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  1. StudyEvent: S0100 CONSOLIDATION TREATMENT FORM
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Physical
PatientWeight
Item
Weight (kg)
double
BodySurfaceArea
Item
BSA (M2)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
Item Group
Chemotherapy
Item
Consolidation Regimen (check only one:)
text
CL.1
Code List
Consolidation Regimen (check only one:)
CL Item
Cyclophosphamide/ara-c/6-mp/mtx (Cyclophosphamide/Ara-C/6-MP/MTX)
CL Item
Mtx/prednisone/vincristine (MTX/Prednisone/Vincristine)
AgentName
Item
Other, specify (treatment)
text
AgentName
Item
Other, specify (treatment)
text
TreatmentStartDate
Item
Start Date
date
TreatmentEndDate
Item
Stop Date
date
AgentTotalDose
Item
Total dose given
double
Item Group
Chemotherapy Dose Modifications
Item
Were there any dose/fractionation modifications or additions/omissions from protocol treatment? (check one)
text
CL.6
Code List
Were there any dose/fractionation modifications or additions/omissions from protocol treatment? (check one)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned (i.e., the treatment was changed according to protocol guidelines))
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned (i.e., the treatment change was not part of protocol guidelines))
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Cranial Irradiation For Cns Leukemia
Item
Did the patient require cranial irradiation according to the protocol? (check one)
text
CL.4
Code List
Did the patient require cranial irradiation according to the protocol? (check one)
CL Item
Yes, For Treatment Of Cns Involvement (Yes, for treatment of CNS involvement)
CL Item
Yes, For Cns Prophylaxis In A Patient Not Expected To Receive Allogeneic Pbsct (Yes, for CNS prophylaxis in a patient not expected to receive allogeneic PBSCT)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Did this patient receive protocol cranial irradiation?
text
CL.5
Code List
Did this patient receive protocol cranial irradiation?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
RTBeginDate
Item
Start Date (RT)
date
RTEndDate
Item
Stop Date (RT)
date
RTTotalDose
Item
Total dose given (RT)
double
Item Group
Cranial Irradiation Dose Modifications
Item
Were there any dose/fractionation modifications or additions/omissions from protocol treatment? (check one)
text
CL.6
Code List
Were there any dose/fractionation modifications or additions/omissions from protocol treatment? (check one)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned (i.e., the treatment was changed according to protocol guidelines))
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned (i.e., the treatment change was not part of protocol guidelines))
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Comments
Item
Comments
text
Item Group
Ccrr Module For S0100 Consolidation Treatment Form
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitials
Item
Patient Initials (L, F, M)
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
TreatingPhysician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
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