[ { "id": "EVT-001", "date": "2024-03-18", "end_date": null, "date_precision": "day", "date_basis": "specimen_collection", "category": "pathology", "title": "Initial rectosigmoid biopsy", "summary": "Superficial biopsy showed at least high-grade dysplasia in a tubulovillous adenoma, suspicious for invasion.", "status": "documented", "source_ids": [ "CL-SRC-001" ], "limitations": [] }, { "id": "EVT-002", "date": "2024-03-20", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "Baseline CT staging", "summary": "Approximately 6 cm proximal rectal mass and indeterminate liver lesions; no definite intrathoracic metastatic disease.", "status": "documented", "source_ids": [ "CL-SRC-003", "CL-SRC-004" ], "limitations": [ "A later clinical chronology uses March 19; primary report dates are March 20." ] }, { "id": "EVT-003", "date": "2024-03-25", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "Pelvic MRI staging", "summary": "Rectal MRI reported T3dN2Mx disease with involved circumferential resection margin and no sphincter involvement.", "status": "documented", "source_ids": [ "CL-SRC-005" ], "limitations": [] }, { "id": "EVT-004", "date": "2024-03-27", "end_date": null, "date_precision": "day", "date_basis": "specimen_collection", "category": "pathology", "title": "Adenocarcinoma confirmed on repeat biopsy", "summary": "Moderately differentiated rectal adenocarcinoma; MLH1, MSH2, MSH6 and PMS2 nuclear expression retained.", "status": "documented", "source_ids": [ "CL-SRC-002" ], "limitations": [] }, { "id": "EVT-005", "date": "2024-03-27", "end_date": null, "date_precision": "day", "date_basis": "report_signed", "category": "imaging", "title": "Liver MRI report", "summary": "Reported 23 mm left hepatic lesion, highly concerning for metastasis.", "status": "documented", "source_ids": [ "CL-SRC-006" ], "limitations": [ "Order dated March 26; acquisition date unverified. Report body and impression differ on segment number." ] }, { "id": "EVT-006", "date": "2024-04-08", "end_date": "2024-05-15", "date_precision": "day", "date_basis": "event_date", "category": "radiotherapy", "title": "Pelvic chemoradiotherapy", "summary": "Clinical history: capecitabine with 45 Gy in 25 fractions to pelvis/rectum, then a rectal boost to 50.4 Gy in 28 fractions total.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Radiotherapy delivery logs, plans and complete dose export unavailable." ] }, { "id": "EVT-041", "date": "2024-05-20", "end_date": null, "date_precision": "day", "date_basis": "portal_study_date_and_primary_report_signed_date", "category": "imaging", "title": "CT response after chemoradiation", "summary": "Decreased primary rectal mass size and enhancement, stable 22 mm segment 3 liver lesion, and no new lesions or progression.", "status": "documented", "source_ids": [ "CL-SRC-253" ], "limitations": [ "Primary report narrative captured; native PDF and imaging series missing." ] }, { "id": "EVT-007", "date": "2024-06-04", "end_date": "2024-09-17", "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Six CAPOX cycles recorded", "summary": "Clinical history: six capecitabine/oxaliplatin cycles, June–September 2024.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Clinical history includes cycle dates; administration records and complete dose modifications unavailable." ], "recorded_cycle_dates": [ "2024-06-04", "2024-06-25", "2024-07-16", "2024-08-06", "2024-08-28", "2024-09-17" ] }, { "id": "EVT-008", "date": "2024-08-02", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "CT response", "summary": "Primary CT reports: slight further decrease in rectal mass size and enhancement, unchanged 20 mm segment 3 liver lesion, no new lesions or intrathoracic metastases.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-251", "CL-SRC-252" ], "limitations": [ "Primary report narrative/signature captured; native PDF and original imaging series missing." ] }, { "id": "EVT-040", "date": "2024-10-04", "end_date": null, "date_precision": "day", "date_basis": "portal_study_date_and_primary_report_signed_date", "category": "imaging", "title": "Abdominal MRI response", "summary": "Segment 3 liver lesion slightly decreased to 17 mm with decreased diffusion restriction, remaining suspicious for metastasis; no new lesions.", "status": "documented", "source_ids": [ "CL-SRC-250" ], "limitations": [ "Primary report narrative captured; native PDF and imaging series missing." ] }, { "id": "EVT-009", "date": "2024-10-11", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "Pelvic MRI response", "summary": "Pelvic MRI: smaller rectal mass with residual tumor and incomplete response; suspicious extramesorectal nodes resolved and suspicious mesorectal nodes decreased.