How would you utilize brachytherapy boost in addition to EBRT for HPV-dependent invasive squamous cell carcinoma present as a large pelvic side wall mass, presumed to be of cervix primary, albeit the negative biopsies of the cervix?

I have had one P16+ SCC of Unknown Primary that presented as a solitary pelvic sidewall mass/node, no FDG avidity outside of that region, who had a full gynecological evaluation.

First things first, ensure a thorough anorectal evaluation to rule out an anal primary.

I would treat with a focus on uni...

I have encountered a few cases like this with presumed primary in cervix, vagina, vulva or anal canal. I have focused on treating the nodal region with boost and not treating the primary.