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 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. -).