A 51-year-old man developed headaches and subsequently had a seizure. Imaging revealed an area of abnormal T2 hyperintensity in the left insular region. He underwent a biopsy, which was nondiagnostic. Four months later, repeat imaging demonstrated an interval expansion of abnormal T2 hyperintensity. A second biopsy was performed, confirming an anaplastic astrocytoma, IDH1 wild-type. He was treated with conventional chemo-RT followed by 7 cycles of adjuvant temozolomide. Imaging subsequently revealed a new area of abnormal enhancement in the medial left temporal lobe. He elected to initiate treatment with dose-intense temozolomide and concurrent TTFields therapy. NovoTAL mapping was performed utilizing the extent of the T2 hyperintense signal, rather than focusing solely on the small area of abnormal enhancement (Fig. ).
A 54-year-old man with a longstanding history of seizures developed new left-sided weakness and was found to have a brain tumor. He underwent a gross total resection and pathology confirmed a diagnosis of GBM with both astrocytic and oligodendroglial features, MGMT unmethylated, IDH1 wild-type and no loss of 1p19q. He was treated with conventional chemo-RT and opted to add TTFields to his maintenance temozolomide. His postradiation MRI showed no clear contrast enhancement and only minor fluid-attenuated inversion recovery (FLAIR) changes. MRI measurements for NovoTAL treatment planning were thus determined using the preoperative scans (Fig. -).