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 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. ).