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. -).
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. ).