1

(A)

F/54

MTC, hypothyroidism

12/97

Bone mets 5/99

Aredia 4/00 qmo

In 2003 was on Zometa (date N/A)

Rx’d in Georgia

01/03

33mos

A: 33mos

(Z: N/A)

Trauma to jaw/anesthesia in 12/02

Trauma never healed

10/03 pain right mandible with exposed bone

Progressive with extension to maxilla

DTIC

Anti-CEA antibody/Adria

2

(AZ)

M/58

MM, COPD, HTN, DM, smoking

10/96

MDA pharmacy

A - 1/98-2/02 

Z - 3/02-9/04

09/02

57 mos

A: 50 mos

Z: 7 mos

Gingivitis 6/02

Dental decay 6/02

Periodontal dz 6/02

Dental Extraction

7/02 (7 teeth)

Dentures XRT to maxilla 7/02

Right maxilla pain and poor healing/exposed bone 9/02

3/03 several areas of exposed bone

6/03 necrotic bone

9/03 larger areas 4x2 cm bilaterally + ant. bone exposure 1/x0.5 cm-debrid.

10/03, 11/03 debridements

Melphalan, prednisone, decadron hyper/cvad, interferon, thiothepa, busulfan, cyclophosphamide, thalidomide, arsenic autologous BMT X2

Ianoxin, vioxx, protonox, codeine, xanax, klonopin, prilosec, buspar, hydrocodone

3

(AZ)

F/79

MM, DVT, HTN

5/01

A – 5/01 – 6/02

Z – 7/02 – 4/04 *see CRF

8/03

26 mos

A: 13 mos

Z: 13 mos

Several dental extractions 9/02 Mandibular tori

Pain left mandible 8/03 (2x1 cm lesion)

Debridements 8/03, 10/03, 11/03, cephalexin, clindamycin,

1/04 worse ON 4/04 1/5 cm lesion

Melphalan, DEX, cyclophosphamide, cytoxan, thalidomide, coumadin, velcade, procrit, darbepoetin

4

(AZ)

F/47

MM, DM, Renal failure

3/97

A - ?

Z - ?

6/02

Unknown

Dental extraction in 6/01 tooth #20 left mandible

2/02 (outside MDA) – sequestrec-                                   

tomy to remove necrotic bone. Mod. Periodontal dz

Pain left mandible since 2/02

Panorex

6/02: lesion left mandible 2/03 debridement

3/03 hyperbaric O2 Rx

4/03 worsening of necrosis (1.5 cm)

9/03 stable

Hyper-CVAD (cytoxan, mesna, adryamycin, vincristine, decradron, cyclophosphamide, decardron, thalidomide, arsenic, melphalan, velcade.

5

(Z)

F/60

Breast ca, Bone mets 12/02

10/99

No A

Z – 5/03-7/03

5/04

Z: 2 doses

Latency 12 months

None

Pain right mandible/exposed bone (1x1cm)

Biopsy: necrotic bone

Sequestrectomy 5/04

Controlled with treatment

Aryamycin, Cyclophosphamide, Paclitaxel, Tamoxifen, Docetaxel, Arimidex, Exemestane, bellerga, xanax, elavil, melatonin, prilosec

6

(AZ)

F/70

Breast ca

1/30/98

A - 22 inf (90 mg q mo)

Z – 28 infus. (4mg q mo) 5/02

A – 8/00-4/02

Z – 5/02-9/04

(22 doses of A,  28 doses of Z

4/04

45 mos

A: 21 mos

Z: 24 mos

Dental extraction

Dentures

Pain right mandible, Poor healing, exposed bone – Infection?

5-FU, adryamycin, cyclophosphamide, tamoxifen, arimidex, exemestane, capecitabine, TAS-108, vinorelbine, gleevec, trastuzumab, paclitaxel 01/03-4/03, dexamethasone 10mg weekly 01/03

7

(AZ)

M/67

MM, osteoporosis

8/98

A-7/99 – 4/02

Z-6/02 – 9/04

2/04

53 mos

A: 32 mos

Z: 21 mos

Moderate periodontal disease

Mandibular Tori

6/99: good dentition

2/04 - pain right mandible: 3mmX4mm bone exposure

6/04: lesion healed

Hyper-CVAD (1/99) autologous BMT (6/99)

Serial dex 8/99

Thalidomide + dexamelphalan

Revimid

8

(Z)

F/42

Breast ca

9/98

Zometa started 10/03 with DX of bone mets

5/04

7 mos

Z: 7 mos

Dental extraction (1/04), Torus mandibularis, Slow healing and dry socket after extraction

Pain tooth #30, Poor healing, Infection, Bone exposure right mandible 5/04

Cytoxan, 5-Fu, methotrexate, tamoxifen, evista, adryamycin/ cytoxan, Taxol (7/03), Arimidex, Faslodex (5/7/04), Prozac, bextra, ambient, cipro, calcium, clindamycin, vicoprofen, XRT chest wall 1999, XRT mediastinum 12/01

9

(AZ)

9 cont.

