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

ADVL0212- Review Form (Dr. Chin) NCT00053963

- 03/06/2015 - 1 Formulaire, 2 Groupes Item, 8 Eléments de données, 1 Langue

Groupes Item: ECG Assessment, CCRR MODULE

ADVL0212- Review Form (Dr. Chin) 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=C0F2E959-BAAB-54D8-E034-0003BA12F5E7 NCT00053963

ACNS1123 Eligibility - FP.0000

- 02/06/2015 - 1 Formulaire, 11 Groupes Item, 42 Eléments de données, 1 Langue

Groupes Item: STRATIFICATION, TUMOR LOCATION Elig - Block 1, TUMOR LOCATION Elig - Block 2, INCLUSION CRITERIA - NGGCT STRATUM 1, INCLUSION CRITERIA - Germinoma STRATUM 2, ORGAN FUNCTION REQUIREMENT - Bone Marrow Function, ORGAN FUNCTION REQUIREMENT - Renal Function, ORGAN FUNCTION REQUIREMENT - Liver Function, CENTRAL NERVOUS SYSTEM FUNCTION, EXCLUSION CRITERIA, REGULATORY

ACNS1123 Eligibility Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=

HIV with Cancer Baseline AMC-061 NCT00890747 - Baseline Evaluation Form HIV with Cancer NCT00890747

- 20/05/2015 - 1 Formulaire, 4 Groupes Item, 19 Eléments de données, 1 Langue

Groupes Item: Header Module, SOLID TUMOR/LYMPHOMA ASSESSMENT, KAPOSI'S SARCOMA ASSESSMENT, HEMATOLOGIC MALIGNANCY ASSESSMENT

AMC-061 Baseline Evaluation Form (B61) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy NCT00890747 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610

Glioma evaluation NCCTGroup N0577 NCT00887146 - Evaluation/Observation Form Glioma NCT00887146

- 18/05/2015 - 1 Formulaire, 3 Groupes Item, 11 Eléments de données, 1 Langue

Groupes Item: Header Module, Patient data, Observation

North Central Cancer Treatment Group N0577 Evaluation/Observation Form Radiation Therapy or Radiation Therapy and Temozolomide or Temozolomide Alone in Treating Patients With Newly Diagnosed Anaplastic Glioma NCT00887146 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4C096CEC-61BF-47DB-E044-0003BA3F9857

Recurring cancer children (ADVL0212 NCT00053963) - Reporting Period Worksheet cancer (NCT00053963)

- 22/03/2015 - 1 Formulaire, 5 Groupes Item, 58 Eléments de données, 1 Langue

Groupes Item: Header, Patient characteristics, Concomitant Medication, Patient status, Adverse event

ADVL0212: Reporting Period Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC15B1-1989-311F-E034-0003BA12F5E7

Refractory tumors in children (NCT00053963) - Eligibility Worksheet (ADVL0212 NCT00053963)

- 20/03/2015 - 1 Formulaire, 2 Groupes Item, 32 Eléments de données, 1 Langue

Groupes Item: Header, Eligibility criteria

ADVL0212: Eligibility Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC07E8-6588-30D1-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00053963 Treatment - ADVL0212: Reporting Period Worksheet (Leukemia) - 2172521v3.0 - Reporting Period Worksheet (Leukemia ADVL0212)

- 12/03/2015 - 1 Formulaire, 7 Groupes Item, 66 Eléments de données, 1 Langue

Groupes Item: Header, Patient characteristics, Treatment, Concomitant Medication, New Cancer, Follow-Up, Adverse event

ADVL0212: Reporting Period Worksheet (Leukemia) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F387DC-C9D3-5664-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00884741 Treatment - RTOG 0825 Phase III GBM Treatment Summary Form (TF) - 2796514v1.0 - RTOG 0825 Phase III GBM Treatment Summary Form (TF)

- 09/01/2015 - 1 Formulaire, 8 Groupes Item, 68 Eléments de données, 1 Langue

Groupes Item: Header Module, Summary of Systemic Treatment, Summary of systemic treatment2, Treatment Summary, Protocol Specific Adverse Event Evaluation1, Protocol Specific Adverse Event Evaluation2, Adverse Events, Footer

RTOG 0825 Phase III GBM Treatment Summary Form (TF) 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=5A7D3B0F-8D23-492E-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00884741 Treatment - RTOG 0825 Phase III GBM Salvage Treatment Summary Form (SF) - 2797440v1.0 - RTOG 0825 Phase III GBM Salvage Treatment Summary Form (SF)

- 09/01/2015 - 1 Formulaire, 8 Groupes Item, 68 Eléments de données, 1 Langue

Groupes Item: Header Module, Summary of Systemic Treatment, Summary of systemic treatment2, Treatment Summary, Protocol Specific Adverse Event Evaluation1, Protocol Specific Adverse Event Evaluation2, Adverse Events, Footer Module

RTOG 0825 Phase III GBM Salvage Treatment Summary Form (SF) 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=5AE2A23C-8AF1-6A8B-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00887146 Toxicity - North Central Cancer Treatment Group N0577 Nadir/Adverse Event Form - 2745613v1.0 - North Central Cancer Treatment Group N0577 Nadir/Adverse Event Form

- 10/01/2015 - 1 Formulaire, 4 Groupes Item, 29 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Required Adverse Events from Section 10.0 of Protocol, Adverse Events beyond those required in Section 10.0 of Protocol

North Central Cancer Treatment Group N0577 Nadir/Adverse Event 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=4C094A66-12E0-40DD-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00887146 Toxicity - North Central Cancer Treatment Group N0577 - Late Effects of Radiation Therapy - 2747295v1.0 - North Central Cancer Treatment Group N0577 - Late Effects of Radiation Therapy

- 09/01/2015 - 1 Formulaire, 4 Groupes Item, 20 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Required Adverse Events from Section 10.0 of Protocol, Adverse Events beyond those required in Section 10.0 of Protocol

North Central Cancer Treatment Group N0577 - Late Effects of Radiation Therapy 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=4C93C0B6-85C4-1ECA-E044-0003BA3F9857

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

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