A 65-year-old man initially presented with word processing difficulties. MRI of the brain revealed a heterogeneously enhancing left temporo-occipital mass. He underwent an awake craniotomy with subtotal resection. Pathology was consistent with GBM, IDH1 wild-type, MGMT unmethylated. He was treated with conventional chemo-RT. His postradiation MRI showed disease progression and bevacizumab was initiated, resulting in a radiographic improvement. After 5 months of treatment, his MRI demonstrated progression of the nonenhancing tumor and the patient declined clinically. At progression, he was started on dexamethasone, temozolomide, and TTFields. NovoTAL mapping was performed targeting the new nonenhancing FLAIR abnormality (Fig. ).
A 55-year-old man developed progressively worsening headaches, nausea, and vomiting. Imaging revealed a large right temporal-parietal mass. A biopsy was performed, confirming a GBM, IDH wild-type, MGMT unmethylated. After 4 cycles of temozolomide, he developed a visual field deficit, more disorientation, right–left confusion and difficulty with memory. He was treated with conventional chemo-RT followed by 4 cycles of adjuvant temozolomide. An MRI then revealed new local growth of mass, as well as the development of a small new enhancing lesion in the splenium of his corpus callosum. There was significant T2 hyperintensity in this area consistent with infiltrative disease. Due to this significant nonenhancing disease, NovoTAL mapping was performed incorporating the region of T2 signal change (Fig. ).