F/44

Breast ca

10/99

A: 11/00 – 2/02

Z: [ED1] [ED2] 12/01 – 8/03

11/02

27 mos

A: 16 mos

Z: 11 mos

Mandibular Tori

12/99 – dental visit: mand. tori

11/02: pain right mandible – exposed bone

4/03: stable

10/03: stable

11/03: necrotic area larger

12/03: debridement

Paclitaxel, FAC, tamoxifen, Herceptin (11/02), navelbine, xeloda, dexamethasone (10/01

XRT: left hip, WBRT, Lspine, chest wall, axilla

10

(A)

M/60

MM

1/99

A: 1/99-4/00

5/99

4 mos

A: 4 mos

Bone exostosis, Dental extraction 5/99, Periodontal disease 5/99, smoking – 34 years

5/99: exposed bone after dental extraction (no pain) in maxilla and mandible; Treated with debridement and antibiotic: resolved 4/04.

Dexamethasone, Cytoxan, Melphalan, Holmium, Pepcid, Valium

11

(A)

F/61

Breast cancer

4/92

A : 3/99 – 12/01

Z: 4/02-5/03

8/00

17 mos

A: 17 mos

Dentures, Dental decay, Periodontal disease, Dental extraction 5/00 with poor healing

8/00: gum pain, exposed bone left mandible and maxilla

Controlled with treatment

FAC ’92, Methotrexate ’92, Vinblastine ’92, Tamoxifen 10/99, Exemestane 2/01, Fulvestrant 8/02, Megestrol 6/04, MVI, Celebrex, Hydrocodone

12

(AZ)

F/69

Breast ca, Melamona 1962, Bone mets 9/00

10/97

A: 11/00-7/02

Z:  8/02-9/04

11/04

46 mos

A: 21 mos

Z: 25 mos

Dental decay 5/04, Dental extraction 5/04

Poor healing after extraction, infection, no pain, exposed bone (11/04) left mandible

Tamoxifen 3/98, Anastrozole, Vioxx, Hydrocodone, Lasix, Bactrim, Clindamycin

13

(AZ)

F/46

Breast ca

7/01 Bone mets

A: 8/01-11/02

Z: 11/02-10/04

8/04

37 mos

A: 15 mos

Z: 22 mos

Gingivitis, advanced periodontal DZ, dental infection

8/04: pain right mandible, spontaneous bone exposure

Taxol 9/01, Herceptin 2/02, Taxoxifen 2/02, Prilosec, Decadron, Darvon

14

(AZ)

F/61

Breast ca, hypothyroidism

2/00 bone mets

A: 2/00-10/02 (~37 doses)

Z: 11/02-10/04 (~23 doses)

10/04

58 mos

A: 34 mos

Z: 24 mos

Gingivitis, Manipulation of right mandible, implants with poor healing and infection

4/04: right mandible pain – bone exposure

9/04: mand. implants removed, 10/04: 2X1x1.5cm bone exposure site, Healing well with irrigation, slicept

Tamoxifen, arimidex, celebrex

15

(Z)

F/71

MM, DM, Hyperlipidemia, ETOH use

1/00

Alendronate (4/00-11/01)

Z: 4/03, 7/03, 8/03, 11/03, 1/04

6/04

5 doses, latency 14 months

Dentures (traumatic wound)

Gum/jaw pain 4/04, Gingivitis, oseomyelitis, bone exposure

6/04: Eikenella corrodens, Rx’d

7/04: 2X1cm

8/04: debrid

11/04: 0.2X0.7cm

*steroids – induced diabetes

Dexamethasone 9/00, Valcade 4/03, Revimid 4/03, Interferon 9/00, Vioxx, Prevacid, Lortab, Zocor, Zoloft, Xanax, Neurontin

16

(AZ)

F/60

Breast ca, melanoma

5/80 bone mets

2/99 last visit to MDA: 9/04 (dead)

A: 3/99-10/01

Z: 12/01-6/04

12/03

56 mos

A: 31 mos

Z: 25 mos

Periodontal dz, Dental extraction 6/03, slow healing 7/03

*Rx’d with clindamycin, salicept, debridement

7/03 slow healing: debridement

8/03: debridement

12/03: bone exposure

2/04 dental at MDA: ONJ 2.5x2cm right mandible (biopsy proven)

¾ : 3/2 cm-debridement

¾ healing

5/04: debridement

6/04: healing  

XRT: chest, nodes, L-spine, and brain 7/04.

Taxotere 3/99, Cytoxan 3/99, Cyclophosphamide 3/99, Adriamycin 3/99, Tamoxifen 6/99, G-CSF 6/99, FEC 5/01, Xeloda 5/01, Aptosyn 5/01, Navelbine 8/01, Gemcitabine 8/01, Doxil 5/02, Faslodex 5/03, CPT-11 6/04, CMF 6/04, Augmentin, Cipro

17

(Z)

F/78

Breast ca, Osteoporosis, Atrial Arrhythmia, anemia

4/83 bone mets

8/02

Z: 9/02-1/05 (qmo)

10/04

26 mos

Z: 26 mos

Being treated outside MDA??

Femara, Tamoxifen, faslodex

18

(Z)

F/63

Breast ca, degenerative joint disease,asthma

10/02

bone mets 11/02

Z: started 4/03 outside MDACC

Last Zometa qmo. @MDACC 2/04

12/04

9 mos

Z: 9 mos

Periodontal disease and tooth extraction 2/04

Facial pain and swelling. Extraction of tooth root 10/04, pain/swelling and purulent drainage @ extraction site 12/04, poor fitting denture – trauma 12/04, osteomyelitis left maxilla 12/04.

Femara 10/02, Capecitabine 7/03, Adriamycin 1/04, Cytoxan 1/04, Fasoldex 7/04, Albuterol, Wellbutrin, Singular, Equagesic, Aleve and Cipro