Search results - Portal of Medical Data Models (MDM-Portal)

ACNS0122 Surgical Checklist Worksheet NCT00047320

- 9/20/21 - 1 form, 7 itemgroups, 22 items, 1 language

Itemgroups: Header,Primary Surgery,REASON FOR SURGERY,CNS PERI-OPERATIVE COMPLICATIONS,POST-OP STEROIDS USED,Comments,CCRR MODULE

ACNS0122 Surgical Checklist 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=BD7B6161-4826-29D3-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00887146 Pathology - North Central Cancer Treatment Group N0577 Pathology Submission Form - 2745984v1.0 - North Central Cancer Treatment Group N0577 Pathology Submission Form

- 9/20/21 - 1 form, 4 itemgroups, 20 items, 1 language

Itemgroups: Header,Header,Institution Contact Information (Please Print),Footer Module

North Central Cancer Treatment Group N0577 Pathology Submission 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=4C08FC47-BFC6-632C-E044-0003BA3F9857

Pathology Reporting Form - Brain Tumor N0577

- 9/20/21 - 1 form, 4 itemgroups, 34 items, 1 language

Itemgroups: Header,I. CRA/RN,II. Completed by the NCCTG Pathology reviewer,Comments and Pathology Reporting

North Central Cancer Treatment Group N0577 Pathology Reporting Form - Brain Tumor 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=4CA85A1E-6D87-49C3-E044-0003BA3F9857

Brain and Central Nervous System Tumors NCT00978458 Quality of Life - E3F05 Quality of Life Assessment Form - FACT-BR - 3299831v1.0 - E3F05 Quality of Life Assessment Form - FACT-BR

- 9/20/21 - 1 form, 8 itemgroups, 64 items, 1 language

Itemgroups: Header Module,Report Period,Header,PHYSICAL WELL-BEING,SOCIAL/FAMILY WELL-BEING,EMOTIONAL WELL-BEING,FUNCTIONAL WELL-BEING,Additional Concerns

E3F05 Quality of Life Assessment Form - FACT-BR 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=B0EE8BE4-1DEE-C782-E040-BB89AD433D2E

Registration Glioblastoma Multiforme N0874 NCT00731731

- 9/20/21 - 1 form, 7 itemgroups, 92 items, 1 language

Itemgroups: Header,Demographics,Inclusion Criteria,Exclusion Criteria,Registration Check,Grouping Factor,Phase II patients: At the time of registration, the following will also be recorded (see section 7.27 second paragraph)

N0874 Registration (Step 2) Eligibility Checklist NCT00731731 Vorinostat, Temozolomide, and Radiation Therapy in Treating Patients With Newly Diagnosed Glioblastoma Multiforme Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7E51877D-925A-72BF-E040-BB89AD436E3B

Registration Glioma E3F05 NCT00978458

- 9/20/21 - 1 form, 2 itemgroups, 24 items, 1 language

Itemgroups: Eligibility,Patient Demographics / Pre-Treatment Characteristics

E3F05 Registration Worksheet (step 1) 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=612A5FBA-FC8E-B3D3-E040-BB89AD437EF0

Brain and Central Nervous System Tumors NCT00884741 On-Study - RTOG 0825: QOL M.D. Anderson Symptom Inventory - 2800871v1.0 - RTOG 0825: QOL M.D. Anderson Symptom Inventory

- 9/20/21 - 1 form, 4 itemgroups, 50 items, 1 language

Itemgroups: Header Module,QOL Cover Sheet,Part I. M.D. Anderson Symptom Inventory (MDASI-BT),Part II

RTOG 0825: QOL M.D. Anderson Symptom Inventory 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=5BABD9A9-3DF8-0152-E044-0003BA3F9857

Cognitive/Functional Effects NCT01372774 Eligibility - N107C Pre-Registration (Step 1) Form and Eligibility Checklist - 3226376v1.0 - N107C Pre-Registration (Step 1) Form and Eligibility Checklist

- 9/20/21 - 1 form, 4 itemgroups, 45 items, 1 language

Itemgroups: Pre-Registration Inclusion Criteria - All responses in this section below must be "Yes.",Pre-Registration Exclusion Criteria,Registration Check,Randomization Check (continued) - All responses in section below may be "Yes" or "No."

N107C Pre-Registration (Step 1) Form and Eligibility Checklist Stereotactic Radiosurgery or Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases That Have Been Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A06D80B4-4143-B9BC-E040-BB89AD437EB8

Cognitive/Functional Effects NCT01279681 Eligibility - N0949 Registration Form and Eligibility Checklist - 3143440v1.0 - N0949 Registration Form and Eligibility Checklist

- 9/20/21 - 1 form, 5 itemgroups, 80 items, 1 language

Itemgroups: Inclusion Criteria - All responses in this section below must be "Yes.",Exclusion Criteria - All responses in section below must be "No.",Randomization Check,Randomized Check (continued) - All responses in section below may be "Yes" or "No".,Stratification Factors (used fo randomization to Arms A-B)

N0949 Registration Form and Eligibility Checklist Combination Chemotherapy Plus Bevacizumab With or Without Oxaliplatin in Treating Older Patients With Metastatic Colorectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9156A820-0337-BDA0-E040-BB89AD435144

Brain and Central Nervous System Tumors NCT00890747 Demographic - AMC-061 Demographic Form (DEM) - 2978032v1.0 - AMC-061 Demographic Form (DEM)

- 9/17/21 - 1 form, 1 itemgroup, 7 items, 1 language

Itemgroup: Demographics

AMC-061 Demographic Form (DEM) 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=7C6E3CDA-FFD3-B993-E040-BB89AD432712

TEST Study - ODM-Form

- 9/1/21 - 1 form, 2 itemgroups, 5 items, 1 language

Itemgroups: Lab Identification Log,Physical Examination

TEST Study

Brain Neoplasms

Lapatinib + Topotecan or + Capecitabine in Recurrent Brain Metastases from Breast Cancer; NCT00437073 - Log

- 4/26/21 - 1 form, 9 itemgroups, 117 items, 1 language

Itemgroups: Date of visit, Assessment Date,Event Log, Status,Non-serious Adverse Event,Serious Adverse Event,Concomitant Agent,Concomitant Agent, Adrenal Cortex Hormones,Blood product; Supportive care,Collection of blood specimen for laboratory procedure, Pharmacogenetic Test, Informed Consent,Pharmacogenetic Test, Informed Consent, Withdraw (activity)

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

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