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. 2021 Jan 20;10:543648. doi: 10.3389/fonc.2020.543648

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Copyright © 2021 Iorio-Morin, Gahide, Morin, Vanderweyen, Roy, St-Pierre, Massicotte-Tisluck and Fortin

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Representative cases from the series. (A, B): Case 1. A 71-year-old man presented with rapidly progressing left-sided hemiparesis combined with a sudden decline in cognitive functioning. On T1-gadolinium enhanced MRI, multiple nodular enhancements are obvious, devoid of significant oedema. Local mass effect can be observed on the ventricular system in axial and coronal acquisitions (A). Same MRI acquisition in axial and coronal after eight cycles of treatment (B). This patient remains disease-free to this date, 18 months after the conclusion of his last cycle. Clinically, he presented a full recovery. (C, D): Case 2. A 62-year-old man presented a gradual deterioration in cognitive functioning over a 2 months interval. Significant slowness in motor initiation and working memory were prominent features on presentation. A T1-enhanced MRI scan revealed multiple nodular enhancing lesions, mostly centered on the corpus callosum, and accompanied by oedema, in axial and coronal (C). T1-enhanced MRI scan in axial and coronal acquired at the conclusion of the treatment plan of 12 cycles, displaying a complete radiological response which was paralleled by a full clinical recovery (D). The patient remains disease-free 7 years after the conclusion of his treatment plan. (E–H): Case 3. A 42-year-old woman presented with mixed aphasia, confusion and severe headaches. What was considered confusion in retrospect was entirely attributable to a receptive speech deficit. She underwent an MRI scan which revealed a diffuse T1-enhancing mass localized in the left parieto-occipital area and diffusely infiltrating the splenium. The mass was partially resected in another center, before she started treatment with our team. The pre-treatment axial T1 MRI is shown in Panel (E), while the post-treatment MRI at the conclusion of eight cycles is shown in Panel (F). The patient was in complete response and had presented a full clinical recovery. She hence decided to stop treatment against our advice. Five months later, she presented with a left-sided deficit prompting an investigation. The T1-enhanced MRI revealed a relapse in disease in the contralateral hemisphere, as displayed on the axial T1-enhanced contrast MRI (G). She resumed treatment and responded for three cycles, only to present a massive progression before the initiation of the 4^th cycle (H). The patient then elected to discontinue all treatment, and she passed away 1 month after the relapse.