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ID
10570
Beschrijving
FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM NCT00020709 S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9E343E83-5F33-119F-E034-080020C9C0E0
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- 19-09-12 19-09-12 -
- 28-05-15 28-05-15 -
- 03-06-15 03-06-15 -
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3 juni 2015
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Creative Commons BY-NC 3.0 Legacy
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FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM NCT00020709
No Instruction available.
- StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM
Similar models
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- StudyEvent: FIRST SITE(S) OF PROGRESSION OR RELAPSE FORM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)
C0237753 (UMLS 2011AA ValueDomain)
C16154 (NCI Thesaurus ValueDomain-2)
C1704379 (UMLS 2011AA ValueDomain-2)
PatientInitials
Item
Patient Initials (L, F,M)
text
Institution/Affiliate
Item
Institution / Affiliate
text
Physician
Item
Physician
text
GroupName
Item
Group Name (Groups other than SWOG )
text
StudyNo.
Item
Study No. (Groups other than SWOG )
float
Pt.ID
Item
Pt. ID (Groups other than SWOG )
text
Dateoflastcontactordeath
Item
Date of last contact or death
text
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C1517741 (UMLS 2011AA ObjectClass-2)
C0011008 (UMLS 2011AA Property)
C47954 (NCI Thesaurus ObjectClass)
C1705415 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass-2)
C1517741 (UMLS 2011AA ObjectClass-2)
CL Item
Alive2005416 (Alive)
CL Item
Dead2005417 (Dead)
Dateofprogressionorrelapse
Item
Date of progression or relapse
text
LocalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Local Site(s) of Progression or Relapse at the time progression/relapse was detected (select all that apply)
text
Lungparenchymaadjacenttoprimarytumor
Item
Lung parenchyma adjacent to primary tumor
text
Bronchialstump
Item
Bronchial stump
text
Regional/NodalSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Regional/Nodal Site(s) of Progression or Relapse at the time progression/relapse was detected
text
Ipsilateralhilarmediastinum(nodal)
Item
Ipsilateral hilar mediastinum (nodal)
text
Contralateralhilarmediastinum(nodal)
Item
Contralateral hilar mediastinum (nodal)
text
Ipsilateralpleuraleffusion
Item
Ipsilateral pleural effusion
text
Contralateralpleuraleffusion
Item
Contralateral pleural effusion
text
Ipsilateralsupraclavicularlymphnodes
Item
Ipsilateral supraclavicular lymph nodes
text
Contralateralsupraclavicularlymphnodes
Item
Contralateral supraclavicular lymph nodes
text
DistantSite(s)ofProgressionorRelapseatthetimeprogression/relapsewasdetected
Item
Distant Site(s) of Progression or Relapse at the time progression/relapse was detected
text
Separatelobeoftheipsilaterallung
Item
Separate lobe of the ipsilateral lung
text
OppositeLungInd
Item
Opposite lung
text
Pericardialeffusion
Item
Pericardial effusion
text
BrainSiteInd
Item
Brain
text
Leptomeninges
Item
Leptomeninges
text
LiverSiteInd
Item
Liver
text
BoneSiteInd
Item
Bone
text
Adrenalglands
Item
Adrenal glands
text
Kidney
Item
Kidney
text
Skinorsubcutaneous
Item
Skin or subcutaneous
text
Othersite,specify
Item
Other site, specify
text
Item
For Local Progression or Relapse Progression/Relapse site within previous RT field? (select one )
text
Code List
For Local Progression or Relapse Progression/Relapse site within previous RT field? (select one )
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Not Applicable (Not Applicable)
Item
For Regional Progression or Relapse Progression/Relapse site within previous RT field? (select one)
text
Code List
For Regional Progression or Relapse Progression/Relapse site within previous RT field? (select one)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Not Applicable (Not Applicable)
Notes
Item
Notes
text