Medical Record : Continuation Sheet for Consent to Participate in a Clinical Research Study 
Number ^Continuation: page 6 of 8 pages 
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Cytovene therapy. Pregnant women are not eligible for this protocol. Cytovene can cause cancer in 
animals. There is no information available to estimate the risk of this in humans. 
Additional Risk: 
This procedure is relatively new and it is possible that despite our extensive efforts other 
! unforeseen problems may occur including the possibility of unknown and possible disabling effects or 
death. 
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DURABLE POWER OF ATTORNEY FOR HEALTHCARE 
You have an illness that at some point may impair your ability to think clearly and to make 
decisions. A Durable Power of Attorney for Healthcare is a process by which you appoint someone to 
make decisions about your medical care should you become, and only if you become, unable to make 
these decisions yourself. Such people might include a husband, wife, other family member or close 
friend. It is important that this person know your moral, religious and/or personal preferences in 
research and medical care. The Durable Power of Attorney for Heathcare form helps us give you 
medical care and assures that your preferences in research and medical care are respected, if you 
should be unable to give informed consent. A Durable Power of Attorney for Healthcare form can be 
obtained from your attorney or from the admissions office at Iowa Methodist Medical Center. 
A TENTATIVE AGREEMENT TO AN AUTOPSY 
In case of death during or after your participation in this research study, we ask you for a 
tentative agreement to an autopsy. This will provide us with an opportunity to learn more about the 
effect of our treatment of your tumor. 
ALTERNATIVE TREATMENTS 
You have been offered the opportunity to participate in this study after your tumor recurred 
despite appropriate standard therapies for your disease. There are no other standard treatments that 
were shown to have significant effects in patients with your disease. You may or may not have 
received chemotherapy for the treatment of your brain tumor. Chemotherapy is sometimes used for 
the treatment of primary brain tumors, but its effect is usually considered marginal. A variety of 
experimental studies for the treatment of brain tumors are conducted in medical centers around the 
world, but the benefit of their approaches is as yet unknown. In addition, there is always the 
possibility for you to decline any further treatment for your disease. 
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