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Informed consent
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Date
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I/E criteria
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Yes; not
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Demographic data
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Age at inclusion; Menstrual State
|
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Comorbidities
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If yes: specify
|
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Cancer Histology and Receptors, SLN OSNA
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Tumour grade; Tumour size (maximum diameter); P53 (%); Ki67 (%); Lymphovascular infiltration; Ductal Ca in situ; % Estrogenic receptors; % Progesterone receptors; HER2 receptor status; OSNA TTL of SLN
|
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Previous medication (Adjuvant therapy)
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Drug; Start date; Stop date
|
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Type of surgery
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Tumour surgery; date; Margins
|
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Randomization
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Treatment randomly allocated; Randomization date
|
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Radiotherapy intervention
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Patient completed the allocated treatment (If no: main reason); Start date; End date; Treatment gaps (If yes, reason); Dose per volume (Mean; Median; D95; D5; Volume) in the breast, tumour bed, supraclavicular and axillary levels I-III, and Internal mammary chain
|
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Co-medication
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Drug; Start date; Stop date
|
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Survival and disease recurrence
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Date of follow-up visit (If not performed, reason); Local recurrence; Regional recurrence (If yes: nodal level); Distant recurrence (If yes: organ); Vital status (if dead: date and cause)
|
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Image evaluation of local recurrence
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Technique; Local recurrence (if yes: Maximum diameter)
|
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Physical examinationa
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Palpable breast tumour (if yes: size, skin infiltration, inflammatory carcinoma, satellite lesions); Palpable axillary nodes (if yes: size); Palpable supraclavicular nodes (if yes: size); Node staging
|
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Acute and chronic toxicity
|
CTCAE term; Grade; Start date; Stop date; Status (recovered w/o sequels; death)
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