Résultats de recherche - Portail des modèles médicaux de données (portail MDM)

Brain and Central Nervous System Tumors NCT00053963 Off Treatment - Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] - 2077867v3.0 - Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212]

- 09/01/2015 - 1 Formulaire, 4 Groupes Item, 28 Eléments de données, 1 Langue

Groupes Item: Header, Patient Status Information, Events of Interest, CCRR MODULE

Off Protocol Therapy Follow-up (OPTF) Report (Master) [ADVL0212] FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B24316ED-D5DA-16A3-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00978458 Eligibility - E3F05 Registration Worksheet (step 0) - 2828702v1.0 - E3F05 Registration Worksheet (step 0)

- 09/01/2015 - 1 Formulaire, 3 Groupes Item, 29 Eléments de données, 1 Langue

Groupes Item: Eligibility, Race, Patient Demographics / Pre-Treatment Characteristics

E3F05 Registration Worksheet (step 0) Radiation Therapy With or Without Temozolomide in Treating Patients With Low-Grade Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6129B720-53B3-074C-E040-BB89AD436AFD

Event Monitoring Form N0577

- 09/01/2015 - 1 Formulaire, 7 Groupes Item, 32 Eléments de données, 1 Langue

Groupes Item: Header Module, VITAL STATUS, Disease Follow-up Status, Notice of First Relapse/Progression in the Event Monitoring Phase, Notice of First Subsequent Treatment, Notice of New Primary, Late Adverse Events

North Central Cancer Treatment Group N0577 Event Monitoring Form Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C090D31-BB06-2FAA-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00884741 Treatment - RTOG 0825 Phase III GBM Salvage Treatment Guideline Questionnaire (SX) - 2797409v1.0 - RTOG 0825 Phase III GBM Salvage Treatment Guideline Questionnaire (SX)

- 09/01/2015 - 1 Formulaire, 3 Groupes Item, 13 Eléments de données, 1 Langue

Groupes Item: Header Module, Inclusion Criteria, Footer Module

RTOG 0825 Phase III GBM Salvage Treatment Guideline Questionnaire (SX) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5AE28686-9246-64D7-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00884741 Transmittal - RTOG 0825 Phase III GBM Code Breaking Form (CX) - 2797360v1.0 - RTOG 0825 Phase III GBM Code Breaking Form (CX)

- 09/01/2015 - 1 Formulaire, 4 Groupes Item, 14 Eléments de données, 1 Langue

Groupes Item: Header Module, RECURRENCE OR PROGRESSION, CONTACT INFORMATION FOR TREATING PHYSICIAN, Footer Module

RTOG 0825 Phase III GBM Code Breaking Form (CX) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5AE1E7F4-0A01-483F-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00884741 Treatment - RTOG 0825 Phase III GBM Radiotherapy Form (T1) - 2796276v1.0 - RTOG 0825 Phase III GBM Radiotherapy Form (T1)

- 09/01/2015 - 1 Formulaire, 1 Groupe Item, 21 Eléments de données, 1 Langue

Groupe Item: Radiotherapy Form

RTOG 0825 Phase III GBM Radiotherapy Form (T1) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A7BC3C4-2306-2CB9-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00304031 Treatment - RTOG-0525 T1: Radiotherapy Form - 2388768v1.0 - RTOG-0525 T1: Radiotherapy Form

- 09/01/2015 - 1 Formulaire, 1 Groupe Item, 20 Eléments de données, 1 Langue

Groupe Item: MODULE 1

RTOG-0525 T1: RadiotherapyForm Radiation Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma or Gliosarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FE14506D-7AFC-4C09-E034-0003BA3F9857

Brain and Central Nervous System Tumors NCT00304031 RT Submission - RTOG-0525 SR: Radiation Therapy Oncology Group Phase III GBM RT & TMZ Followed by Adjuvant TMZ Central Radiology Review Form - 2402984v1.0 - RTOG-0525 SR: Radiation Therapy Oncology Group Phase III GBM RT & TMZ Followed by Adjuvant TMZ Central Radiology Review Form

- 09/01/2015 - 1 Formulaire, 1 Groupe Item, 12 Eléments de données, 1 Langue

Groupe Item: MODULE 1

RTOG-0525 SR: Radiation Therapy Oncology Group Phase III GBM RT & TMZ Followed by Adjuvant TMZ Central Radiology Review Form Radiation Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma or Gliosarcoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0032097F-A80D-47A4-E044-0003BA3F9857

Neurocognitive Evaluation Summary Form (RTOG 0834)

- 09/01/2015 - 1 Formulaire, 5 Groupes Item, 36 Eléments de données, 1 Langue

Groupes Item: Header, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA)

RTOG 0834/EORTC 26053_22054/NCIC CTG CEC.1: Neurocognitive Evaluation Summary Form Radiation Therapy With or Without Temozolomide in Treating Patients With Anaplastic Glioma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5A667C59-2D09-6D69-E044-0003BA3F9857

GBM Neurocognitive Evaluation Summary Form (CS) RTOG 0825 Phase III

- 09/01/2015 - 1 Formulaire, 6 Groupes Item, 39 Eléments de données, 1 Langue

Groupes Item: Header Module, Hopkins Verbal Learning Test - Revised Administration, Trail Making Test Part A, Trail Making Test Part B, Contolled Oral Word Association (COWA), Footer

RTOG 0825 Phase III GBM Neurocognitive Evaluation Summary Form (CS) Temozolomide and Radiation Therapy With or Without Bevacizumab in Treating Patients With Newly Diagnosed Glioblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=5BE60D36-11E5-00FF-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00890747 Treatment - AMC-061 Concomitant Medication Form (MED) - 2935086v1.0 - AMC-061 Concomitant Medication Form (MED)

- 09/01/2015 - 1 Formulaire, 2 Groupes Item, 12 Eléments de données, 1 Langue

Groupes Item: Concomitant Medications, Comments

AMC-061 Concomitant Medication Form (MED) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=71988CF7-F951-68F0-E040-BB89AD4358A1

Brain and Central Nervous System Tumors NCT00890747 Treatment - AMC-061 Study Drug Administration Form (DA1) - 2913633v1.0 - AMC-061 Study Drug Administration Form (DA1)

- 09/01/2015 - 1 Formulaire, 3 Groupes Item, 9 Eléments de données, 1 Langue

Groupes Item: Header Module, Study Drug Administration, Footer Module

AMC-061 Study Drug Administration Form (DA1) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6DBDC738-4455-D324-E040-BB89AD433B23

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