Radiation parameters

Q11: What is the radiation protocol?

Q11A: Total dose (in gray) received

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Q11B: Boost (in Gray)

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Q11C: Dose per Fraction/fractionation (in Gray):

1 = 1.8 2 = 2 3 = 2.5 4 = 3

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Q11D: Duration (in days)

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Q12: Discontinue treatment before the scheduled time? 1 = Yes 2 = no

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Q12A: Reason____________________________________________