308 lines
18 KiB
Plaintext
308 lines
18 KiB
Plaintext
English French Notes Complete/Exclude
|
|
23. NUMBER OF TUMORS
|
|
24. DATE OF FIRST SYMPTOMS
|
|
25. DATE OF INITIAL DIAGNOSIS
|
|
26. DATE OF PATHOLOGIC DIAGNOSIS
|
|
27. PRIMARY SITE (ICD-O-2)
|
|
28. WHO HISTOLOGICAL CLASSIFICATION OF TUMOR
|
|
29. BEHAVIOR CODE (ICD-O-2)
|
|
31. DIAGNOSTIC CONFIRMATION
|
|
32. MOLECULAR MARKERS
|
|
33. TUMOR SIZE
|
|
34. TUMOR SIZE (SOURCE
|
|
35. KARNOFSKY'S RATING PRIOR TO THERAPY
|
|
34. TUMOR SIZE (SOURCE)
|
|
17. CLASS OF CASE.................:
|
|
1222 CHANGE IN SENSE OF SMELL AND/ OR TASTE....................
|
|
1223 ALTERED ALERTNESS............
|
|
1225 SPEECH DISTURBANCE...........
|
|
1226 PERSONALITY CHANGES..........
|
|
1228 MEMORY LOSS..................
|
|
1229 LACK OF CONCENTRATION........
|
|
1230 DOUBLE VISION................
|
|
1231 OTHER VISUAL DISTURBANCE.....
|
|
1232 DECREASED HEARING............
|
|
1236 WEAKNESS OR PARALYSIS........
|
|
1237 DIFFICULTY IN COORDINATION/ BALANCE.....................
|
|
1238 GENERALIZED SEIZURE..........
|
|
1239 FOOD SEIZURE.................
|
|
1240 BLADDER INCONTINENCE.........
|
|
1241 BOWEL INCONTINENCE...........
|
|
1242 PAIN (OTHER THAN HEADACHE)...
|
|
1243 WEIGHT CHANGE................
|
|
19. NEUROLOGICAL FINDINGS:
|
|
1248 MEMORY OR JUDGEMENT..........
|
|
1249 VISUAL ACUITY................
|
|
1250 VISUAL FIELDS................
|
|
1251 EYE MOVEMENTS (EOM)..........
|
|
1252 FACIAL SENSATION.............
|
|
1253 FACIAL MOVEMENT..............
|
|
1255 GAG REFLEX...................
|
|
1256 STERNOCLEIDOMASTOID/SHOULDER SHRUG STRENGTH..............
|
|
1257 ARTICULATION OR ENUNCIATION..
|
|
1259 TONGUE FASCICULATIONS OR ATROPHY.....................
|
|
1260 DECREASE IN SENSATION OF ANY SITE........................
|
|
1261 CORTICAL SENSORY DEFICIT.....
|
|
1262 WEAKNESS, ATROPHY OR FASCICULATION OF ANY SITE.................
|
|
1263 ATAXIA OF GAIT...............
|
|
1264 TRUNCAL ATAXIA...............
|
|
1266 RAPID ALTERNATING MOVEMENTS..
|
|
1267 FINGER TO FINGER NOSE TESTING
|
|
1268 HEEL TO KNEE TO SHIN TESTING.
|
|
1269 DEEP TENDON REFLEXES IN UPPER EXTREMITIES.................
|
|
1270 DEEP TENDON REFLEXES IN LOWER EXTREMITIES.................
|
|
1271 BABINSKI SIGN................
|
|
1272 HOFFMAN REFLEX...............
|
|
1273 OTHER ABNORMAL REFLEXES......
|
|
20. PRE-THERAPY DIAGNOSTIC STUDIES:
|
|
1275 CT SCAN OF BRAIN.............
|
|
1276 CT SCAN OF SPINE.............
|
|
1278 ISOTOPE BRAIN SCAN...........
|
|
1279 PET SCAN.....................
|
|
1280 SPECT SCAN...................
|
|
1281 MRI OF BRAIN.................
|
|
1282 MRI OF SPINE.................
|
|
1283 FUNCTIONAL MRI...............
|
|
21. TUMOR LOCATION/INVOLVEMENT:
|
|
1286 FRONTAL LOBE.................
|
|
1287 TEMPORAL LOBE................
|
|
1288 PARIETAL LOBE................
|
|
1289 OCCIPITAL LOBE...............
|
|
1290 OPTIC NERVES.................
|
|
1291 PITUITARY GLAND..............
|
|
1292 PINEAL GLAND.................
|
|
1294 BRAIN STEM...................
|
|
1295 SKULL BASE...................
|
|
1296 OTHER SKULL..................
|
|
1297 SPINAL CORD..................
|
|
1298 CEREBRAL SPINAL FLUID (CSF)..
|
|
1299 CRANIAL MENINGES.............
|
|
1300 SPINAL MENINGES..............
|
|
1305 23. NUMBER OF TUMORS..............
