Quantitative assessment of the clavicle radiostructure as a tool for estimation of the osteopathic effect of breast cancer chemotherapy

Radiological structure (trabeculation) of the clavicle was quantitatively evaluated using the chest X-ray images obtained in 36 pre-menopausal women subjected to CMF (cyclophosphamide, methotrexate, fluorouracil) chemotherapy. For comparison, the values of the quantitative radiostructural indices were estimated from the X-ray images obtained in 65 age-matched pre-menopausal healthy women and 19 post-menopausal women with clinically confirmed osteoporosis. For the analyses, the high-quality routine chest P-A films were used in which the central segment of the clavicle was well visualised. Evaluation of the skeletal radiostructure was carried out using the original software developed by K.W. Zieliński which, in addition to standardising the quality of the image, calculated the structural density as well as the arrangement and mean thickness of the trabeculae. The results demonstrate in a reproducible way that structural density and mean thickness of the clavicular trabeculae were significantly (p < 0.01) lower in pre-menopausal, CMF-treated and post-menopausal, osteoporotic patients than in healthy, control women. Likewise, the relative radiological density of the clavicle was reduced in the former two groups of women as compared to their control counterparts and the difference approached statistical significance. When the X-ray films were compared in each breast cancer patient before and after the chemotherapy the values of all the three parameters were decreased in up to 86% of the treated patients. Overall, the obtained results demonstrate the significant osteopathic side effect of the CMF chemotherapy in pre-menopausal breast cancer patients.