Recall Phenomena Research Articles

A review of the literature on radiation recall phenomena in induced by COVID-19 infection or vaccination in cancer patients

A review of the literature on radiation recall phenomena in induced by COVID-19 infection or vaccination in cancer patients

The role of rehearsal and reminding in the recall of categorized word lists

Most theories of free recall emphasize the importance of retrieval in explaining temporal and semantic regularities in recall; rehearsal mechanisms are often absent or limit rehearsal to a subset of what was last rehearsed. However, in three experiments using the overt rehearsal method, we show clear evidence that just-presented items act as retrieval cues during encoding (study-phase retrieval) with prior related items rehearsed despite well over a dozen intervening items. Experiment 1 examined free recall of categorized and uncategorized lists of 32 words. In Experiments 2 and 3, we presented categorized lists of 24, 48, and 64 words for free recall or cued recall, with the category exemplars blocked in successive list positions (Experiment 2) or randomized throughout the list (Experiment 3). The probability of rehearsing a prior word was affected by its semantic similarity to the just-presented item, and the frequency and recency of its prior rehearsals. These rehearsal data suggest alternative interpretations to well-known recall phenomena. With randomized designs, the serial position curves were reinterpreted by when words were last rehearsed (which contributed to the list length effects), and semantic clustering and temporal contiguity effects at output were reinterpreted by whether words were co-rehearsed during study. The contrast with the blocked designs suggests that recall is sensitive to the relative (not absolute) recency of targeted list items. We discuss the benefits of incorporating rehearsal machinery into computational models of episodic memory, and suggest that the same retrieval processes that generate the recalls are used to generate the rehearsals.

Sociodemographic, clinical profile, and treatment characteristics of oncology patients developing radiation recall phenomenon: Two tertiary care center's experience of an eternal unpredictable phenomenon of cancer treatment.

ABSTRACTObjectives:To determine the socio-demographic and clinical profile of cancer patients developing radiation recall phenomenon or radiation recall dermatitis following chemotherapy administration, previously treated with external irradiation. We assessed its incidence, severity, frequency, differentiation from radio-sensitization and radiation-dermatitis, its correlation with radiation dose and chemotherapeutic agent, and various parameters affecting its occurrence.Materials and Methods:This observational prospective study was designed for 1092/2676 (50.2%) patients of histologically proven carcinoma breast, carcinoma lung, lymphomas, chest wall sarcomas, thymomas, thymic carcinomas, nasopharyngeal cancer, bladder carcinoma, rectal cancer, and metastatic cases who received radiation therapy followed by chemotherapy. Intake, treatment, observation, and follow-up were done from July 2014 to July 2021 for 7 years in two tertiary care cancer institutes of government setup.Results:In our study, majority of recall phenomena were reported in breast carcinoma 43/71 (60.5%) followed by carcinoma esophagus with 07/71 (9.8%) cases. Females developed 54.9% grade-I/II and 90% grade-III/IV recall cases compared to males with 45.1% and 10% cases, respectively (P = 0.005). Median radiation dose used was 45 Gy (dose range 8–70 Gy) (P = 0.656). Docetaxel resulted in 55% recall cases followed by paclitaxel with 12.7% of cases. Combination therapy reported 71.8% of cases compared to monotherapy with 28.2% of cases. Recall-cases recorded in the time period of 3–4 weeks between radiation and chemotherapy were 59/71 (83%) and those reported in >4 weeks were 12/71 (17%). Time-gap between 3 and 4 weeks reported 49% grade-I/II and 100% grade-III/IV recall-cases while time-gap >4 weeks resulted in 26% and 0% cases respectively (P = 0.000).Conclusion:In this study, taxanes and platinum-agents were the most common chemotherapeutic drugs involved in the occurrence of the recall phenomenon. Multi-drug regimens resulted in higher recall cases compared to monotherapy. Radiation dosage did not cause any significant impact. The risk and severity of recall reactions increased with female gender and shorter time-interval between radiation and systemic therapy, while early-onset recall cases displayed greater severity. This precedented but unpredictable phenomenon ceases to be a topic to be discarded in this modern era of highly conformal radiation therapy techniques and targeted cancer therapy.

Establishment, maintenance, and recall of inflammatory memory.

