GOG-0263: Fast Fact Sheet for Protocol 0263 (Cervix) Radiation Therapy With or Without Chemotherapy in Patients With Stage I or Stage II Cervical Cancer Who Previously Underwent Surgery Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - 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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Cervical Cancer NCT01101451 Pre-Study - GOG-0263: Fast Fact Sheet for Protocol 0263 (Cervix) - 3206071v1.0

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  1. StudyEvent: GOG-0263: Fast Fact Sheet for Protocol 0263 (Cervix)
    1. No Instruction available.
Tracking Information
Did the patient sign an approved informed consent
Has HIPAA authorization been obtained
Is the patient age 18 years or older
Does the patient have pathologically proven primary cervical cancer I-IIA with squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma initially treated with a standard radical hysterectomy with pelvic lymphadenectomy?
What is the cell type?
What was the grade of the primary tumor
Performance Status
Please select the option which best describes the patient's disease characteristics:
Will the patient receive standard 4-field External Beam Radiotherapy or Intensity Modulated Radiation Therapy (IMRT)?
If IMRT is planned, 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 ULN
If no, is calculated creatinine clearance greater than 60 mL/min?
Is the bilirubin less than or equal to 1.5 x ULN
Are SGOT and Alkaline Phosphatase less than or equal to 3 X institutional upper limits of normal?
Has the patient met the pre-entry requirements as specified in section 7.0
Will the patient have the following parameters measured within 14 days prior to initiating protocol therapy (CBC, Differential, Platelets, Bilirubin, SGOT, Alkaline Phosphatase and Creatinine)
Will the patient have the following parameters measured within 28 days prior to initiating protocol therapy (Physical Exam, Pelvic Exam and Chest X-Ray)
Does the patient have tumor in the parametria, pelvic lymph nodes or any other extra uterine site or with positive surgical margins?
Does the patient have septicemia or severe infection?
Does the patient have intestinal obstruction or GI bleeding?
Does that patient have a post-operative fistula?
Has the patient received prior chemotherapy/radiation therapy treatment?
Are there circumstances that will not permit completion of study therapy or the required follow-up
Does the patient have any renal abnormalities that would require modification of radiation fields?
Does the patient have a history of the presence of other invasive malignancies, other than non-melanoma skin cancer, within the past 5 years?
Has the patient had previous cancer treatment which contraindicates this protocol therapy

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