How would you approach therapy for a patient with non-seminomatous germ cell tumor, cT3N3Mx and symptomatic lower extremity thrombus extending to the IVC when it is unclear if bland or tumor thrombus?

This is not a common setting, but it is well described and high volume centers have fairly uniform approaches to patients presenting with caval thrombus. With the pre-orch HCG of 850, he is likely IGCCC good risk unless he is found to have brain or hepatic mets. He is likely non seminoma with a larg...