PURPOSE: Orbital rhabdomyosarcoma (RMS) historically has been associated with an excellent survival rate. The majority of patients are cured with the use of both chemotherapy and radiation therapy, but a significant number experience important late sequelae of treatment. In an attempt to determine optimal therapy in relation both to cure and to sequelae, the experience of the four international collaborative groups (Intergroup Rhabdomyosarcoma Study Group [IRSG], International Society of Paediatric Oncology [SIOP] Sarcoma Committee, German Collaborative Soft Tissue Sarcoma Group [CWS], and Italian Cooperative Soft Tissue Sarcoma Group [ICG] studies) was shared at an international workshop. PATIENTS AND METHODS: A total of 306 eligible patients were identified from group records (186 from IRS, 43 from SIOP MMT, 40 from CWS, and 37 from ICG). Median age was 6.8 years, and median follow-up was 6.5 years. Eighty percent of patients received radiation therapy (RT) as part of primary therapy, but there were significant differences in the use of RT between the individual groups (93% in IRSG, 76% in ICG, and 70% in CWS, but only 37% in the SIOP MMT group). RESULTS: At 10 years, event-free and overall survival for the whole cohort were 77% (range, 71% to 81%) and 87% (range, 82% to 92%), respectively. There was no difference in overall survival between the collaborative groups regardless of differences in the use of initial RT. In total, 34 (12%) of 273 survivors had not received RT, although this varied between the different groups (41% in the SIOP MMT group, 20% in CWS, 7% in ICG, and 6% in IRSG). There was no difference in overall survival for the whole cohort regardless of whether radiotherapy was used as part of initial therapy (86% at 10 years for both). CONCLUSION: These data suggest that a subset of patients with orbital RMS can be cured without systematic local therapy, although the total burden of treatment (primary therapy and treatment for relapse) must be taken into account when assessing the implications for late sequelae.

THE SYMPTOM of headache constitutes one of the most perplexing diagnostic and therapeutic problems with which the physician is confronted.1 It is also one of the most frequent complaints, accounting in one series, for example, for 24 per cent of more than 15,000 absences among factory employees.1Several factors contribute to the frequency of the complaint, even when the condition responsible for the headache is not in the head.The head is logically a region where functional complaints are centered. However, Friedman and others2 wisely warned against diagnosing a headache as psychogenic purely on the patient's description of the pain, and they pointed out that emotional stress and inner conflicts readily exacerbate or precipitate not only psychogenic but migrainous and post \ x=req-\ traumatic headaches as well.Many anatomically uninformed persons consider the neck, except anteriorly, an imaginary plane separating the shoulders from the head. Therefore, if the ache or discomfort is above the shoulders, it is a "headache." Often patients complain of headache, and when asked to indicate Read at a meeting

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