Case Reporting Form (CRF)
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Trial ID: T-002
Initials: AB
Gender: Male
Age: 34
Date of Entry: 06/12/2025
Habit Details
| Habit Name | Status | From Age | To Age | Frequency/Day |
|---|---|---|---|---|
| Smoking | Stopped a year ago | 23 | 34 | 3 |
| Alcohol | Occasional user | 23 | 34 | 1 |
Clinical Course Details
Diagnosis & Staging
Site: Oral Cavity
Subsite: GB Sulcus
TNM: T:T4a N:N1 M:M0
Dimensions: Max: 5 cm, Min: 2 cm
Biopsy Report: MDSCC
Treatment History
Prior Radiotherapy: No
Prior Chemotherapy: Yes (Cisplatin weekly Paclitaxel Weekly)
Treatment Plan: Surgery followed by adjuvant CTRT
Surgery & Hospital Course
Admission Date: 01/11/2025
Surgery Date: 02/11/2025
Primary Surgery: WLE
Neck Dissection: Level I, Level II, Level III, Level IV, Level V
Reconstruction: Regional flap
Post-Op & Discharge
Course in Hospital: Uneventful
Tracheostomy: Yes
NG Tube: Yes
NG Tube Removal Date: 30/11/2025
Discharge Date: 12/11/2025