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Record details of prior surgery related to the disease being studies by the protocol or when the details would be clinically significant for the evaluation of this study.

Prior Surgery Supplement eCRF

Field Name

Description / Instructions


Date of Surgery(m)

Enter the date of the surgical procedure. Partial dates are acceptable when the day is not known.


Surgery Relapse DateEnter the calendar date of return of disease following surgery with a period of improvement or complete remission.DD-MMM-YYYY
Surgery ReasonSelect text term to explain the surgical setting or reason surgery was used for a patient.

Use pick list.


Select the name of a surgical procedure used to resection or remove a portion of a brain lesion.

Use pick list.

Extent of tumor resectionSelect the extent to which an abnormal mass of tissue that results from excessive cell division was surgically removed.

Use pick list.

Other SpecifyThe free-text field used to describe the name assigned to a surgical procedure done for diagnostic, surveillance, treatment, palliation, or study-directed purposes.

200 characters

Surgery OrganSelect the named location with the central nervous system that was the site of a surgical procedure.

Use pick list.

Surgery Site

Select the named and more specified location in the body that was the site of a surgical procedure.

Use pick list.

Surgery LocationSelect the named location in the body for a surgical procedure.

Use pick list.

Site LocationSelect the text term to identify the specified/detailed anatomic location of a malignant neoplasm that arises from or metastasize to structures within the cranium.

Use pick list.

Side DetailSelect specification relating to the side or laterality of an anatomic location.

Use pick list.

Post-op Histologic Diagnosis

Select the brain tumor histologic term.

Use pick list.

Histology Grade

Enter the histologic grade

10 characters

CSF Cytology Results Select the summary result of a cerebrospinal fluid (CSF) cytological laboratory finding. Use pick list.
Did the patient re-initiate protocol Tx post-operatively?Select from the yes/no indicator related to a patient initiating the administration of therapy. Use pick list.

Post-op Chemotherapy Start Date

Enter the calendar date on which a chemotherapy agent or regimen was started on a postoperative patient.


Post-op Radiographic Assessment DateEnter the calendar date on which a radiographic assessment was done on a postoperative patient.DD-MMM-YYYY

Legend: (m) RDC mandatory






Date of Surgery is in the future.

Enter a date that is equal to or earlier than the current date.

Last updated by Blackburn, Katie (NIH/NCI) [C] on Apr 18, 2017