Breast Cancer Research and Treatment 73: 189–197, 2002. © 2002 Kluwer Academic Publishers. Printed in the Netherlands. Report Quantitative assessment of the clavicle radiostructure as a tool for estimation of the osteopathic effect of breast cancer chemotherapy Krzysztof Le´ sniewski-Kmak 1 , Krzysztof W. Zieli´ nski 2 , and Cezary Szczylik 1 1 Clinic of Oncology, Central Clinical Hospital, Military University School of Medicine, Warszawa; 2 Department of Clinical Pathomorphology, Military University School of Medicine, L´ od´ z, Poland Key words: bone, breast cancer, chemotherapy side effects, image analysis, methotrexate, osteoporosis, radiometry Summary 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) chemo- therapy. 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 clin- ically 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. Zieli´ nski 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. Introduction Although the first study on the effects of methotrex- ate on calcium metabolism was published as early as in 1965 [1], osteopathy is still one of the less appreciated complications of the anti-tumour chemo- therapy. In view of the high incidence of breast cancer worldwide and the fact that the chemotherapy often contains methotrexate [2], we aimed in the present study to estimate the effect of the adjuvant therapy ac- cording to the Bonadonna CMF (cyclophosphamide, methotrexate, fluorouracil) regimen on the morpho- logical structure of claviles of the treated patients. Indeed, the radiologically defined morphological ar- chitecture of bones is responsible for their mech- anical strength and is regarded as the most important criterion in the diagnosis of osteoporosis; this para- meter, however, should not be mistaken for the mineral density of bones which is assessed by densitometric methods. Material For the studies, 134 high-quality routine chest P–A films were used in which the central segment of the clavicle was well visualised with no overlapping by other bone structures. The films were obtained from the three groups of women: (1) ‘chemotherapy group’ consisting of 36 pre-menopausal (mean age 44.6 years; age range 32– 50 years), stage I and II breast cancer patients; the X-ray tests were performed between 6 and 24 months (mean 10.5 months) after completion of the adjuvant