Description:

S1007 Prestudy Form (45282) Tamoxifen Citrate, Letrozole, Anastrozole, or Exemestane With or Without Chemotherapy in Treating Patients With Invasive RxPONDER Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90DB6C43-AEA1-137D-E040-BB89AD432116

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=90DB6C43-AEA1-137D-E040-BB89AD432116

Keywords:
Versions (2) ▾
  1. 8/27/12
  2. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01272037 Pre-Study - S1007 Prestudy Form (45282) - 3141026v1.0

Instructions: Submit this form within 7 days of registration. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in the Comments section. Place an X in appropriate boxes. Circle AMENDED items in red and write AMENDED across top of form

Header
Disease Description
Kg
Menopausal Status (select one)
Tumor Laterality (select one)
ER Status
PgR Status
HER2 results/IHC
Additional Prestudy Data
Breast cancer was first detected by (select one)
Histologic Grade (combined histologic grade by SBR/Elston classification)
Nuclear Grade
Histology
Lymphovascular space invasion
Extranodal extension
Multifocal Tumors
Multicentric Tumors
Breast: Surgical Procedures
Most Extensive Primary Surgery (select one)
Was sentinel node sampling performed
Sentinel Node Biopsy Results
mm
Was axillary dissection performed?
Comments

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