How would you approach treatment in a patient with Fanconi anemia and glioblastoma?

This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tissue. I would probably opt against alkylating agents like temozolomide/CCNU, but I would characterize the tumor molecularly and use targeted agents in maintenance if available. For adults especially, Optune would be indicated in maintenance therapy as well. And I would consider clinical trial enrollment if the patient is eligible.