Very late recurrence of glioblastoma after 8 years of progression-free survival: A case report and review of tumor dormancy

Abstract Background Glioblastoma is typically characterized by early recurrence despite aggressive multimodal therapy. Progression-free survival (PFS) beyond five years is uncommon, and recurrence after a prolonged remission is rarely described. Case description: A patient initially treated in 2017 at the Department of Neurosurgery, Combined Military Hospital CMH, Rawalpindi, Pakistan, presented with generalized tonic–clonic seizures and diffuse headaches. Gross total resection of a supratentorial glioblastoma (WHO grade 4) was followed by adjuvant external beam radiotherapy (45 Gy in 25 fractions) without temozolomide or other chemotherapy. The patient remained clinically stable for nearly eight years. In November 2025, progressive headaches and memory impairment prompted re-evaluation. Examination demonstrated ECOG performance status 1 and GCS 15, with no focal neurological deficits; a large alopecia patch over the scalp was noted, attributed to prior radiotherapy. MRI with contrast revealed a large heterogeneously enhancing necrotic mass in the left frontotemporal region involving the basal ganglia, thalamus, and genu of the corpus callosum (7.3 × 5.3 × 6.4 cm) with extensive vasogenic edema and patchy diffusion restriction. Multivoxel MR spectroscopy showed markedly elevated choline (Cho/Cr up to 4.5) and suppressed N-acetylaspartate, strongly supporting recurrent high-grade neoplasm. Conclusion This case highlights an unusually prolonged PFS after surgery and radiotherapy alone and illustrates that very late recurrence can occur. Long-term surveillance remains warranted in glioblastoma survivors, and contemporary tissue sampling with molecular profiling at recurrence may guide salvage management.