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Treatment - Brain Cancer - Neurologic Evaluation Form - 2286577v3.0 - Brain Cancer - Neurologic Evaluation Form

- 1/9/15 - 1 form, 3 itemgroups, 32 items, 1 language
Itemgroups: CRF Header, Brain: Form Administration, Brain: Neurologic Evaluation
Brain Cancer - Neurologic Evaluation Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE951920-1FCC-25F8-E034-0003BA12F5E7

Treatment - Brain Cancer - Definitive Surgery Form - 2286489v3.0 - Brain Cancer - Definitive Surgery Form

- 1/9/15 - 1 form, 5 itemgroups, 20 items, 1 language
Itemgroups: CRF Header, Brain: Form Administration, Brain: Surgical Treatment for Primary Site, Brain: Most Recent Surgery, Comments
Brain Cancer - Definitive Surgery Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE9506AA-7EEF-2525-E034-0003BA12F5E7

Treatment - Brain Cancer - Treatment by Cycle Form - 2287531v3.0 - Brain Cancer - Treatment by Cycle Form

- 1/9/15 - 1 form, 7 itemgroups, 48 items, 1 language
Itemgroups: CRF Header, Brain: Treatment Reporting Interval, Brain: Treatment Cycle Information - Clinical Evaluation Follow-up, Brain: Treatment Cycle Information - Systemic Therapy, Brain: Treatment Cycle Information - Concomitant Therapy, Brain: Treatment Schedule - Non-Protocol Therapy, Comments
Brain Cancer - Treatment by Cycle Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E51F0AB1-37FF-4133-E034-0003BA3F9857

On-Study Form Brain Metastases NCT00377156

- 7/25/15 - 1 form, 5 itemgroups, 14 items, 1 language
Itemgroups: Header, Description of Primary Disease, Disease/History, Neurologic Examination, Height
On-Study - North Central Cancer Treatment Group On-Study Form - 2467371v1.0 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=104D18F2-219E-2AE1-E044-0003BA3F9857

Treatment - Brain Cancer - Radiation Therapy Treatment Form - 2286709v3.0 - Brain Cancer - Radiation Therapy Treatment Form

- 1/9/15 - 1 form, 3 itemgroups, 18 items, 1 language
Itemgroups: CRF Header, Brain: Radiation Therapy, Comments
Brain Cancer - Radiation Therapy Treatment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE952E13-775D-272C-E034-0003BA12F5E7

North Central Cancer Treatment Group Evaluation/Observation Form NCT00377156

- 9/20/21 - 1 form, 8 itemgroups, 29 items, 1 language
Itemgroups: Header, Patient status assessment, Neurologic Examination, Observation, Systemic Disease Follow-up Status, Notice of First Recurrence, Treatment of Any Recurrence, Notice of New Primary
North Central Cancer Treatment Group Evaluation/Observation Form NCT00377156 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=109FB871-880B-538E-E044-0003BA3F9857

Breast Cancer NCT00377156 Treatment - North Central Cancer Treatment Group Radiosurgery (SRS) Reporting Form - 2470949v1.0 - North Central Cancer Treatment Group Radiosurgery (SRS) Reporting Form

- 9/17/21 - 1 form, 6 itemgroups, 31 items, 1 language
Itemgroups: Header, Header, Treatment Unit, Technique, Target Volume, Prescription Dose
North Central Cancer Treatment Group Radiosurgery (SRS) Reporting Form Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=10DCBEEF-8D3C-3745-E044-0003BA3F9857

Lung Cancer NCT00096265 Treatment - TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form - 2277910v3.0 - TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form

- 1/9/15 - 1 form, 1 itemgroup, 74 items, 1 language
Itemgroup: Header
TF RTOG Phase III - Multiple Brain Mets Treatment Summary Form Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D81D1978-6B15-04EC-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00887146 On-Study - North Central Cancer Treatment Group CD Submission Form - 2804515v1.0 - North Central Cancer Treatment Group CD Submission Form

- 1/8/15 - 1 form, 3 itemgroups, 15 items, 1 language
Itemgroups: Header Module, Header, Completed by VIEW Personnel:
North Central Cancer Treatment Group CD 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=5C3973FB-A21F-4ECE-E044-0003BA3F9857

Breast Cancer NCT00377156 RT Submission - North Central Cancer Treatment Group ARM B Radiation Therapy Reporting Form - 2470699v1.0 - North Central Cancer Treatment Group ARM B Radiation Therapy Reporting Form

- 1/8/15 - 1 form, 6 itemgroups, 26 items, 1 language
Itemgroups: Header, Brain, Technique, Treatment Areas, Dose and Time, Header, Footer Module
North Central Cancer Treatment Group ARM B Radiation Therapy Reporting Form Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=10D87E75-C2B0-0CB3-E044-0003BA3F9857

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

- 3/12/15 - 1 form, 7 itemgroups, 66 items, 1 language
Itemgroups: 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

North Central Cancer Treatment Group Evaluation/Treatment Form NCT00377156

- 6/8/15 - 1 form, 2 itemgroups, 11 items, 1 language
Itemgroups: Header, Reporting period
North Central Cancer Treatment Group Evaluation/Treatment Form NCT00377156 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=38AF9EF4-0FAC-2541-E044-0003BA3F9857

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