA ObjectClass-2)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C25548 (NCI Thesaurus Property-2)
C1314939 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)

CL.9

Code List

Metastatic Site (s - check all that apply)

CL Item

Bone (Bone)

C12366 (NCI Thesaurus)
C0262950 (UMLS 2011AA)

CL Item

Bone Marrow (Bone marrow)

C12431 (NCI Thesaurus)
C0005953 (UMLS 2011AA)

CL Item

Cns/brain (CNS/Brain)

CL Item

Liver (Liver)

C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)

CL Item

Lung (Lung)

C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)

CL Item

Pleural Nodules (Pleural nodules)

CL Item

Peritoneal Nodules (Peritoneal nodules)

CL Item

Soft Tissue (Soft tissue)

C12471 (NCI Thesaurus)
C0225317 (UMLS 2011AA)

CL Item

Pleural Effusion (Pleural effusion)

C3331 (NCI Thesaurus)
C0021071 (UMLS 2011AA)

CL Item

Ascites (Ascites)

C2885 (NCI Thesaurus)
C0003962 (UMLS 2011AA)

CL Item

Cerebrospinal Fluid (csf) (Cerebrospinal fluid (CSF))

CL Item

Distant Nodes, Specify (Distant Nodes)

CL Item

Other Specify (Other)

MalignantNeoplasmDistantLymphNodeMetastaticInvolvementSpecify

Item

Distant nodes specify

text

C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C14174 (NCI Thesaurus Property)
C0036525 (UMLS 2011AA Property)
C12745 (NCI Thesaurus Property-2)
C0024204 (UMLS 2011AA Property-2)
C25321 (NCI Thesaurus Property-3)
C0443203 (UMLS 2011AA Property-3)
C25548 (NCI Thesaurus Property-4)
C1314939 (UMLS 2011AA Property-4)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

Metastatic Sites, other

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C0280457 (UMLS CUI-1)
C14174 (NCI Thesaurus Property)
C3844311 (UMLS CUI-2)
C9305 (NCI Thesaurus ObjectClass)
C25548 (NCI Thesaurus Property-2)

LungDiseaseStatus

Item

Lung Specificity

text

C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)

CL.10

Code List

Lung Specificity

CL Item

Unilateral (Unilateral)

C28012 (NCI Thesaurus)
C0205092 (UMLS 2011AA)

CL Item

Bilateral (Bilateral)

C13332 (NCI Thesaurus)
C0238767 (UMLS 2011AA)

LeftLungNoduleCount

Item

Number of pulmonary nodules, left

text

C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C0024109 (UMLS 2011AA ObjectClass-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C3280 (NCI Thesaurus Property)
C0028259 (UMLS 2011AA Property)

CL.11

Code List

Number of pulmonary nodules, left

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

CL Item

4 (4)

CL Item

5 Or More (5 or more)

RightLungNoduleCount

Item

Number of pulmonary nodules, right

text

C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus ObjectClass-2)
C0024109 (UMLS 2011AA ObjectClass-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C3280 (NCI Thesaurus Property)
C0028259 (UMLS 2011AA Property)

CL.12

Code List

Number of pulmonary nodules, right

CL Item

1 (1)

CL Item

2 (2)

C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)

CL Item

3 (3)

CL Item

4 (4)

CL Item

5 Or More (5 or more)

SequenceMetastasisIrregularPresentInd-3

Item

Are skip metastases present?

text

C19151 (NCI Thesaurus ObjectClass)
C0027627 (UMLS 2011AA ObjectClass)
C25673 (NCI Thesaurus ObjectClass-2)
C1519249 (UMLS 2011AA ObjectClass-2)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C63815 (NCI Thesaurus Property-2)
C0205271 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)

CL.13

Code List

Are skip metastases present?

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

TumorLargestDimensionMeasurement

Item

Dimension 1 (Longest)

float

C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25550 (NCI Thesaurus Property)
C0443228 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property-2)
C0439534 (UMLS 2011AA Property-2)

TumorSecondDimensionMeasurement

Item

Dimension 2 (cm)

float

C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property-2)
C0439534 (UMLS 2011AA Property-2)

TumorThirdDimensionMeasurement

Item

Dimension 3 (cm)

float

C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25260 (NCI Thesaurus Property)
C0205437 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property-2)
C0439534 (UMLS 2011AA Property-2)

Resection type primary tumor

Item

Status of Primary Tumor

text

C25284 (NCI Thesaurus ValueDomain)
C0449522 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C0677930 (UMLS CUI-2)
C25251 (NCI Thesaurus ObjectClass-2)
C15232 (NCI Thesaurus Property)

