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

Follow-Up - Follow-Up Brain Tumor Evaluation Form - 2290890v3.0 - Follow-Up Brain Tumor Evaluation Form

- 09/01/2015 - 1 Formulaire, 8 Groupes Item, 44 Eléments de données, 1 Langue

Groupes Item: CRF Header, Brain: Follow-up Form Administration, Brain: Baseline Status, Brain: Measurable Lesion(s) Follow-up Evaluation, Brain: Non-measureable/evaluable Lesion(s) Follow-up Evaluation, Brain: New Lesion(s) at Follow-up Evaluation, Brain: Evaluation Summary, Comments

Follow-Up Brain Tumor Evaluation Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E12EA69C-FEB7-54BA-E034-0003BA12F5E7

ACNS0122 Follow-up Worksheet NCT00047320

- 16/06/2015 - 1 Formulaire, 6 Groupes Item, 29 Eléments de données, 1 Langue

Groupes Item: Header, FOLLOW-UP STUDIES, DISEASE STATUS, EVALUATIONS, SIGNIFICANT EVENTS DURING THIS REPORTING PERIOD, CCRR MODULE

ACNS0122 Follow-up Worksheet NCT00047320 Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=BD7AAA29-31DD-2A8B-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00978458 Follow-Up - E3F05 Long-Term Follow-up Form - 2900961v1.0 - E3F05 Long-Term Follow-up Form

- 08/01/2015 - 1 Formulaire, 9 Groupes Item, 34 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, Section I - Vital Status, Section II - Reporting Period, Section III - Notice of New Primary, Section IV - Disease Follow-up Status, Section V - Adverse Events, Section VI - Non-Protocol Therapy Prior To (CNS) Progression, Footer Module

E3F05 Long-Term Follow-up Form 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=6C1889F9-D142-5474-E040-BB89AD431A23

RTOG-0525 F1: Follow-Up Form NCT00304031

- 16/06/2015 - 1 Formulaire, 6 Groupes Item, 45 Eléments de données, 1 Langue

Groupes Item: Clinical trial administrative data, Assessment, Disease Progression, Non-Protocol Therapy, Non-Protocol Therapy To Brain, Footer

RTOG-0525 F1: Follow-Up Form NCT00304031 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=FD9AAA90-325E-6D58-E034-0003BA3F9857

Brain and Central Nervous System Tumors NCT00978458 Follow-Up - E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form - 2902962v1.0 - E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form

- 08/01/2015 - 1 Formulaire, 16 Groupes Item, 94 Eléments de données, 1 Langue

Groupes Item: Header Module, Header, ON TREATMENT, OFF TREATMENT, Section I, Section II MEASURABLE LESIONS, T2/FLAIR, T1/Contrast, Section III - Lesions Reported as Non-Measurable at Baseline, T2/FLAIR , T1/Contrast, Section IV New CNS Lesions/New Enhancement of Previously Reported Lesions, T2/FLAIR, T1/Contrast, Section V Progression, Comments

E3F05 Primary Brain Tumor Follow-Up Disease Evaluation Form 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=6CB91C46-8BDC-9A0D-E040-BB89AD433170

Follow-Up - Brain Cancer - Event Monitoring Form - 2287724v3.0 - Brain Cancer - Event Monitoring Form

- 09/01/2015 - 1 Formulaire, 7 Groupes Item, 29 Eléments de données, 1 Langue

Groupes Item: CRF Header, Brain: Vital Status, Brain: Off Study Reason, Brain: Disease Follow-Up Status, Brain: Notice of Progression, Brain: Notice of New Primary, Brain: Long-Term Toxicity

Brain Cancer - Event Monitoring Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E51DD029-A8BB-3E76-E034-0003BA3F9857

RTOG 0825 Phase III GBM Follow-Up Form (F1) NCT00884741

- 08/07/2015 - 1 Formulaire, 7 Groupes Item, 65 Eléments de données, 1 Langue

Groupes Item: RTOG clinical trial administrative data, Patient status assessment, RECURRENCE OR PROGRESSION, Non-Protocol Therapy, Protocol Specific Adverse Event Evaluation1, Protocol Specific Adverse Event Evaluation2, Comments

RTOG 0825 Phase III GBM Follow-Up Form (F1) NCT00884741 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=5A7D0D0E-5E03-3FE7-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

Lapatinib + Topotecan or + Capecitabine in Recurrent Brain Metastases from Breast Cancer; NCT00437073 - Survival Follow-Up

- 13/10/2020 - 1 Formulaire, 2 Groupes Item, 5 Eléments de données, 1 Langue

Groupes Item: Date of visit, Assessment Date, follow-up, Continuance of life

Study ID: 107671 Clinical Study ID: 107671 Study Title: EGF107671 – A Phase II Study of Lapatinib plus Topotecan or Lapatinib plus Capecitabine in the Treatment of Recurrent Brain Metastases from ErbB2-Positive Breast Cancer Following Cranial Radiotherapy Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00437073 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: N/A Trade Name: capecitabine, topotecan, lapatinib Study Indication: Neoplasms, Breast; Recurrent Brain Metastases

Brain and Central Nervous System Tumors NCT00887146 Follow-Up - North Central Cancer Treatment Group N0577 - Patient Questionnaire Booklet Compliance Form - 2745216v1.0 - North Central Cancer Treatment Group N0577 - Patient Questionnaire Booklet Compliance Form

- 09/01/2015 - 1 Formulaire, 2 Groupes Item, 11 Eléments de données, 1 Langue

Groupes Item: Header, Header

North Central Cancer Treatment Group N0577 - Patient Questionnaire Booklet Compliance 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=4C07E8C3-3298-293D-E044-0003BA3F9857

ADVL0212: Secondary Malignancy Report Worksheet NCT00053963

- 05/07/2015 - 1 Formulaire, 3 Groupes Item, 12 Eléments de données, 1 Langue

Groupes Item: Header, Secondary Malignancy, CCRR MODULE

ADVL0212: Secondary Malignancy Report Worksheet NCT00053963 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=B1EADE06-A88A-30BB-E034-0003BA12F5E7

ADVL0212: Relapse/Progression Worksheet NCT00053963

- 05/07/2015 - 1 Formulaire, 3 Groupes Item, 16 Eléments de données, 1 Langue

Groupes Item: Header, Relapse/Progression, CCRR MODULE

ADVL0212: Relapse/Progression Worksheet NCT00053963 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=B1EAD72E-7E69-3077-E034-0003BA12F5E7

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