RADT-82. MULTIFOCAL GLIOBLASTOMA: A REPORTING OF TWO DE NOVO CASES FROM A TERTIARY CARE CENTRE

Abstract INTRODUCTION Multifocal glioblastomas are defined by discrete areas of contrast enhancing tumors which are spatially connected by T2/FLAIR abnormalities. They comprise of 2- 20% of de novo cases and are associated with a poorer prognosis. METHODOLOGY We are reporting two cases that presented to our center out of the 38 de novo GBM over the last year that are managed with adjuvant radiation and chemotherapy. RESULTS Both patients are 50 years old females who were diagnosed with multifocal glioblastoma. The first patient who had two lesions- the largest size being 32mm, in the left temporal lobe, underwent near total excision with adjuvant radiation to the postoperative bed to 60Gy in 30 fractions with concurrent temozolomide at 75mg/m2 followed by six cycles of adjuvant temozolomide at 150- 200mg/m2 and is disease free at 10 months. The other patient had two lesions- the larger of 58mm in the left frontal lobe for which she underwent a gross total resection, and a smaller of 12mm in the right temporal lobe which was not excised in view of functional loss limiting future quality of life. She has been started on adjuvant temozolomide at 150mg/m2 with dose increment over further cycles and is planned for a staged radiation therapy with evaluation of the smaller lesion for hypofractionated radiation therapy. CONCLUSION Multifocal glioblastomas present a challenge to conventional radiation therapy planning and there is need to evaluate hypofractionated radiation therapy with novel systemic agents in this setting.