|
|
1306 24. DATE OF FIRST SYMPTOMS........
|
|
25. DATE OF INITIAL DIAGNOSIS.....:
|
|
1307 26. DATE OF PATHOLOGIC DIAGNOSIS..
|
|
27. PRIMARY SITE (ICD-O-2)........:
|
|
1308 28. WHO HISTOLOGICAL CLASSIFICATION OF TUMOR.....................
|
|
29. BEHAVIOR CODE (ICD-O-2).......:
|
|
31. DIAGNOSTIC CONFIRMAITON.......:
|
|
1309 32. MOLECULAR MARKERS.............
|
|
1394 33. TUMOR SIZE....................
|
|
34. TUMOR SIZE (SOURCE)...........: Size not recorded
|
|
1310 34. TUMOR SIZE (SOURCE)...........
|
|
1311 35. KARNOFSKY'S RATING PRIOR TO THERAPY......................
|
|
36. PROTOCOL PARTICIPATION
|
|
37. PROTOCOL PHASE
|
|
38. DATE OF FIRST COURSE TREATMENT
|
|
39. DATE OF INPATIENT ADMISSION
|
|
40. DATE OF INPATIENT DISCHARGE
|
|
41. DATE OF NON CA-DIRECTED SURGERY
|
|
42. DIAGNOSTIC/EVALUATIVE/PALLIATIVE (NON CA-DIRECTED) SURGERY
|
|
43. DATE OF CA-DIRECTED SURGERY
|
|
44. SURGICAL APPROACH
|
|
45. EXTENT OF SURGICAL RESECTION
|
|
46. SIZE OF RESIDUAL PRIMARY TUMOR FOLLOWING CA-DIRECTED SURGERY
|
|
47. SIZE OF RESIDUAL PRIMARY TUMOR FOLLOWING CA-DIRECTED SURGERY (SOURCE)
|
|
48. SURGICAL COMPLICATIONS/POST SURGICAL EVENTS
|
|
49. REASON FOR NO SURGERY
|
|
50. RADIATION THERAPY
|
|
51. DATE RADIATION STARTED
|
|
52. DATE RADIATION ENDED
|
|
53. TOTAL RADIATION DOSE (cGy)
|
|
54. NUMBER OF TREATMENTS TO THIS VOLUME
|
|
55. TYPE OF EXTERNAL BEAM RADIATION
|
|
56. INTERSTITIAL RADIATION/BRACHYTHERAPY
|
|
57. STEREOTACTIC RADIOSURGERY
|
|
58. RADIATION/SURGERY SEQUENCE
|
|
59. RADIATION COMPLICATIONS
|
|
60. REASON FOR NO RADIATION
|
|
61. DATE CHEMOTHERAPY STARTED
|
|
63. TYPE OF CHEMOTHERAPEUTIC AGENTS ADMINISTERED
|
|
64. CHEMOTHERAPEUTIC ROUTE
|
|
65. CHEMOTHERAPY COMPLICATIONS
|
|
66. REASON FOR NO CHEMOTHERAPY
|
|
67. DATE OTHER TREATMENT STARTED
|
|
68. OTHER TREATMENT
|
|
69. KARNOFSKY'S RATING AT TIME OF DISCHARGE/TRANSFER
|
|
1312 36. PROTOCOL PARTICIPATION........
|
|
37. PROTOCOL PHASE................: Not on
|
|
1313 37. PROTOCOL PHASE................
|
|
38. DATE OF FIRST COURSE TREATMENT:
|
|
1 39. DATE OF INPATIENT ADMISSION...
|
|
1.1 40. DATE OF INPATIENT DISCHARGE...
