Description:

RTOG 1010 Surgery Form (S1) Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=87FDA2A8-3F52-6C0D-E040-BB89AD433137

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=87FDA2A8-3F52-6C0D-E040-BB89AD433137

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Versions (2) ▾
  1. 8/26/12
  2. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Adenocarcinoma of the Gastroesophageal Junction NCT01196390 Treatment - RTOG 1010 Surgery Form (S1) - 3104579v1.0

INSTRUCTIONS: Submit for all patients within 2 weeks of study entry. Submit with copies of the operative report (S2) and surgical pathology report (S5). Dates are mm-dd-yyyy unless otherwise specified

Unnamed Module 1
Amended Data
Endoscopy/biopsy/surgery
Endoscopic biopsy of esophageal tumor
Reason biopsy not done (ENDOSCOPY WITH)
Biopsy Result
Surgical Resection
Was resection attempted?
Reason surgery not performed
Protocol Surgery Type
Was patient nodal status determined (STAGING INCLUDE LEVELS 7,8,9,15,16,17 AND 20)
Resection Classification
Footer Module