How do you manage the timing of adjuvant therapy in a patient with a glioblastoma and a post-operative surgical site infection?

There have been several studies on the timing of adjuvant therapy for glioblastoma including our institution https://www.ncbi.nlm.nih.gov/pubmed/26440447. In general, our practice has been to start adjuvant radiotherapy as soon as reasonably possible. If a glioblastoma patient has postoperative surgical site infection, I would discuss with my neurosurgeon the expected recovery period. If a patient can be cleared for radiotherapy within 5-6 weeks after surgery I would proceed with radiotherapy. In the uncommon scenario that a patient would need over 6 weeks before clearance this would require a discussion with my neurosurgeon and neuro-oncologist. I may favor continued management of postoperative surgical site infection and reimage if adjuva...

Luckily, this situation of a postoperative infection delaying treatment for a GBM doesn’t come up too often. Because while waiting for the infection to resolve, the GBM has sometimes progressed/recurred, requiring a discussion about second debulking surgery (which the surgeons are always tring to avoid also). But I don’t think I have started radiation in someone with a known active scalp/bone infection. And I don’t think our neuro-oncologists have started TMZ in that situation either.