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 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. ).