|
|
41. DATE OF NON CA-DIR SURGERY...:
|
|
42. DIAGNOSTIC/EVALUATIVE/PALLIATIVE (NON CA-DIRECTED) SURGERY:
|
|
NONE, NO NON CA-DIRECTED SURGICAL PROCEDURE...: Yes
|
|
VENTRICULOSTOMY, OR EXTERNAL VENTRICULAR DRAIN: No
|
|
CSF SHUNT, VENTRICULOPERITONEAL...............: No
|
|
CSF SHUNT, THIRD VENTRICULOSTOMY..............: No
|
|
CSF SHUNT, OTHER..............................: No
|
|
STEREOTACTIC BIOPSY...........................: No
|
|
OPEN BRAIN BIOPSY.............................: No
|
|
OPEN BIOPSY OF SPINAL CORD TUMOR..............: No
|
|
LAMINECTOMY FOR SPINAL CORD TUMOR, W/O TUMOR RESECTION, W/O OPENING DURA........: No
|
|
UNKNOWN IF SURGERY DONE.......................: No
|
|
NONE, NO NON CA-DIRECTED SURGICAL PROCEDURE..........: No
|
|
1314 NONE, NO NON CA-DIRECTED SURGICAL PROCEDURE..........
|
|
1315 VENTRICULOSTOMY, OR EXTERNAL VENTRICULAR DRAIN...........
|
|
1316 CSF SHUNT, VENTRICULOPERITONEAL........
|
|
1317 CSF SHUNT, THIRD VENTRICULOSTOMY.......
|
|
1318 CSF SHUNT, OTHER.......................
|
|
1319 STEREOTACTIC BIOPSY..........
|
|
1320 OPEN BRAIN BIOPSY............
|
|
1321 OPEN BIOPSY OF SPINAL CORD TUMOR.......................
|
|
1322 LAMINECTOMY FOR SPINAL CORD TUMOR, W/O TUMOR RESECTION, W/O OPENING DURA...........
|
|
1323 LAMINECTOMY FOR SPINAL CORD TUMOR, W/O TUMOR RESECTION, W OPENING DURA.............
|
|
1325 UNKNOWN IF SURGERY DONE......
|
|
43. DATE OF CA-DIRECTED SURGERY...:
|
|
44. SURGICAL APPROACH.............: None, no ca-directed surgery
|
|
45. EXTENT OF SURGICAL RESECTION..: None, no surgery performed
|
|
46. SIZE OF RESIDUAL PRIMARY TUMOR AFTER CA-DIR SURGERY.........: NA, surgical treatment not administered
|
|
47. SIZE OF RESIDUAL PRIMARY TUMOR AFTER CA-DIR SURGERY (SOURCE): Size not recorded
|
|
48. SURGICAL COMPLICATIONS/POST SURGICAL EVENTS:
|
|
ANESTHETIC PROBLEM...........: NA, surgery not performed
|
|
HEMORRHAGE AT OPERATIVE SITE.: NA, surgery not performed
|
|
SEIZURE......................: NA, surgery not performed
|
|
INFECTION(S).................: NA, surgery not performed
|
|
DVT (DEEP VENOUS THROMBOSIS..: NA, surgery not performed
|
|
PERSISTENT NEUROLOGICAL WORSENING OVER 4 DAYS POST-OP.........: NA, surgery not performed
|
|
OTHER........................: NA, surgery not performed
|
|
44. SURGICAL APPROACH.............: Surgical approach unknown
|
|
45. EXTENT OF SURGICAL RESECTION..: Unknown if surgery performed
|
|
ANESTHETIC PROBLEM...........: Unknown
|
|
HEMORRHAGE AT OPERATIVE SITE.: Unknown
|
|
DVT (DEEP VENOUS THROMBOSIS..: Unknown
|
|
1326 44. SURGICAL APPROACH.............
|
|
1327 45. EXTENT OF SURGICAL RESECTION..
|
|
1328 46. SIZE OF RESIDUAL PRIMARY TUMOR AFTER CA-DIR SURGERY.........
|
|
1329 47. SIZE OF RESIDUAL PRIMARY TUMOR AFTER CA-DIR SURGERY (SOURCE)
|
|
1330 ANESTHETIC PROBLEM...........
|
|
1331 HEMORRHAGE AT OPERATIVE SITE.
|
|
1334 DVT (DEEP VENOUS THROMBOSIS).
|
|
1335 PERSISTENT NEUROLOGICAL WORSENING OVER 4 DAYS POST-OP.........
|
|
58 49. REASON FOR NO SURGERY.........