CL.14

Code List

Status of Primary Tumor

CL Item

Unresected (Unresected)

CL Item

Not Recurrent, Resected, No Residual Tumor (Not recurrent, resected, no residual tumor)

CL Item

Not Recurrent, Resected, Residual Tumor (Not recurrent, resected, residual tumor)

CL Item

Recurrent (Recurrent)

C14173 (NCI Thesaurus)
C2945760 (UMLS 2011AA)

SarcomaHistologicCategory

Item

Histologic Type (check all that apply)

text

C9118 (NCI Thesaurus ObjectClass)
C1261473 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25161 (NCI Thesaurus Property-2)
C0008902 (UMLS 2011AA Property-2)
C25372 (NCI Thesaurus ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C25526 (NCI Thesaurus ValueDomain-2)
C0205462 (UMLS 2011AA ValueDomain-2)

CL.15

Code List

Histologic Type (check all that apply)

CL Item

Conventional Central Osteosarcoma (Conventional central osteosarcoma)

CL Item

Parosteal (juxtacortical) Osteosarcoma (Parosteal (juxtacortical) osteosarcoma)

CL Item

Periosteal Osteosarcoma (Periosteal osteosarcoma)

CL Item

Surface Osteosarcoma, High-grade (Surface osteosarcoma, high-grade)

CL Item

Telangiectatic Osteosarcoma (Telangiectatic osteosarcoma)

CL Item

Intraosseous Osteosarcoma (Intraosseous osteosarcoma)

CL Item

Small Cell Osteosarcoma (Small cell osteosarcoma)

CL Item

Osteosarcoma Nos (Osteosarcoma NOS)

CL Item

Chondrosarcoma (Chondrosarcoma)

CL Item

Dedifferentiated Chondrosarcoma (Dedifferentiated chondrosarcoma)

CL Item

Mesenchymal Chondrosarcoma (Mesenchymal chondrosarcoma)

CL Item

Clear Cell Chondrosarcoma (Clear cell chondrosarcoma)

CL Item

Undifferentiated Pleomorphic Sarcoma/"mfh" (Undifferentiated pleomorphic sarcoma/"MFH")

CL Item

Fibrosarcoma (Fibrosarcoma)

C3043 (NCI Thesaurus)
C0016057 (UMLS 2011AA)

CL Item

Malignant Giant Cell Tumor (Malignant giant cell tumor)

CL Item

Chordoma (Chordoma)

CL Item

Ewing's Sarcoma/pnet (Ewing's sarcoma/PNET)

CL Item

Maligant Peripheral Nerve Sheath Tumor (Malignant peripheral nerve sheath tumor)

CL Item

Leiomyosarcoma (Leiomyosarcoma)

C3158 (NCI Thesaurus)
C0023269 (UMLS 2011AA)

CL Item

Liposarcoma Nos (Liposarcoma NOS)

CL Item

Angiosarcoma (Angiosarcoma)

C3088 (NCI Thesaurus)
C0018923 (UMLS 2011AA)

CL Item

Epithelioid Hemagioendothelioma (Epithelioid hemangioendothelioma)

CL Item

Hemagioendothelioma Nos (Hemangioendothelioma NOS)

CL Item

Lymphoma (primary) (Lymphoma (primary))

CL Item

Hematopoietic Malignancy Nos (Hematopoietic malignancy NOS)

CL Item

Sarcoma Nos (Sarcoma NOS)

CL Item

Other Specify (Other specify)

Histologic Type, other

Item

Other specify

text

C25685 (NCI Thesaurus ValueDomain)
C1299220 (UMLS CUI-1)
C3262 (NCI Thesaurus ObjectClass)
C25526 (NCI Thesaurus Property)
C25161 (NCI Thesaurus Property-2)

SarcomaHistologicSubcategorySpecify

Item

Histologic Subtype (specify)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C9118 (NCI Thesaurus ObjectClass)
C1261473 (UMLS 2011AA ObjectClass)
C25526 (NCI Thesaurus Property)
C0205462 (UMLS 2011AA Property)
C25692 (NCI Thesaurus Property-2)
C1515010 (UMLS 2011AA Property-2)

Bone Sarcoma: Prior Health History

Item Group

Bone Sarcoma: Prior Health History

OtherDiseaseRadiationTherapyInd-3

Item

Prior Radiation Therapy for Other Disease?

text

C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus Property)
C1522449 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)

CL.16

Code List

Prior Radiation Therapy for Other Disease?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PriorRTSite

Item

Prior Radiation Therapy Site (If Yes,)

text

C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)

PriorRTHistoryInd-3

Item

Is there a history of prior radiation therapy to the primary site?

