What treatment would you recommend for a healthy patient with an 8 cm central pelvic recurrence of leiomyosarcoma not involving any vital structures, associated with an FDG-avid 1 cm external iliac LN?

Assuming in good health, I would consider an attempt at resection. Worst case, you can’t, and you aren’t any worse off. I have debulked these before and found them often to be surprisingly resectable without high morbidity. Then I would make sure to test for ER/PR, and if positive, follow that with ...