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-249" ], "limitations": [ "Primary report narrative/signature captured; native PDF and original imaging series missing.", "October 11 is the pelvis study date; the abdomen MRI was a separate October 4 study." ] }, { "id": "EVT-010", "date": "2024-10-22", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "surgery", "title": "Rectal and liver resection", "summary": "Rectal and left lateral liver resections: residual rectal adenocarcinoma and liver metastasis, negative margins; pathology stage ypT3N1aM1a.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-009" ], "limitations": [ "Surgical pathology available; operative report missing." ] }, { "id": "EVT-011", "date": "2025-01-23", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "surgery", "title": "Ileostomy reversal recorded", "summary": "Ileostomy takedown specimen collected January 23, 2025; January 28 pathology showed no dysplasia or malignancy.", "status": "documented", "source_ids": [ "CL-SRC-007", "CL-SRC-008", "CL-SRC-239" ], "limitations": [ "Pathology confirms the takedown specimen date; full operative report missing. Another assessment gives an inconsistent year." ] }, { "id": "EVT-012", "date": "2025-03-31", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "CT without recurrent or metastatic disease", "summary": "Primary CT reports: no recurrent disease or new metastases in abdomen/pelvis; no radiographic intrathoracic metastatic disease.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-245", "CL-SRC-246" ], "limitations": [ "Primary report narrative/signature captured; native PDF and original imaging series missing." ] }, { "id": "EVT-013", "date": "2025-04-28", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "Abdominal MRI without metastatic disease", "summary": "Primary abdominal MRI report: no abdominal metastatic disease after liver resection.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-244" ], "limitations": [ "Primary report narrative/signature captured; native PDF and original imaging series missing." ] }, { "id": "EVT-014", "date": "2025-07-03", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "FDG-avid periportal/periceliac soft tissue", "summary": "New FDG-avid periportal/periceliac soft tissue concerning for metastatic disease; pelvic soft-tissue thickening was non-FDG avid and favored postsurgical change.", "status": "documented", "source_ids": [ "CL-SRC-007", "CL-SRC-008", "CL-SRC-234" ], "limitations": [ "Primary imaging report available; original images missing." ] }, { "id": "EVT-015", "date": "2025-07-17", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan and panitumumab started", "summary": "Clinical history: first irinotecan/panitumumab cycle.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Original administration record unavailable." ] }, { "id": "EVT-016", "date": "2025-08-01", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Panitumumab held for rash", "summary": "Clinical history: irinotecan alone because of panitumumab-associated rash.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Original administration and adverse-event records unavailable." ] }, { "id": "EVT-035", "date": "2025-09-08", "end_date": null, "date_precision": "day", "date_basis": "study_date_explicit_in_primary_report", "category": "imaging", "title": "PET/CT suggests response", "summary": "Slightly decreased periportal/periceliac soft tissue size and decreased mild FDG uptake since July 3, suggesting treatment response. No definite new lesions or FDG-avid local rectal recurrence.", "status": "documented", "source_ids": [ "CL-SRC-235" ], "limitations": [] }, { "id": "EVT-017", "date": "2025-09-30", "end_date": "2025-10-10", "date_precision": "day", "date_basis": "event_date", "category": "radiotherapy", "title": "Adaptive abdominal SBRT", "summary": "Clinical history: MR-guided upper-abdominal stereotactic radiotherapy, 50 Gy in five fractions, with daily adaptation.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Fraction-specific plans, doses and delivery records unavailable." ] }, { "id": "EVT-037", "date": "2025-11-28", "end_date": null, "date_precision": "day", "date_basis": "report_date", "category": "pathology", "title": "City of Hope resection-slide review", "summary": "Outside review agreed with rectal and liver resection diagnoses; tissue collected October 22, 2024.", "status": "documented", "source_ids": [ "CL-SRC-237" ], "limitations": [] }, { "id": "EVT-018", "date": "2025-12", "end_date": null, "date_precision": "month", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan and panitumumab resumed", "summary": "Clinical history: irinotecan/panitumumab restarted after radiation.