A 49-year-old man developed left arm weakness. Imaging revealed a ring-enhancing nodule in the posterior right frontal lobe. He underwent a gross total resection with pathology confirming a GBM, MGMT unmethylated. He was treated with conventional chemo-RT, followed by 1 cycle of maintenance temozolomide. The patient experienced disease progression and was started on bevacizumab, with continuation of temozolomide. After completing 6 cycles of temozolomide, he had a further progression and underwent a repeat tumor resection, with placement of Gliadel wafers. Following the surgery, he received bevacizumab in combination with dose-intense (daily) temozolomide for 2 months. Subsequently, the patient developed new symptoms of worsening left-sided weakness. Imaging performed at that time demonstrated three areas of abnormal enhancement, including the resection cavity with Gliadel wafers, an enhancing area in the medial right frontal lobe suggestive of a subdural collection, and a new enhancing mass in the deep right hemisphere (Fig. ). NovoTAL mapping was performed utilizing measurements of the deep tumor, and TTFields therapy was initiated.
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.