|
|
50. RADIATION THERAPY.............: None
|
|
51. DATE RADIATION STARTED........:
|
|
52. DATE RADIATION ENDED..........: 00/00/0000
|
|
53. TOTAL RADIATION DOSE (cGy)....: No radiation administered
|
|
54. NUMBER OF TREATMENTS TO THIS VOLUME.......................:
|
|
55. TYPE OF EXT BEAM RADIATION....: No radiation therapy
|
|
56. INTERSTITIAL RAD/BRACHYTHERAPY: None, brachytherapy not given
|
|
57. STEREOTACTIC RADIOSURGERY.....: None, not administered
|
|
58. RADIATION/SURGERY SEQUENCE....:
|
|
59. RADIATION COMPLICATIONS:
|
|
SKIN REACTIONS...............: NA, radiation tx not administered
|
|
ANOREXIA.....................: NA, radiation tx not administered
|
|
NAUSEA OR VOMITING...........: NA, radiation tx not administered
|
|
FATIGUE......................: NA, radiation tx not administered
|
|
NEUROLOGIC WORSENING.........: NA, radiation tx not administered
|
|
50. RADIATION THERAPY.............: Unk, death cert cases only
|
|
52. DATE RADIATION ENDED..........: 99/99/9999
|
|
53. TOTAL RADIATION DOSE (cGy)....: Dose unknown
|
|
55. TYPE OF EXT BEAM RADIATION....: Unknown
|
|
56. INTERSTITIAL RAD/BRACHYTHERAPY: Unknown
|
|
57. STEREOTACTIC RADIOSURGERY.....: Unknown
|
|
SKIN REACTIONS...............: Unknown
|
|
NAUSEA OR VOMITING...........: Unknown
|
|
NEUROLOGIC WORSENING.........: Unknown
|
|
1345 50. RADIATION THERAPY.............
|
|
361 52. DATE RADIATION ENDED..........
|
|
1336 53. TOTAL RADIATION DOSE (cGy)....
|
|
56 54. NUMBER OF TREATMENTS TO THIS VOLUME......................
|
|
1337 55. TYPE OF EXT BEAM RADIATION....
|
|
1338 56. INTERSTITIAL RAD/BRACHYTHERAPY
|
|
1339 57. STEREOTACTIC RADIOSURGERY.....
|
|
51.3 58. RADIATION/SURGERY SEQUENCE....
|
|
1340 SKIN REACTIONS...............
|
|
1342 NAUSEA OR VOMITING...........
|
|
1344 NEUROLOGIC WORSENING.........
|
|
75 60. REASON FOR NO RADIATION.......
|
|
61. DATE CHEMOTHERAPY STARTED.....:
|
|
63. TYPE OF CHEMOTHERAPEUTIC AGENTS ADMINISTERED:
|
|
PROCARBAZINE.................: NA, chemotherapy not administered
|
|
CCNU.........................: NA, chemotherapy not administered
|
|
VINCRISTINE..................: NA, chemotherapy not administered
|
|
HYDROXYUREA..................: NA, chemotherapy not administered
|
|
METHOTREXATE.................: NA, chemotherapy not administered
|
|
CISPLATIN....................: NA, chemotherapy not administered
|
|
BCNU.........................: NA, chemotherapy not administered
|
|
BCNU WAFER IMPLANT...........: NA, chemotherapy not administered
|
|
VP-16........................: NA, chemotherapy not administered
|
|
CARBOPLATIN..................: NA, chemotherapy not administered
|
|
TEMOZOLOMIDE.................: NA, chemotherapy not administered
|
|
CYCLOPHOSPHAMIDE.............: NA, chemotherapy not administered
|
|
CPT-11.......................: NA, chemotherapy not administered
|
|
TAMOXIFEN....................: NA, chemotherapy not administered
|
|
INTERFERON...................: NA, chemotherapy not administered
|
|
CYTARABINE (ARA-C)...........: NA, chemotherapy not administered
|
|
OTHER........................: NA, chemotherapy not administered
|
|
BCNU WAFER IMPLANT...........: Unknown
|
|
1351 BCNU WAFER IMPLANT...........
|
|
64. CHEMOTHERAPEUTIC ROUTE........: NA, chemotherapy not administered
|
|
64. CHEMOTHERAPEUTIC ROUTE........: Unknown
|
|
1358 64. CHEMOTHERAPEUTIC ROUTE........
|
|
65. CHEMOTHERAPY COMPLICATIONS:
|
|
HEARING LOSS.................: NA, chemotherapy not administered
|
|
INFECTION....................: NA, chemotherapy not administered
|
|
NAUSEA AND VOMITING REQUIRING CESSATION OF CHEMOTHERAPY....: NA, chemotherapy not administered
|
|
PERIPHERAL BLOOD COUNT DROP/ BLEEDING/CESSATION OF CHEMO- THERAPY AND/OR TRANSFUSION.: NA, chemotherapy not administered
