Description:

NSABP PROTOCOL B-39: ON-STUDY FORM Radiation Therapy in Treating Women Who Have Undergone Surgery For Ductal Carcinoma In Situ or Stage I or Stage II Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E74657B5-A500-0931-E034-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E74657B5-A500-0931-E034-0003BA3F9857
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  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/5/15 7/5/15 -
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August 26, 2012

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00103181 On-Study - NSABP PROTOCOL B-39: ON-STUDY FORM - 2295516v3.0

Submit form as soon as possible after patient has been randomized.

  1. StudyEvent: NSABP PROTOCOL B-39: ON-STUDY FORM
    1. Submit form as soon as possible after patient has been randomized.
Unnamed1
Unnamed2
Are data amended (check box if yes, and circle amended items)
Unnamed3
Core (or Tru Cut) Needle Biopsy
Excisional Biopsy or Lumpectomy
Resection of Lumpectomy Margins (If more than one, list final resection.)
Sentinel Node Biopsy
Axillary Dissection or Axillary Sampling
Unnamed4
Tumor Laterality
Are the final margins of the resected specimen histologically free of invasive tumor and DCIS
Disease Stage
ER
PgR
Histologic Grade (Use combined histologic grade SBR/Elston classification.)
Is gross disease unifocal or multifocal (Answer without regard to whether disease is DCIS only, invasive only, or mixed DCIS/invasive.)
Pathologic Primary Tumor Size (Answer without regard to whether disease is DCIS only, invasive only, or mixed DCIS/invasive.)
The Invasive Tumor
Histologic Type

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