Known for nearly a century but through mechanisms that remain elusive, cells retain a memory of inflammation that equips them to react quickly and broadly to diverse secondary stimuli. Using murine epidermal stem cells as a model, we elucidate how cells establish, maintain, and recall inflammatory memory. Specifically, we landscape and functionally interrogate temporal, dynamic changes to chromatin accessibility, histone modifications, and transcription factor binding that occur during inflammation, post-resolution, and in memory recall following injury. We unearth an essential, unifying role for the general stress-responsive transcription factor FOS, which partners with JUN and cooperates with stimulus-specific STAT3 to establish memory; JUN then remains with other homeostatic factors on memory domains, facilitating rapid FOS re-recruitment and gene re-activation upon diverse secondary challenges. Extending our findings, we offer a comprehensive, potentially universal mechanism behind inflammatory memory and less discriminate recall phenomena with profound implications for tissue fitness in health and disease.

A temporal context repetition effect in rats during a novel object recognition memory task.

Recent research in humans has used formal models of temporal context, broadly defined as a lingering representation of recent experience, to explain a wide array of recall and recognition memory phenomena. One difficulty in extending this work to studies of experimental animals has been the challenge of developing a task to test temporal context effects on performance in rodents. The current study presents results from a novel object recognition memory paradigm that was adapted from a task used in humans and demonstrates a temporal context repetition effect in rats. Specifically, the findings indicate that repeating the first two objects from a once-encountered sequence of three objects incidentally cues memory for the third object, even in its absence. These results reveal that temporal context influences item memory in rats similar to the manner in which it influences memory in humans and also highlight a new task for future studies of temporal context in experimental animals.

Neurophysiological and Neuropsychological Correlates of Subconscious Auditory Processing During Anesthesia and Their Implications in Anesthesia Awareness.

Like any other unusual state of consciousness, the condition of anesthesia remains a mystery, especially regarding the information processing events of the brain. Evoked potentials are the only known way to understand the neurophysiological events of brain in this condition. Auditory evoked potentials (AEPs) have been used as a measure of the depth of anesthesia during the intra-operative process. AEPs have been classically divided, on the basis of their latency, into first, fast, middle, slow, and late components. Auditory evoked potential has been advocated for the assessment of intra-operative awareness (IOA) but has not been considered seriously enough to be universalized.It is because we have not explored enough the impact of auditory perception and auditory information processing on the IOA phenomena as well as on the subsequent psychological impact of IOA on the patient. This limitation is because we have poor understanding of the subconscious auditory processing itself. This perspective is especially important because more of the IOA phenomena exist in the subconscious domain than they do in the conscious domain of explicit recall. Two important forms of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to the operation. Here we present a review of the neurophysiological and neuropsychological correlates of auditory processing during anesthesia. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and subconscious information processing by auditory modality and how they interact during and after intra-operative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented using auditory evoked potential during monitoring of anesthesia, especially the midlatency auditory evoked potentials. To conclude, we propose that the use of Auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during anesthesia.

Use of Auditory Evoked Potentials for Intra-Operative Awareness in Anesthesia: A Consciousness-Based Conceptual Model

Auditory evoked potentials (AEPs) have been used as a measure of the depth of anesthesia during the intra-operative process. AEPs are classically divided, on the basis of their latency, into first, fast, middle, slow, and late components. The use of auditory evoked potential has been advocated for the assessment of Intra-operative awareness (IOA), but has not been considered seriously enough to universalize it. It is because we have not explored enough the impact of auditory perception and auditory processing on the IOA phenomena as well as on the subsequent psychological impact of IOA on the patient. More importantly, we have seldom tried to look at the phenomena of IOP from the perspective of consciousness itself. This perspective is especially important because many of IOA phenomena exist in the subconscious domain than they do in the conscious domain of explicit recall. Two important forms of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to the operation. Here, we present an integrated auditory consciousness-based model of IOA. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and subconscious information processing by auditory modality and how they interact during and after intra-operative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented by using auditory evoked potential during monitoring of anesthesia, especially the mid-latency auditory evoked potentials (MLAERs). To conclude our model with present hypothesis, we propose that the use of auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during anesthesia.

Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district

Ionizing and ultraviolet radiations, as well as burns, can selectively damage and immunologically mark the cutaneous area they act on through direct and indirect mechanisms. After the causal event has disappeared, the affected skin district may appear clinically normal, but its immune behavior is often compromised forever. In fact, irradiated or burned skin areas undergo a destabilization of the immune control, which can lead to either a reduction of immunity (as suggested by the facilitated local occurrence of tumors and infections) or an excess of it (as suggested by the possible local onset of disorders with exaggerated immune response). In other words, these areas become typical immunocompromised districts (ICD). Also, in recall phenomena the damaged skin area usually behaves as an ICD with an exaggerated immune response toward a wide range of drugs (especially chemotherapeutic agents) that prove to be harmless on the undamaged skin surface.The occurrence of any skin disorder on an irradiated, photoexposed, or burned skin area can be defined as an isoradiotopic, isophototopic, or isocaumatopic response, respectively; however, the opposite may also occur when elsewhere generalized cutaneous diseases or eruptions selectively spare irradiated, photoexposed, or burned skin sites (isoradiotopic, isophototopic, and isocaumatopic nonresponse, respectively). The pathomechanisms involved in any secondary disorder occurring on irradiated or burned skin areas may be linked to locally decreased or altered lymph flow (with dysfunction of lymph drainage) on the one hand, and to fibrotic throttling or reduction of peptidergic nerve fibers (with dysfunction of neuroimmune signaling) on the other hand, resulting in a significant dysregulation of the local immune response. Future clinical observations and experimental investigations on radiation dermatitis, sunburns, and thermal or chemical skin injuries should shed new light on the mechanisms regulating regional resistance to infectious agents, local oncogenesis, and district propensity to dysimmune reactions.

Subconscious Auditory Processing in Anesthesia: The Common Theme Between Dreams, Implicit Memory and Anesthesia Awareness

The fact that auditory evoked potentials (AEPs) have been used widely as a measure of the depth of anesthesia highlights the importance of auditory modality in consciousness-related neural processing during anesthesia, a phenomena more specifically known as Intra-operative awareness (IOA). The phenomena of IOA has seldom been observed from the perspective of consciousness itself. This perspective is especially important because the dimensions of IOA exist in the subconscious domain of mind as much as they exist in the conscious domain of explicit recall. Two important aspects of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to anesthesia experiences. Here we present an integrated auditory-consciousness based model of IOA. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and sub-conscious information processing by auditory modality and their interactions during and after intraoperative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented by using auditory evoked potential during monitoring of anesthesia, especially the Mid-latency Auditory Evoked Potentials (MLAERs). To conclude, we propose that the use of Auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during anesthesia.

Recall phenomena: another facet of the immunocompromised district

Recall phenomena: another facet of the immunocompromised district

The First Description of Docetaxel-Induced Recall Inflammatory Skin Reaction after Previous Drug Extravasation

To describe a cutaneous recall soft tissue injury at the site of previous extravasation of docetaxel. A 65-year-old white female with an invasive ductal carcinoma of the right breast was treated with carboplatin AUC 2 and docetaxel 30 mg/m(2) weekly via a peripheral vein access. During the 14th cycle, drug extravasation of docetaxel occurred in the left antecubital fossa characterized by a mild erythema without edema. A severe erythema developed in the former area of extravasation after the 15th cycle of carboplatin/docetaxel. The recall dermatitis continued to exacerbate after each course of systemic docetaxel chemotherapy and finally led to termination of this therapy. In general, extravasation of docetaxel causes only mild local skin reactions without further necessity of intervention. For pegylated liposomal doxorubicin and paclitaxel, inflammatory recall phenomena at sites of previous drug extravasation are rare and often occur as single events following administration of the same cytotoxic drug. According to the Naranjo probability scale, the administration of docetaxel in this case probably led to the cutaneous soft tissue injury as a result of extravasation. Caution is needed after an episode of docetaxel extravasation. Even after a therapy interruption of several weeks, resumption of chemotherapy with docetaxel might lead to recrudescence of the inflammatory skin reaction.

