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Article |

Massive Osteolysis of the Right Clavicle Developing After Radiation Therapy

William L. Skinner, MD; Aman U. Buzdar, MD; Herman I. Libshitz, MD
JAMA. 1988;260(3):375-376. doi:10.1001/jama.1988.03410030091035.
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History  A 52-year-old woman had a right modified radical mastectomy in February 1980 for a stage II, Tl (2-cm mass), N1 (three of 13 lymph nodes positive), MO, estrogen receptor-positive breast cancer. She received postoperative irradiation with 40 Gy delivered by opposing tangential fields to the chest wall and by a single anterior field to the supraclavicular and internal mammary areas; 10 Gy of additional radiation was also given to the posterior axilla. Adjuvant combination chemotherapy was given with six courses of fluorouracil, doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), vincristine, and prednisone. The total doxorubicin dose was 300 mg/m2.2. After completion of adjuvant combination chemotherapy, 10 mg of tamoxifen twice a day was given for six months concomitantly with three months of methotrexate therapy followed by three months of vinblastine therapy.The patient sustained a fall in February 1981 and suffered a fracture of the medial aspect of her right


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