How would you manage a non-surgical poorly differentiated neuroendocrine tumor of unknown primary with a bulky nodal conglomerate causing pain?

This is a question that could have many reasonable answers. Depending on PS, site, symptoms, and overall onc plan - many standard palliative regimens could be deployed, including more aggressive palliative if this were the only (known) site of disease and more durable local control is intended. Also depending on the path features/aggressiveness, whether platinum-based chemo regimen should be utilized should be discussed in a multi-disciplinary setting.