PMC4025148_01
Response characteristics from combination TTFields and bevacizumab therapy. At the time of first recurrence, the tumor cyst measured 3.4 x 4.4 cm on gadolinium-enhanced T1-weighted (a) and FLAIR (b) images. After 2 cycles of bevacizumab, there was a partial decrease in the size of the cystic tumor to 1.9 x 3.6 cm as seen on gadolinium-enhanced T1-weighted images (c) and a partial resolution of the edema as detected on FLAIR (d) images. After 6 cycles of combination TTFields and bevacizumab therapy, there was a further decrease of the cystic tumor to 1.7 x 3.1 cm, or 65% reduction, as seen on gadolinium-enhanced T1-weighted images (e) and a resolution of edema as detected on FLAIR (f) images.
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F1
After 5 cycles of adjuvant temozolomide, new cystic enhancement was discovered while performing a head MRI (fig. 1a, b), and she was placed on 4 mg of dexamethasone 4 times/day. After 2 cycles of bevacizumab, there was only a partial decrease in the gadolinium enhancement and the size of the cystic tumor (fig. 1c, d). After a total of 6 cycles of bevacizumab plus TTFields therapy, with a respective mean and median compliance of 17.6 hours (73% of the day) and 18.4 hours (77% of the day) (range 3.6 to 22.8 h), there was a near complete resolution of gadolinium enhancement and a 65% reduction in the size of the cystic tumor (fig. 1e, f).
Foci of relapsed disease outside of the previously irradiated glioblastoma. Gadolinium enhancement was detected in the internal capsule (a) and medial left frontal brain (b) after 6 cycles of TTFields and bevacizumab therapy.
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F2
However, there were also recurrent tumors detected in the left internal capsule and the medial left frontal brain (fig. 2a, b), which were located outside of the prior radiation treatment fields.