| Study identification: Form filled in by:
Reference checked by:
Date completing form:
Name study:
1st author, journal, year:
Study properties
RCT, non‐randomised controlled study, CCT, observational study prospective/retrospective
Time of inclusion:
Purpose of the study, as stated by authors:
Selection bias
Performance bias
Attribution bias
Detection bias
Analysis (statistics)
Study eligible for review: yes / no
If not, why not:
Types of participants: Intervention A Intervention B
Number of patients:
Age:
Mean:
Median:
SD:
Ranges:
Primary tumours:
FIGOstage IA
IB‐IIA
IIB‐
Histological type
Adenocarcinoma
Adenosquamous
Other (specify)
Grade: I
II
III
unknown
Performance Status: WHO
Types of intervention:
Surgery planned
Conservative surgery
Radical surgery
Protocol violations
Radiationtherapy planned
‐External & brachytherapy:
total Gy: fractions: frequency: field:
‐Chemoradiation
total Gy: fractions: frequency: field:
CT agent(s) doses: frequency
Protocol violations
Surgery & Radiation therapy
‐reason:
Outcome A B
Total patients entering the study
Declared ineligible
Removed from study for other reasons
Included in analysis
Completed prescribed treatment plan
(and available for response)
Follow up: A B
Known of .. patients.
Time of f.u. median:
SD:
Range:
Alive (5‐yr survival)
Without evidence of disease
With disease
Death:
DOD
Treatment complications
Not related death
Unknown
Recurrence: yes / no
If yes time‐interval (month)
If yes: local, distant, both
Complications:
‐radiation‐related
‐surgery‐related
‐death |
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