A 45-year-old man presented with headaches and was found to have a right frontal GBM (MGMT promoter unmethylated, EGFR not amplified, 1p/19q codeletion status unknown) (Figure a), for which he had a gross total resection followed by radiation and daily TMZ and then metronomic TMZ with NovoTTF therapy. He remained neurologically intact with no radiographic evidence of recurrence for 22 months. A surveillance MRI revealed a small enhancing lesion in the left parietal lobe (Figure b), which was resected, and his fields were adjusted accordingly. The histology of the recurrent lesion showed multiple giant syncytial-type cells, and he has remained in good health over the subsequent nine months.
A 39-year-old woman who presented after a new-onset seizure was found to have a left parietal GBM (genetics not available) (Figure a). She underwent subtotal resection followed by radiotherapy with daily temozolomide (TMZ), and then NovoTTF Therapy with metronomic TMZ. After 3 months, her MRI showed progression near her initial resection site, and temozolomide was replaced by bevacizumab (BEV), with NovoTTF Therapy continuing. Nine months later, she had local recurrence in addition to bifrontal enhancing lesions (Figure b), and her TTFields were adjusted. Over the next five months, her multifocal tumor burden increased, and death was preceded by a right insular recurrence.