Recall dermatitis after systemic treatment with paclitaxel

Recall phenomena of the skin at the site of prior radiation treatment are well established after systemic anti-neoplastic therapy. The aim of this report is to describe a rare clinical entity of recall dermatitis after systemic treatment with paclitaxel without a history of previous radiation at the site of reaction. A 63-year-old Caucasian female patient treated with paclitaxel because of breast cancer (T3 N1 M0) is presented. Five days after the fifth-in-a-row infusion swelling and redness occurred on the left arm, where the drug has been administered. The skin changes were interpreted as erysipelas and the patient was treated with systemic antibiotic. One month later, when a new cycle of chemotherapy with paclitaxel was performed, the medication was administered on the opposite (right) arm. Several days after the procedure, the same changes occurred again on the left arm, as in the previous hospitalization. Based on the clinical features and the laboratory findings, diagnosis of "recall dermatitis" was coined. The presented case serves as a basis for discussion on the etiopathogenetic mechanism of the skin recall phenomenon. The drugs associated with the onset of such a reaction are debated. The specificity of this rare dermatological entity is important for setting up the exact diagnosis and therapeutic approach.

Sequential learning using temporal context

The temporal context model (TCM) has been extensively applied to recall phenomena from episodic memory. Here we use the same formulation of temporal context to construct a sequential learning model called the predictive temporal context model (pTCM) to extract the generating function of a language from sequentially-presented words. In pTCM, temporal context is used to generate a prediction vector at each step of learning and these prediction vectors are in turn used to construct semantic representations of words on the fly. The semantic representation of a word is defined as the superposition of prediction vectors that occur prior to the presentation of the word in the sequence. Here we create a formal framework for pTCM and prove several useful results. We explore the effect of manipulating the parameters of the model on learning a sequence of words generated by a bi-gram generating function. In this simple case, we demonstrate that feeding back the constructed semantic representation into the temporal context during learning improves the performance of the model when trained with a finite training sequence from a language with equivalence classes among some words. We also describe pTCM A , a variant of the model that is identical to pTCM at steady state. pTCM A has significant computational advantages over pTCM and can improve the quality of its prediction for some training sequences.

Examining the relationship between free recall and immediate serial recall: Similar patterns of rehearsal and similar effects of word length, presentation rate, and articulatory suppression

In five experiments, rehearsal and recall phenomena were examined using the free recall and immediate serial recall (ISR) tasks. In Experiment 1, participants were presented with lists of eight words, were precued or postcued to respond using free recall or ISR, and rehearsed out loud during presentation. The patterns of rehearsal were similar in all the conditions, and there was little difference between recall in the precued and postcued conditions. In Experiment 2, both free recall and ISR were sensitive to word length and presentation rate and showed similar patterns of rehearsal. In Experiment 3, both tasks were sensitive to word length and articulatory suppression. The word length effects generalized to 6-item (Experiment 4) and 12-item (Experiment 5) lists. These findings suggest that the two tasks are underpinned by highly similar rehearsal and recall processes.

Gemcitabine‐induced radiation recall in the treatment of pancreatic cancer

AbstractAim: To evaluate two cases of gemcitabine‐induced radiation recall in patients who were treated for localized pancreatic cancer, and review the literature.Methods: The two cases of radiation recall (from a cohort of 80 patients treated for pancreatic carcinoma) were retrospectively identified using patient medical records. Prior publications were identified through an English language literature search of MEDLINE Ovid from January 1966 to October 2006, using the key words gemcitabine and radiation recall.Results: Both the radiation recall reactions were limited to the gastrointestinal system, localized to previous radiotherapy field. No pathology was identified on radiological investigation. The onset of the radiation recall phenomenon was 2 and 10 days, respectively, from the time gemcitabine was initiated. The treatment of radiation recall consisted of the cessation of gemcitabine, initiating steroid therapy and supportive therapy. Both of the patients' symptoms achieved complete resolution. A comprehensive review of the literature found 15 previous cases of radiation recall related to gemcitabine but one reported effect involving the gastrointestinal system. Previously reported sites of recall phenomena included the skin, muscles, brain stem and optic nerve. In the treatment of pancreatic carcinomas, there were only four reported cases, three involving the onset of myositis of abdominal muscle and one case of gastrointestinal bleeding.Conclusion: Radiation recall from gemcitabine chemotherapy is uncommon. It can potentially arise in any site that has been irradiated previously. The treating doctor needs to be aware of this phenomenon to be able to manage this condition appropriately.