|
|
PERIPHERAL NEUROPATHY........: NA, chemotherapy not administered
|
|
RENAL FAILURE................: NA, chemotherapy not administered
|
|
PULMONARY TOXICITY...........: NA, chemotherapy not administered
|
|
HEARING LOSS.................: Unknown
|
|
PERIPHERAL NEUROPATHY........: Unknown
|
|
RENAL FAILURE................: Unknown
|
|
PULMONARY TOXICITY...........: Unknown
|
|
1359 HEARING LOSS.................
|
|
1361 NAUSEA AND VOMITING REQUIRING CESSATION OF CHEMOTHERAPY...
|
|
1362 PERIPHERAL BLOOD COUNT DROP/ BLEEDING/CESSATION OF CHEMO- THERAPY AND/OR TRANSFUSION.
|
|
1363 PERIPHERAL NEUROPATHY........
|
|
1364 RENAL FAILURE................
|
|
1365 PULMONARY TOXICITY...........
|
|
76 66. REASON FOR NO CHEMOTHERAPY....
|
|
67. DATE OTHER TREATMENT STARTED..:
|
|
68. OTHER TREATMENT...............:
|
|
1367 69. KARNOFSKY'S RATING AT TIME OF DISCHARGE/TRANSFER...........
|
|
70. DATE OF FIRST RECURRENCE
|
|
71. TYPE OF FIRST RECURRENCE
|
|
72. DATE OF PROGRESSION
|
|
73. TYPE OF PROGRESSION
|
|
74. RECURRENCE/PROGRESSION DOCUMENTATION
|
|
75. KARNOFSKY'S RATING AT TIME OF RECURRENCE/PROGRESSION
|
|
70. TYPE OF FIRST RECURRENCE
|
|
71. DATE OF FIRST RECURRENCE
|
|
70 70. DATE OF FIRST RECURRENCE......
|
|
1372 71. TYPE OF FIRST RECURRENCE......
|
|
1368 72. DATE OF PROGRESSION...........
|
|
1369 73. TYPE OF PROGRESSION...........
|
|
74. RECURRENCE/PROGRESSION DOCUMENTATION................: No recurrence/progession
|
|
1370 74. RECURRENCE/PROGRESSION DOCUMENTATION................
|
|
75. KARNOFSKY'S RATING AT TIME OF RECURRENCE/PROGRESSION.......: 888
|
|
1371 75. KARNOFSKY'S RATING AT TIME OF RECURRENCE/PROGRESSION.......
|
|
76. DATE OF SUBSEQUENT TREATMENT FOR RECURRENCE/PROGRESSION
|
|
77. PROTOCOL PARTICIPATION (SUBSEQUENT TREATMENT)
|
|
78. TYPE OF SUBSEQUENT SURGICAL TREATMENT FOR RECURRENCE/PROGRESSION
|
|
79. TYPE OF SUBSEQUENT RADIATION TREATMENT FOR RECURRENCE/PROGRESSION
|
|
80. TYPE OF SUBSEQUENT CHEMOTHERAPY FOR RECURRENCE/PROGRESSION
|
|
81. OTHER TYPE OF SUBSEQUENT TREATMENT FOR RECURRENCE/PROGRESSION
|
|
SUBSEQUENT TREATMENT
|
|
76. DATE OF SUBSEQUENT TREATMENT FOR RECURRENCE/PROGRESSION...:
|
|
77. PROTOCOL PARTICIPATION (SUBSEQUENT TREATMENT).......: Not on
|
|
1373 77. PROTOCOL PARTICIPATION (SUBSEQUENT TREATMENT).......
|
|
78. TYPE OF SUBSEQUENT SURGICAL TX FOR RECURRENCE/PROGRESSION...: None, no subsequent surgery
|
|
1374 78. TYPE OF SUBSEQUENT SURGICAL TX FOR RECURRENCE/PROGRESSION...
|
|
79. TYPE OF SUBSEQUENT RADIATION TX FOR RECURRENCE/PROGRESSION...: None
|
|
1375 79. TYPE OF SUBSEQUENT RADIAITON TX FOR RECURRENCE/PROGRESSION...
|
|
80. TYPE OF SUBSEQUENT CHEMOTHERAPY FOR RECURRENCE/PROGRESSION:
|
|
Chemotherapy not administered
|
|
PROCARBAZINE.......: NA CARBOPLATIN........: NA
|
|
CCNU...............: NA TEMOZOLOMIDE.......: NA
|
|
VINCRISTINE........: NA CYCLOPHOSPHAMIDE...: NA
|
|
HYDROXYUREA........: NA CPT-11.............: NA
|
|
METHOTREXATE.......: NA TAMOXIFEN..........: NA
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|