Author reply

Abstract

Drs. Abramson and Sagerman have been instrumental in both past and present therapeutic protocols regarding many ocular neoplasms. Their contribution to the field of rhabdomyosarcoma is notable and should be included in any major review of this subject. The goal of our paper primarily was to educate the ophthalmic community on the results of the Intergroup Rhabdomyosarcoma Study Group (IRSG), a major prospective collaborative investigation of chemotherapy and radiotherapy for rhabdomyosarcoma. In the opening paragraph of our report, we discuss this study and point out that IRSG reports have been published in the pediatric, oncologic, and radiologic literature, but few have been published in the ophthalmic literature. Thus, the focus of our report was to inform the ophthalmic readers of the results from nearly three decades of work emanating from the IRSG. A secondary focus of the report was to discuss our own results and, importantly, to evaluate ophthalmic complications from therapy, a subject that had not been completely evaluated previously. As we reviewed the literature using Medline research at the National Library of Medicine, we noted that there had been 7269 published reports on rhabdomyosarcoma and 230 published reports on orbital rhabdomyosarcoma. Thus, we could not include all published literature in our report, and we referenced the 42 most relevant reports, including those on the IRSG (19 references), general pediatric oncology (five references), general ophthalmic oncology (four references), survey of orbital tumors in children (one reference), orbital imaging (two references), major survey of orbital rhabdomyosarcoma (one reference), large series of orbital rhabdomyosarcoma (one reference predating IRSG and one reference regarding refractory cases), and relevant case reports (eight references). Two of the articles that we quoted (references 16 and 17) did reflect the early experience by physicians at Columbia Presbyterian Hospital. The additional articles by Drs. Abramson and Sagerman were important contributions and likely would have added depth to our list of references. We do acknowledge their contributions to the treatment of rhabdomyosarcoma and we regret that we could not quote all of the early work from Columbia Presbyterian Hospital. However, the more recent organized studies of the IRSG, which have established the groundwork for current management, are appropriately cited. Overall, we believe we all should be pleased with our unified goal of improving survival for those children with rhabdomyosarcoma. Our joint enthusiasm from many centers in the United States and worldwide has provided major progress in the therapy and outcome for these children.