Instability in memory phenomena: A common puzzle and a unifying explanation

In mixed lists, stable free recall advantages are observed for encoding conditions that are unusual, bizarre, or attract extensive individual item elaboration relative to more common encoding conditions; but this recall advantage is often eliminated or reversed in pure lists. We attempt to explain this ubiquitous memory puzzle with an item-order account that assumes that (1) free recall of unrelated lists depends on order and item information; (2) unusual items attract greater individual item-processing but disrupt order encoding regardless of list composition; and (3) list composition determines differences in order encoding across unusual and common items. We show that the item-order account provides a unifying explanation of five memory phenomena for which the requisite data exist. The account also successfully anticipates pure-list reversals, in which the standard mixed-list recall pattern is obtained in pure, structured lists, a finding that competing accounts cannot handle. Extending the item-order account to other "established" recall phenomena may prove fruitful.

Gemcitabine and radiotherapy: Analysis of safe use

18146 Background: Radiation in combination with chemotherapy offers a significant survival advantage. Preclinical and clinical data indicate that gemcitabine (GEM) is a potent radiosensitizing agent in numerous cancer types used subsequently with radiation given in different doses and techniques. We compared safety/toxic effects of GEM with GEM plus radiation. Methods: Lilly Safety Database was searched for all reports where patients received radiation before, during and after GEM therapy. The string search for ‘radio’, ‘radia’ and a search for MedDRA terms covering possible radiation recall and typical recall phenomena were conducted. Cases were reviewed by a physician and allocated to one of the categories: ‘concurrent’ (radiation and GEM was given at the same time or 7 days apart), and ‘non-concurrent’ (treatment was given more than 7 days apart). Results: In one third of cases who received concurrent treatment the toxicity reported was higher in 3 System Organ Classes (SOC): ‘Injury’, ‘Gastrointestinal disorders’ (GI), and ‘Respiratory’ in comparison to non radiation treated patients: 4.1%, 16%, 14.8% versus 1.4%, 11.2% and 10.5% respectively but toxicity was lower for ‘Blood and lymphatic disorders’ and ‘General disorders’. In cases with ‘non-concurrent’ treatment the results were similar to ‘concurrent’ treatment for the Injury, Respiratory and Blood SOCs but GI toxicity was only 60% of the one seen in non radiation treated patients. In patients with reported radiation recall the most frequent were skin reactions, pneumonitis and myositis. Radiation injury mainly affected targeted tissue organs exposed to direct radiation e.g eosophagitis and pneumonitis for chest irradiation, GI effects for abdominal irradiation. In Non-concurrent administration no correlation between GEM dose and toxicity could be established. In Concurrent cases, treatment dose and technique of radiation, target tissue and volume were factors together with dose and frequency of GEM administration. Conclusions: Review of adverse drug reactions for GEM and radiation treatment reported from estimated GEM exposure of nearly 1.1 million patients suggests that any increase in GEM toxicity in non- concurrent combination regimen other than radiation recall is due to typical radiation toxicity and mainly affects directly irradiated tissues. No significant financial relationships to disclose.

Risk of severe radiation pneumonitis in gemcitabine (GEM) based consolidation chemotherapy after concurrent chemo-radiation (C-RT) in stage III non-small-cell lung cancer (NSCLC)

17079 Background: Recent phase II study (S9504) showed that 3 cycles of consolidation docetaxel after C-RT is associated with prolonged survival but 6 pts (7%) had severe (≥gr 3) radiation pneumonitis and 2 (2.4%) died.(None at S9019) LCRG, a multinational Asian study group, designed a randomized phase II study aiming to assess the treatment outcomes of consolidation GEM or GEM/Carboplatin (CAR) after C-RT. GEM is a potent radiation sensitizer with known recall phenomena, thus we evaluated the risk of severe radiation pneumonitis with GEM-based consolidation chemotherapy after C-RT in this interim report. Methods: Enrollment criteria: Histologic proven NSCLC; attained CR/PR/SD after C-RT (Cisplatin-based chemotherapy between 25 mg/m2 and 40 mg/m2 per week or 60 mg/m2 to 100mg/m2 every 3 to 4 weeks; fraction dose not more than 2.0 Gy; total dose not less than 54 Gy and not higher than 64 Gy); ECOG PS 0–1; adequate hematologic/renal/liver function. Patients were screened for eligibility within 6 weeks after C-RT. Eligible patients are randomized to receive GEM 1250mg/m2 day 1,8 q21days with or without CAR 5XAUC day 1. Results: Between 3/04 and 9/05 we screened 51 patients and excluded 19. Six (31.5%) were excluded due to radiation pneumonitis.(gr 1=5 and gr 3 = 1). C-RT induced toxicity was the main reason for difficulty with accrual to this trial. We enrolled 32 patients (m:f 29:3; mean age 58 (40–78); adeno:scc:other 14:16:2; IIIa:IIIb 4:28) Median RT fraction and dose was 30 (27–32) and 60 Gy (54–64), respectively. 19 pts received GEM and 13 received GEM/CAR. Severe (≥gr 3) radiation pneumonitis was reported in 3 pts (9.3%) and 1 (3.1%) died from the complication. Another 10 and 6 pts had grade 1 and 2 radiation pneumonitis, respectively, but without significant clinical compromise. Conclusions: Radiation pneumonitis is common after C-RT with or without consolidation chemotherapy. However, severe radiation pneumonitis is relatively uncommon in pts who received GEM based consolidation chemotherapy after C-RT. A possible explanation is that we have screened out the high risk pts prior to enrollment. [Table: see text]

