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December 2, 1988

Osteolysis of the Clavicle-Reply

Author Affiliations

University of Texas M. D. Anderson Cancer Center Houston

University of Texas M. D. Anderson Cancer Center Houston

JAMA. 1988;260(21):3129. doi:10.1001/jama.1988.03410210039020

In Reply.—  We appreciate the comments of Dr Ahmad regarding our report of osteolysis of the clavicle. Osteolysis is not uncommon in ribs that have been included in radiotherapy fields and have subsequently fractured. The same phenomenon also is seen occasionally in the shoulder and pelvic bones under these circumstances.1 While the pathophysiology of the osteolysis is not clear, we believe that phenomenon occurred in our case to a greater and more obvious extent.This patient was treated with cobalt 60 photons at an outside institution. The depth of maximum dose from this energy is 0.5 cm,2 and we doubt there was any contribution to the clavicle dose from the posterior axillary supplement of 10 Gy. The superficial location of the clavicle placed it on the region of maximum dose. No sparing of the clavicle can be assumed.The fracture in this case was traumatic and not pathological;