A 45-year-old man presented with headaches and was found to have a right frontal GBM (MGMT promoter unmethylated, EGFR not amplified, 1p/19q codeletion status unknown) (Figure a), for which he had a gross total resection followed by radiation and daily TMZ and then metronomic TMZ with NovoTTF therapy. He remained neurologically intact with no radiographic evidence of recurrence for 22 months. A surveillance MRI revealed a small enhancing lesion in the left parietal lobe (Figure b), which was resected, and his fields were adjusted accordingly. The histology of the recurrent lesion showed multiple giant syncytial-type cells, and he has remained in good health over the subsequent nine months.
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. ).