The difficulty with recalling people's names: the plausible phonology hypothesis.

Recalling the name of a person is a simple, but often a problematic, everyday task. There are various explanations of this phenomenon, but here it is argued that the explanations offered so far, by failing to consider learning of names, have overlooked a simple account of name recall difficulty. The starting observation for this viewpoint is that names of people are often non-words, in that they have never been encountered before. This is not true of, say, names of professions. Not only does the relatively high rate of new exemplars mean that people's names are likely to be underlearned, but furthermore, even for equal degrees of learning, a person's name is at a disadvantage because of the high plausibility of most phonologies: "dreaner" is much more readily accepted as the name of a person than as the name of their profession. So specifying the phonology of people's names is inherently a more demanding task, compared to the phonology of other names. The implications of this view are explored with regard to explanations of empirically established name recall phenomena in normal subjects, the patterns of performance of anomic patients and the difficulty of name recall in different word domains. It is shown that these arguments, derived from a real world fact, account in a simple way for existing data and make predictions in different areas of research.

The late effects of toxicity scoring

The introduction of multimodal management to cancer treatment has resulted in differences in the patterns of toxicity and therefore in end results reporting. The radiation oncologist is concerned with late effects whereas the chemotherapist is more limited by acute toxicities. The final dose chosen by a radiation oncologist is a combination of the fractionation schedules and the total dose in a total time period. This is modified only in some anatomic sites by an acute reaction but is more likely to be chosen because of a concept of an accumulated dose reaching a threshold. This threshold dose concept is based upon organ tolerance and has been defined as the radiation tolerance dose (TD) that causes 5% or 50% of severe complications in 5 years, that is, TD 5/5 and TD 50/5.2 In contrast, the dose limiting factors for chemotherapy administration are more often the maximum tolerated dose per cycle and the resulting acute reaction.4 The cyclic dose may produce acute effects such that there is dose modification based upon the toxicity level. The maximum tolerated dose, akin to threshold dose, is less often known for chemotherapeutic agents than for radiation late effects. As a result of the interaction of these two major treatment modalities-radiation and chemotherapy, and their differences in toxicity, two different scoring or grading systems have emerged. The radiation scores have been oriented to the specific pathologic lesions of late effects which are usually permanent whereas the chemotherapy grades usually reflect functional or physiologic effects which tend to be reversible. There has been a tendency, when both modalities are combined, to refer to the late normal tissue reactions as “recall phenomena.” However, the recent literature recognizes that radiation and chemotherapy may be additive in producing late effect injury’ and that chemotherapy alone can lead to an unsuspected late complication without an obvious acute phase much as is true for irradiation. Toxicity reporting of multi-agent chemotherapy combinations and/or their interaction with radiation effects has lead national cooperative groups to form committees to assess late effects and develop Scoring or Grading Systems for the toxicities resulting from combined cancer treatment, As a starting point for developing a uniform scoring system, a review and compilation of these systems has been undertaken. An analysis of endpoints, the diagnostic tests to assess them, their reversibility and treatability as documented by ten major investigative cooperative groups forms the basis of this position paper. A recommendation for a uniform system is the endproduct based upon extraction of the “consensus criteria”-that is, the similar features recurring in each of the cooperative group’s toxicity charts.