Description:

NSABP-B-47 Radiation Therapy Form (Form RT) A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women With Node- Positive or High-Risk Node-Negative HER2-Low Invasive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=955B416B-5B63-F8A3-E040-BB89AD43125A

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=955B416B-5B63-F8A3-E040-BB89AD43125A

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

January 9, 2015

DOI:
No DOI assigned. 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.

Breast Cancer NCT01275677 Treatment - NSABP-B-47 Radiation Therapy Form (Form RT) - 3161989v1.0

This paper worksheet may be completed to facilitate the entry of information in NSABP Coordinator Online. Partially completed online forms may be saved in Coordinator Online. DO NOT SUBMIT THIS WORKSHEET VIA FAX OR MAIL. Submit this form when radiation therapy has ended, or when it is known that radiation therapy will not be administered

Header
Section A - Radiation Therapy (rt) -- All Patients
Did the patient receive radiation therapy? (If no, omit the remaining questions)
Region irradiated (mark all that apply)
Section A - Radiation Therapy (rt) -- All Patients
Was a Boost given?
Was brachytherapy used?
Were there any unscheduled interruptions in radiation therapy?
Was RT interruption possibly, probably, or definitely due to RT toxicity? (if yes)
Section A - Radiation Therapy (rt) -- All Patients
PBI Technique
Were there any unscheduled interruptions in radiation therapy?
Was RT interruption possibly, probably, or definitely due to RT toxicity? (if yes)
Section A - Radiation Therapy (rt) -- All Patients
Was a Boost given?
Were there any unscheduled interruptions in radiation therapy?
Was RT interruption possibly, probably, or definitely due to RT toxicity? (if yes)
Footer

Similar models