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Exact restart date and original administration records unavailable." ] }, { "id": "EVT-036", "date": "2025-12-23", "end_date": null, "date_precision": "day", "date_basis": "study_date_explicit_in_primary_report", "category": "imaging", "title": "PET/CT with reduced uptake and an indeterminate finding", "summary": "Stable-size periportal/periceliac soft tissue with decreased mild uptake. New soft tissue and increased uptake around the proper hepatic and pancreaticoduodenal arteries favored post-radiation change, with follow-up requested to exclude recurrent disease. No definite FDG-avid local rectal recurrence.", "status": "documented", "source_ids": [ "CL-SRC-236" ], "limitations": [] }, { "id": "EVT-038", "date": "2026-01-22", "end_date": null, "date_precision": "day", "date_basis": "report_date", "category": "pathology", "title": "Partial resection-slide review", "summary": "Massachusetts General Hospital reviewed ten of thirty-nine rectal slides and one liver slide, confirming residual rectal adenocarcinoma and colorectal liver metastasis.", "status": "documented", "source_ids": [ "CL-SRC-238" ], "limitations": [] }, { "id": "EVT-032", "date": "2026-02-10", "end_date": null, "date_precision": "day", "date_basis": "explicit_clinical_history_date", "category": "systemic_therapy", "title": "Panitumumab alone recorded; irinotecan held", "summary": "Complete June oncology note: cycle 7 panitumumab alone; irinotecan held for abdominal pain. Assessment dates the hold to February 10, 2026.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-008" ], "source_references": [ { "source_id": "CL-SRC-008", "snapshot_lines": [ 99, 665 ] } ], "limitations": [ "Clinician-note evidence; original medication administration records not reviewed." ], "drugs_recorded": [ "panitumumab" ], "drugs_held": [ "irinotecan" ] }, { "id": "EVT-019", "date": "2026-03-06", "end_date": "2026-03-08", "date_precision": "day", "date_basis": "event_date", "category": "treatment_complication", "title": "Hospital admission for upper gastrointestinal bleeding", "summary": "Clinical history: hospitalization for bleeding attributed to a duodenal ulcer.", "status": "clinician_reported_completed", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Primary admission, endoscopy and discharge records unavailable." ] }, { "id": "EVT-033", "date": "2026-03-10", "end_date": null, "date_precision": "day", "date_basis": "explicit_clinical_history_date", "category": "systemic_therapy", "title": "Chemotherapy hold recorded", "summary": "Complete June oncology chronology: chemotherapy held for abdominal pain on March 10, 2026.", "status": "clinician_reported_treatment_hold", "source_ids": [ "CL-SRC-008" ], "source_references": [ { "source_id": "CL-SRC-008", "snapshot_lines": [ 100 ] } ], "limitations": [ "Clinician-note evidence; original medication administration records not reviewed." ] }, { "id": "EVT-020", "date": "2026-04-08", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "New metabolically active periaortic nodes", "summary": "PET/CT showed new FDG-avid periaortic lymph nodes concerning for metastases, with no definite FDG-avid local rectal recurrence.", "status": "documented", "source_ids": [ "CL-SRC-010" ], "limitations": [] }, { "id": "EVT-039", "date": "2026-04-16", "end_date": null, "date_precision": "day", "date_basis": "specimen_collection", "category": "pathology", "title": "Surveillance biopsies and colon-polyp pathology", "summary": "Peptic duodenitis, minimal chronic gastric inflammation and sessile serrated adenoma/polyp without cytologic dysplasia.", "status": "documented", "source_ids": [ "CL-SRC-240" ], "limitations": [] }, { "id": "EVT-021", "date": "2026-04-21", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan and panitumumab resumed", "summary": "Clinical history: irinotecan/panitumumab resumed after progression.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-007", "CL-SRC-008" ], "limitations": [ "Original administration record unavailable." ] }, { "id": "EVT-022", "date": "2026-04-29", "end_date": null, "date_precision": "day", "date_basis": "report_date", "category": "pathology", "title": "HER2-negative result on archived liver tissue", "summary": "HER2 immunohistochemistry negative (HERACLES score 0) on liver tissue collected in October 2024.", "status": "documented", "source_ids": [ "CL-SRC-009" ], "limitations": [] }, { "id": "EVT-023", "date": "2026-05-06", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan alone; panitumumab held", "summary": "Clinical history: irinotecan alone; panitumumab held for rash.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-008" ], "limitations": [ "Original administration record unavailable." ] }, { "id": "EVT-024", "date": "2026-05-19", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan and panitumumab recorded", "summary": "Clinical note: combination treatment recorded.