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 41-year-old man presented after a week of intermittent headaches and was found to have a left frontal enhancing mass (Figure a). A gross total resection was performed and the pathology showed GBM with primitive neuroectodermal tumor (PNET) component (MGMT promoter unmethylated, EGFR not amplified, 1p/19q co-deletion negative). Surgery was followed by radiotherapy and daily TMZ and then NovoTTF therapy/metronomic TMZ. Six months later, a distal lesion were noted (Figure b), and he underwent further resection with adjustment of his fields. In order to address the PNET component if his tumor, and because a combination of ifosfamide, carboplatin, etoposide (ICE) has been shown to be effective against this tumor type [], his chemotherapy was changed to bevacizumab with ICE (ifosfamide, carboplatin, etoposide) × six cycles. He continued on bevacizumab with NovoTTF therapy for over a year until he developed leptomeningeal disease and passed away in July 2013.