Sarcoma - Follow-Up Form Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 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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Follow-Up - Sarcoma - Follow-Up Form - 2290562v3.0

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  1. StudyEvent: Sarcoma - Follow-Up Form
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Crf Header
Sarcoma: Follow-up Reporting Period
Sarcoma: Vital Status
Patient's Vital Status
Primary Cause of Death (check only one)
Sarcoma: Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (since submission of the previous follow-up form)
Sarcoma: Notice Of Progression
Has the patient developed a first progression (or relapse) that has not been previously reported?
Has the patient been diagnosed with first local-regional recurrence
Has the patient been diagnosed with first distant recurrence/progression?
Has the patient been diagnosed with a local-regional lymph node recurrence that has not been previously reported
Site(s) of Progression (mark all that apply)
Sarcoma: Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Is there a history of prior radiation therapy to the primary site?
New Primary, Histologic Type (check all that apply)
Sarcoma: Long-term Toxicity
Has the patient experienced (prior to diagnosis of recurrence or second primary) any severe (Grade >=3), long term toxicity that has not been previously reported

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