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Updated: Feb 28, 2026
Tumor Treating Field Therapy in Combination with Bevacizumab for the Treatment of Recurrent Glioblastoma
Published on: October 27, 2014
[Bevacizumab-Related Hyperintense Lesions on Diffusion-Weighted Imaging at Different Locations in a Patient with
Shinya Oshiro1, Naoki Wakuta, Shinichi Kawai
1Department of Neurosurgery, National Fukuoka-Higashi Medical Center.
Abstract:
We report the case of a 60-year-old man who first presented with transient difficulty of word recall. Subsequent MRI revealed an invasive brain tumor in the left frontal lobe. The patient underwent open biopsy, and diffuse astrocytoma(WHO grade II)was diagnosed. However, the malignant potential of this tumor was not particularly low because of a few enhancement on preoperative evaluation, and radiation therapy was initially performed. Four months after ending irradiation, temozolomide treatment was introduced for tumor regrowth. After another 2 months, combined chemotherapy with bevacizumab was also started due to tumor enlargement, which was evaluated as malignant transformation to glioblastoma. Two focal lesions with signal hyperintensity on DWI appeared in the frontal and temporal lobes at different locations 3 months after starting bevacizumab. The left temporal lesion subsequently changed to a ring-enhanced tumor, and glioblastoma(WHO grade IV)was finally diagnosed at decompressive surgery. Another frontal lesion, however, continued to maintain a favorable course without any changes in signal despite appearing as similar signal-hyperintense lesions. The temporal hyperintense lesion may undergo malignant transformation into glioblastoma with typical radiological appearance. Recent studies on image changes following bevacizumab treatment have attracted widespread attention, and the clinical significance of such hyperintense lesions has gained attention. This present case was thought to be valuable because of the contradistinctive aspects at the same time, in which the hyperintense lesions of the frontal and temporal lobes seemed to represent antitumor activity or drug refractory effects based on bevacizumab treatment.
Insights
This case study highlights contrasting brain lesion responses to bevacizumab treatment in a glioblastoma patient. One lesion transformed into glioblastoma, while another showed favorable stability, suggesting varied treatment effects.
Area of Science:
- Neuro-oncology
- Radiology
- Oncology
Background:
- A 60-year-old man presented with word recall difficulties, leading to the discovery of a left frontal lobe invasive brain tumor.
- Initial diagnosis was diffuse astrocytoma (WHO grade II), with initial treatment including radiation therapy due to concerning preoperative enhancement.
Observation:
- Tumor regrowth led to temozolomide treatment, followed by combined chemotherapy with bevacizumab for suspected malignant transformation to glioblastoma.
- Two distinct hyperintense lesions on DWI appeared in the frontal and temporal lobes after bevacizumab initiation.
Findings:
- The temporal lesion evolved into a ring-enhanced glioblastoma (WHO grade IV), confirmed surgically.
- Concurrently, the frontal lesion remained stable, showing no signal changes despite similar initial appearance, indicating a potential differential response to bevacizumab.
Implications:
- This case illustrates the complex and sometimes contradictory radiological changes observed during bevacizumab therapy for brain tumors.
- The distinct lesion behaviors may reflect either antitumor activity or drug refractory effects, underscoring the need for careful monitoring and interpretation of imaging findings.
