How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?

I would treat with definitive intent.

May do chemo IO first and then definitive chemo RT.

I would consider this stage IVB given the presence of bone invasion. I would recommend a staging MRI of the spine to rule out spinal cord invasion.

If there is no evidence of cord compression and the bony disease is limited to the anterior vertebral body, it is reasonable to treat the patient with d...

Agree. This would be IVB but would consider it a sort of oligometastatic state.

Depending on anticipated organ dosimetry, I might start with chemo IO to shrink the disease. I would also incorporate the vertebral body into my CTV to account for microscopic spread (similar to spine SBRT volume delinea...

In 2010, I treated a woman in her early 30s with this presentation. I treated her with definitive intent with chemo RT and simultaneous integrated boost to a total dose of 55 Gy in 25 fx to the para-aortic gross disease inclusive of the anterior vertebral body. She had significant side effects but r...