ID

759

Beschrijving

NSABP Protocol B-35 Radiation Therapy Report Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01A1AE7-8AF7-36F3-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A01A1AE7-8AF7-36F3-E034-080020C9C0E0

Trefwoorden

Versies (3)
  1. 26-08-12 26-08-12 -
  2. 22-05-15 22-05-15 -
  3. 03-06-15 03-06-15 -
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26 augustus 2012

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053898 Treatment - NSABP Protocol B-35 Radiation Therapy Report - 2033448v3.0

Engels

Form E1 (04-30-2002) Breast radiation is required on this protocol. Submit form when radiation therapy has ended. If breast radiation was not done, submit form within 90 days of randomization.

1 Formulieren  
Unnamed1
Beschrijving

Unnamed1

First Three Letters of Patient's Last Name
Beschrijving

FirstThreeLettersofPatient'sLastName

Datatype

text

Patient Study ID
Beschrijving

PatientStudyID

Datatype

text

Institution Name
Beschrijving

InstitutionName

Datatype

text

Affiliate Name
Beschrijving

AffiliateName

Datatype

text

Person Completing Form Last Name
Beschrijving

PersonCompletingForm,LastName

Datatype

text

Person Completing Form First Name
Beschrijving

PersonCompletingForm,FirstName

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Person Completing Form Phone
Beschrijving

PersonCompletingForm,Phone

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Are data amended? (If Yes, circle the amended items in red.)
Beschrijving

AmendedDataInd

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Unnamed2
Beschrijving

Unnamed2

Has the patient received adjuvant RT? (prior to treatment failure or second primary cancer)
Beschrijving

AdjuvantRTInd

Datatype

text

Unnamed3
Beschrijving

Unnamed3

Adjuvant RT Begin Date (month day year)
Beschrijving

AdjuvantRTBeginDate

Datatype

date

Adjuvant RT End Date (month day year)
Beschrijving

AdjuvantRTEndDate

Datatype

date

Was the patient enrolled in NSABP Protocol B-39/RTOG 0413?
Beschrijving

NationalSurgicalAdjuvantBreastandBowelProjectBreastRadiationTherapyPriorReceivedInd-2

Datatype

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass
C15818
UMLS 2011AA ObjectClass
C1513905
NCI Thesaurus ObjectClass
C12971
UMLS 2011AA ObjectClass
C0006141
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C25639
UMLS 2011AA Property
C1514756
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NSABP Patient ID
Beschrijving

PatientNationalSurgicalAdjuvantBreastProjectIdentifierNumber

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C15818
UMLS 2011AA Property
C1513905
Breast
Beschrijving

Breast

Breast Irradiated
Beschrijving

RadiationTherapyBreastLocationSideAnatomicSite

Datatype

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C12971
UMLS 2011AA Property
C0006141
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
NCI Thesaurus ValueDomain
C25306
UMLS 2011AA ValueDomain
C0441987
RT Total Dose (cGY)
Beschrijving

RTTotalDose

Datatype

double

No. of Fractions (if applicable)
Beschrijving

RTTotalFractionCount

Datatype

double

Beam Energy (Kev if applicable)
Beschrijving

BeamEnergy

Datatype

text

Energy Type (if applicable)
Beschrijving

EnergyType

Datatype

text

Operative Area Boost
Beschrijving

Operative Area Boost

Operative Area Boost
Beschrijving

OperativeAreaBoost

Datatype

text

RT Total Dose (cGY)
Beschrijving

RTTotalDose

Datatype

double

No. of Fractions (if applicable)
Beschrijving

RTTotalFractionCount

Datatype

double

Beam Energy (Kev if applicable)
Beschrijving

BeamEnergy

Datatype

text

Energy Type (if applicable)
Beschrijving

EnergyType

Datatype

text

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Similar models

Form E1 (04-30-2002) Breast radiation is required on this protocol. Submit form when radiation therapy has ended. If breast radiation was not done, submit form within 90 days of randomization.

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed1
FirstThreeLettersofPatient'sLastName
Item
First Three Letters of Patient's Last Name
text
PatientStudyID
Item
Patient Study ID
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PersonCompletingForm,LastName
Item
Person Completing Form Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PersonCompletingForm,Phone
Item
Person Completing Form Phone
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
Are data amended? (If Yes, circle the amended items in red.)
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended? (If Yes, circle the amended items in red.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Unnamed2
Item
Has the patient received adjuvant RT? (prior to treatment failure or second primary cancer)
text
CL.2
Code List
Has the patient received adjuvant RT? (prior to treatment failure or second primary cancer)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Unnamed3
AdjuvantRTBeginDate
Item
Adjuvant RT Begin Date (month day year)
date
AdjuvantRTEndDate
Item
Adjuvant RT End Date (month day year)
date
Item
Was the patient enrolled in NSABP Protocol B-39/RTOG 0413?
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C15818 (NCI Thesaurus ObjectClass)
C1513905 (UMLS 2011AA ObjectClass)
C12971 (NCI Thesaurus ObjectClass)
C0006141 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25639 (NCI Thesaurus Property)
C1514756 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.3
Code List
Was the patient enrolled in NSABP Protocol B-39/RTOG 0413?
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
PatientNationalSurgicalAdjuvantBreastProjectIdentifierNumber
Item
NSABP Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C15818 (NCI Thesaurus Property)
C1513905 (UMLS 2011AA Property)
Item Group
Breast
Item
Breast Irradiated
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12971 (NCI Thesaurus Property)
C0006141 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
C25306 (NCI Thesaurus ValueDomain)
C0441987 (UMLS 2011AA ValueDomain)
CL.4
Code List
Breast Irradiated
CL Item
Left (Left)
C25229 (NCI Thesaurus)
C0205091 (UMLS 2011AA)
CL Item
Right (Right)
C25228 (NCI Thesaurus)
C0205090 (UMLS 2011AA)
RTTotalDose
Item
RT Total Dose (cGY)
double
RTTotalFractionCount
Item
No. of Fractions (if applicable)
double
BeamEnergy
Item
Beam Energy (Kev if applicable)
text
Item
Energy Type (if applicable)
text
CL.7
Code List
Energy Type (if applicable)
CL Item
X-ray Or Photon (X-ray or Photon)
CL Item
Electron (Electron)
C40428 (NCI Thesaurus)
C0005166 (UMLS 2011AA)
Item Group
Operative Area Boost
Item
Operative Area Boost
text
CL.6
Code List
Operative Area Boost
CL Item
By Brachytherapy (By brachytherapy)
CL Item
By Other Method (By other method)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
RTTotalDose
Item
RT Total Dose (cGY)
double
RTTotalFractionCount
Item
No. of Fractions (if applicable)
double
BeamEnergy
Item
Beam Energy (Kev if applicable)
text
Item
Energy Type (if applicable)
text
CL.7
Code List
Energy Type (if applicable)
CL Item
X-ray Or Photon (X-ray or Photon)
CL Item
Electron (Electron)
C40428 (NCI Thesaurus)
C0005166 (UMLS 2011AA)
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