E2108 Surgical Resection Form Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer Source Form: NCI FormBuilder:

  1. 12/15/14 12/15/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01242800 Follow-Up - E2108 Surgical Resection Form - 3145725v1.0

INSTRUCTIONS: Complete this form within 30 days of the surgical procedure, or at the time the decision is made to forgo surgery. Submit original to the ECOG Coordinating Center. Keep a copy for your files.

General information
Report Period (Choose one)
Intent of Surgery
Type of surgery (resection)
Was axillary dissection performed?
Was sentinel node biopsy performed
Were free surgical margins achieved?
If reconstruction is planned or has already occurred, indicate below which type(s):

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