When would you recommend surgical debulking of pelvic or para-aortic lymph nodes in cervical cancer prior to definitive chemoradiation therapy?

We have not favored dissection and treated with SIB and sometimes added sequential boost ( EQ@ dose 58-66 Gy) based on size

most current literature shows excellent regional control but high distant failure in these pts

for bowel and duodenum ( two organs which could be limiting factor) we use v55 dose...

Often these large pelvic and periaortic nodes are adherent to surrounding nerves and vessels and resection is not possible. Our usual approach in this situation is to consider neo-adjuvant chemotherapy. The hope would be that the chemotherapy would reduce the size of the nodes definitive chemo- radi...