Fast Fact Sheet for Protocol 0258 (Endometrium) Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer Source Form: NCI FormBuilder:

  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

To request one please log in.
License :
Creative Commons BY-NC 3.0 Legacy
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Endometrial Cancer NCT00942357 Pre-Study - Fast Fact Sheet for Protocol 0258 (Endometrium) - 3244339v1.0

No Instruction available.

  1. StudyEvent: Fast Fact Sheet for Protocol 0258 (Endometrium)
    1. No Instruction available.
Tracking Information
Did the patient sign an approved informed consent
Is this the first patient to receive IMRT on this study (GOG 0258) from your Institution?
Will the treatment plan for this first patient to be treated at your institution be digitally submitted to the ITC for processing in preparation for the rapid review?
Has HIPAA authorization been obtained
What is the site of the disease
What is the cell type?
What is the grade of the primary tumor
Positive Adnexa (For patients with Surgical Stage III disease, please indicate the areas of involvement at least one must be Yes - answer Yes to all that apply:)
Tumor involves the serosa
Positive pelvic nodes
Positive para-aortic nodes
Vaginal involvement
Parametrial involvement
Does the patient have FIGO 2009 Surgical Stage I or II endometrial clear cell or serous carcinoma with positive peritoneal cytology?
Has the patient had a hysterectomy and bilateral salpingo-oophorectomy?
Does the patient have residual tumor after surgery (any single site) exceeding 2 cm in maximum dimension?
What type of external beam radiation is planned in the event that Regimen I is assigned to the patient?
Has the treating Institution been credentialed for IMRT by the Radiological Physics Center (RPC) at M.D. Anderson Cancer Center?
Is the Serum Creatinine less than or equal to institutional ULN?
Is the bilirubin less than or equal to 1.5 x ULN
Are the SGOT, SGPT and Alkaline Phosphatase less than or equal to 2.5 X ULN?
Will the patient have the following parameters measured within 14 days prior to initiating protocol therapy (HGB or HCT, ANC, Differential, Platelets, Creatinine, Bilirubin, SGOT, SGPT, Alkaline Phosphatase, Urinalysis and Quality of Life Assessment)
Will the patient have the following parameters measured within 28 days prior to initiating protocol therapy (History and Physical Exam, Toxicity Assessment, Pelvic Examination, Chest X-Ray, Abdominal/Pelvi CT and if required a Chest CT scan)
Do the testing values/results meet the eligibility criteria as specified in Section 3.1?
Has the patient met the pre-entry requirements as specified in section 7.0
Performance Status
Is the patient age 18 years or older
Does the patient have a diagnosis of carcinosarcoma?
Does the patient have recurrent endometrial cancer
Has the patient received prior radiotherapy to any portion of the abdominal cavity or pelvis
Does the patient have a history of invasive cancer other than non-melanoma skin cancer that has been active within the last 5 years?
Has the patient had previous cancer treatment which contraindicates this protocol therapy
Does the patient have a history of serious co-morbid illness or uncontrolled illnesses that would preclude protocol therapy?
Does the patient have an estimated survival of less than 3 months?
Does the patent have FIGO 2009 Stage IVB endometrial cancer?
Does the patient have a history of myocardial infarction, unstable angina or uncontrolled arrythmia within 3 months of enrollment?
Does the patient have parenchymal liver metastases?
Has patient received prior chemotherapy for endometrial cancer?

Similar models

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial