A 49-year-old man developed left arm weakness. Imaging revealed a ring-enhancing nodule in the posterior right frontal lobe. He underwent a gross total resection with pathology confirming a GBM, MGMT unmethylated. He was treated with conventional chemo-RT, followed by 1 cycle of maintenance temozolomide. The patient experienced disease progression and was started on bevacizumab, with continuation of temozolomide. After completing 6 cycles of temozolomide, he had a further progression and underwent a repeat tumor resection, with placement of Gliadel wafers. Following the surgery, he received bevacizumab in combination with dose-intense (daily) temozolomide for 2 months. Subsequently, the patient developed new symptoms of worsening left-sided weakness. Imaging performed at that time demonstrated three areas of abnormal enhancement, including the resection cavity with Gliadel wafers, an enhancing area in the medial right frontal lobe suggestive of a subdural collection, and a new enhancing mass in the deep right hemisphere (Fig. ). NovoTAL mapping was performed utilizing measurements of the deep tumor, and TTFields therapy was initiated.
A 65-year-old man initially presented with word processing difficulties. MRI of the brain revealed a heterogeneously enhancing left temporo-occipital mass. He underwent an awake craniotomy with subtotal resection. Pathology was consistent with GBM, IDH1 wild-type, MGMT unmethylated. He was treated with conventional chemo-RT. His postradiation MRI showed disease progression and bevacizumab was initiated, resulting in a radiographic improvement. After 5 months of treatment, his MRI demonstrated progression of the nonenhancing tumor and the patient declined clinically. At progression, he was started on dexamethasone, temozolomide, and TTFields. NovoTAL mapping was performed targeting the new nonenhancing FLAIR abnormality (Fig. ).