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 definitive intent (concurrent chemoradiation) and boost the PALN and bony disease to 55-57.5 Gy simultaneous integrated boost in 25 fractions. The decision to add brachytherapy will depend on tumor res...

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 delineation) and boost disease to an equivalent dose in the mid-60s respecting cord constraints. I would follow this with brachy. If chemo IO is not utilized up front, I would follow definitive treatment wit...

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 recovered completely and has been disease-free ever since.