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 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.