A 41-year-old man presented after a week of intermittent headaches and was found to have a left frontal enhancing mass (Figure a). A gross total resection was performed and the pathology showed GBM with primitive neuroectodermal tumor (PNET) component (MGMT promoter unmethylated, EGFR not amplified, 1p/19q co-deletion negative). Surgery was followed by radiotherapy and daily TMZ and then NovoTTF therapy/metronomic TMZ. Six months later, a distal lesion were noted (Figure b), and he underwent further resection with adjustment of his fields. In order to address the PNET component if his tumor, and because a combination of ifosfamide, carboplatin, etoposide (ICE) has been shown to be effective against this tumor type [], his chemotherapy was changed to bevacizumab with ICE (ifosfamide, carboplatin, etoposide) × six cycles. He continued on bevacizumab with NovoTTF therapy for over a year until he developed leptomeningeal disease and passed away in July 2013.
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. ).