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)

CL.17

Code List

Is there a history of prior radiation therapy to the primary site?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PriorRTHistorySpecify

Item

Specify (If Yes,)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)

RetinoblastomaHistoryInd-3

Item

Is there a history of retinoblastoma?

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
CL053852 (NCI Metathesaurus ObjectClass)

CL.18

Code List

Is there a history of retinoblastoma?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

RetinoblastomaHistorySpecify

Item

Specify (If Yes,)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
CL053852 (NCI Metathesaurus ObjectClass)

Paget'sDiseaseHistoryInd-3

Item

Is there a history of Paget's Disease?

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C3292 (NCI Thesaurus ObjectClass)
C0029401 (UMLS 2011AA ObjectClass)

CL.19

Code List

Is there a history of Paget's Disease?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Paget'sDiseaseHistorySpecify

Item

Specify (If Yes,)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C3292 (NCI Thesaurus ObjectClass)
C0029401 (UMLS 2011AA ObjectClass)

Li-FraumeniSyndromeHistoryInd-3

Item

Is there a history of Li-Fraumeni syndrome?

text

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C3476 (NCI Thesaurus ObjectClass)
C0085390 (UMLS 2011AA ObjectClass)

CL.20

Code List

Is there a history of Li-Fraumeni syndrome?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

Li-FraumeniSyndromeHistorySpecify

Item

Specify (If Yes,)

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C18772 (NCI Thesaurus Property)
C0262926 (UMLS 2011AA Property)
C3476 (NCI Thesaurus ObjectClass)
C0085390 (UMLS 2011AA ObjectClass)

PriorPatientMedicalConditionInd-3

Item

Are there any other prior medical conditions, such as any bone abnormalities?

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)

CL.21

Code List

Are there any other prior medical conditions, such as any bone abnormalities?

CL Item

Yes (Yes)

C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)

CL Item

No (No)

C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)

CL Item

Unknown (Unknown)

C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)

PriorPatientMedicalConditionSpecify

Item

Specify (If Yes,)

text

C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25457 (NCI Thesaurus Property-2)
C0348080 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)

Sarcoma: Prior Treatment

Item Group

Sarcoma: Prior Treatment

CancerPriorTreatmentInd-3

Item

Prior Treatment?

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property-2)

PriorChemotherapyAdministeredInd-3

Item

Prior Systemic Chemotherapy

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

PriorImmunotherapyAdministeredInd-3

Item

Prior Immunotherapy

boolean

C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15262 (NCI Thesaurus ObjectClass)
C0021083 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

Prior Radiation Therapy

Item

Prior Radiation Therapy

boolean

C38148 (NCI Thesaurus ValueDomain)
C1522449 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C0332152 (UMLS CUI-2)
C25629 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)

Prior Surgery

Item

Prior Surgery

boolean

C38148 (NCI Thesaurus ValueDomain)
C0744961 (UMLS CUI-1)
C38000 (NCI Thesaurus Property)
C15329 (NCI Thesaurus ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)

PrimarySurgeryPriorPerformedText

Item

Type of Prior Primary Surgery

text

C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)

PrimarySurgeryPriorPerformedDate

Item

Prior Primary Surgery Date (MM DD YYYY)

date

C25251 (NCI Thesaurus ObjectClass)
C0205225 (UMLS 2011AA ObjectClass)
C15329 (NCI Thesaurus ObjectClass-2)
C0543467 (UMLS 2011AA ObjectClass-2)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)

PriorTherapyOtherAdministeredInd-3

Item

Any Other Prior Therapy?

boolean

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)

PriorTherapyAdministeredSpecify

Item

Yes, specify

text

C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)

Sarcoma: Prior Treatment - Systemic Regimens

Item Group

Sarcoma: Prior Treatment - Systemic Regimens

PriorTreatmentRegimenName

Item

Prior Treatment Regimen Name (Drug, Agent, Biologic)

text

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)

PriorTreatmentRegimenBeginDate

Item

Prior Treatment Regimen Start Date (MM DD YYYY)

date

C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)

PriorTreatmentRegimenEndDate

Item

Prior Treatment Regimen End Date (MM DD YYYY)

date

C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)

PriorTreatmentRegimenText

Item

Prior Treatment Regimen Type (Adjuvant, High Dose)

text

C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)

Comments

Item Group

Comments

Research Comments

Item

Comments

text

C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)

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On-Study - Bone Sarcoma - On-Study Form Recurrent Treatment - 2290047v3.0

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