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-008" ], "limitations": [ "Original administration record unavailable.", "Complete note labels May 19 as C10 in the chronology and C11 in the assessment; conflicting cycle numbers retained." ] }, { "id": "EVT-025", "date": "2026-06-02", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Irinotecan recorded", "summary": "Clinical note: irinotecan cycle recorded; panitumumab administration unconfirmed.", "status": "clinician_reported_delivered", "source_ids": [ "CL-SRC-008" ], "limitations": [ "Omitted drugs cannot be assumed given or withheld. Original administration record unavailable." ] }, { "id": "EVT-026", "date": "2026-06-11", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "FDG avidity resolved in previously hypermetabolic nodes", "summary": "Primary June 11 PET/CT report: resolved FDG avidity in previously hypermetabolic retroperitoneal nodes; no new lesions or evidence of tumor progression.", "status": "documented", "source_ids": [ "CL-SRC-008", "CL-SRC-233" ], "limitations": [ "Primary report reviewed via authenticated portal capture; this update excludes DICOM images and native PDF.", "Primary report has unresolved comparison-date inconsistencies and an incomplete prior SUV entry." ] }, { "id": "EVT-034", "date": "2026-06-16", "end_date": null, "date_precision": "day", "date_basis": "dated_visit_plan", "category": "systemic_therapy", "title": "Treatment hold and July BOT/BAL start planned", "summary": "June oncology plan: hold irinotecan/panitumumab and begin BOT/BAL in the UK on July 3, 2026. Subsequent dosing and actual start date unconfirmed.", "status": "clinician_reported_plan", "source_ids": [ "CL-SRC-008" ], "source_references": [ { "source_id": "CL-SRC-008", "snapshot_lines": [ 685, 686 ] } ], "limitations": [ "Clinician-note evidence; original medication administration records not reviewed.", "Planned July 3 start differs from the separately retained patient-reported July 2 start." ], "planned_treatment": "BOT/BAL", "planned_start_date": "2026-07-03" }, { "id": "EVT-027", "date": "2026-07-02", "end_date": "2026-09-17", "date_precision": "day", "date_basis": "event_date", "category": "systemic_therapy", "title": "Botensilimab and balstilimab course reported", "summary": "I report two cycles between July 2 and September 17, 2026.", "status": "patient_reported_administered", "source_ids": [ "CL-SRC-012" ], "limitations": [ "Cycle-specific dates, doses and original administration records unavailable. Prior June note planned a July 3 start." ] }, { "id": "EVT-029", "date": "2026-09-28", "end_date": null, "date_precision": "day", "date_basis": "event_date", "category": "imaging", "title": "Progressive nodal disease on PET/CT", "summary": "PET/CT: progression in supraclavicular, mediastinal, retrocrural and retroperitoneal nodes. No suspicious liver lesion or focal osseous disease described; small subpleural lung nodules remained nonspecific.", "status": "documented", "source_ids": [ "CL-SRC-011" ], "limitations": [] }, { "id": "EVT-028", "date": null, "end_date": null, "date_precision": "unknown", "date_basis": "relative_timing", "category": "biomarker", "title": "Rising circulating tumor DNA reported", "summary": "I report Signatera rising from 1.7 before botensilimab/balstilimab to 100 MTM/mL before the September 2026 PET/CT; exact collection dates are unconfirmed.", "status": "patient_reported_result", "source_ids": [ "CL-SRC-012" ], "limitations": [ "Exact collection dates and original reports unavailable; observations excluded from verified laboratory results." ], "reported_values": [ { "value": 1.7, "unit": "MTM/mL", "timing": "before botensilimab/balstilimab" }, { "value": 100, "unit": "MTM/mL", "timing": "before September 2026 PET/CT; exact collection date unconfirmed" } ] }, { "id": "EVT-030", "date": null, "end_date": null, "date_precision": "unknown", "date_basis": "unknown_procedure_date", "category": "biopsy", "title": "Recent clavicular-node biopsy reported", "summary": "I report a clavicular-node biopsy, with some material reserved for diagnostic pathology and some sent for tissue banking.", "status": "patient_reported_completed", "source_ids": [ "CL-SRC-012" ], "limitations": [ "Procedure date, side, pathology, tumor content, intact-core count and banked viable inventory unverified." ], "curated_on": "2026-10-07" }, { "id": "EVT-031", "date": null, "end_date": null, "date_precision": "unknown", "date_basis": "planned_date_not_confirmed", "category": "systemic_therapy", "title": "Chemotherapy restart plan reported", "summary": "My plan is to restart irinotecan/panitumumab and potentially add capecitabine.", "status": "patient_reported_plan", "source_ids": [ "CL-SRC-012", "CL-SRC-254" ], "limitations": [ "Actual restart date, drugs and doses undocumented; treatment delivery unconfirmed.", "Patient clarification, 7 October 2026: capecitabine is a potential addition; final regimen unconfirmed." ] } ]