{"id":"722b7a82-9e53-4d03-8fcd-308d25324a42","slug":"sni-17-645","title":"Very late recurrence of glioblastoma after 8 years of progression-free survival: A case report and review of tumor dormancy","authors":["Burhan Ul Haq","Simon John","Saadia Ziaulhaque","Siraj Ulhaq"],"abstract":"Background: Very late recurrence of glioblastoma (GBM) after prolonged progression-free survival is exceptionally rare, particularly in patients who did not receive temozolomide. Such cases offer a rare window into the biological heterogeneity and dormancy potential of an otherwise rapidly lethal tumor. Case Description: A middle-aged man underwent gross total resection of an isocitrate dehydrogenase (IDH)-wild-type GBM followed by adjuvant radiotherapy alone (45 Gy/25 fractions), temozolomide having been unavailable for financial reasons. He remained clinically and radiologically disease-free for approximately 8 years before developing progressive headache and memory impairment. Magnetic resonance (MR) imaging demonstrated a large recurrent left frontotemporal mass with extensive edema and corpus callosum involvement. Multivoxel MR spectroscopy showed a markedly elevated choline-to-creatine ratio (4.5) with reduced N-acetylaspartate, favoring recurrent high-grade glioma over radiation necrosis. Repeat biopsy confirmed recurrent GBM with a molecular profile of IDH1/IDH2 wild-type status, telomerase reverse transcriptase promoter mutation, epidermal growth factor receptor amplification, CDKN2A/B homozygous deletion, PTEN alteration, and a methylated O6-methylguanine-DNA methyltransferase promoter. Conclusion: This case illustrates that very late recurrence can occur in IDH-wild-type GBM after radiotherapy alone, despite aggressive molecular features, and supports the emerging biological model of therapy-induced tumor cell dormancy. It reinforces the need for long-term surveillance and repeat molecular profiling at recurrence to guide individualized salvage therapy.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/sni-17-645/figures/SNI-17-645-g001.jpg","publishDate":"2026-11-06T00:00:00.000Z","doi":"10.25259/SNI_954_2026","categories":["Neuro-oncology","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/722b7a82-9e53-4d03-8fcd-308d25324a42/pdf"}