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How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar vertebral body invasion impact your decision to offer palliative or definitive management?
Answer from: Radiation Oncologist at Academic Institution
I would treat with definitive intent.
May do chemo IO first and then definitive chemo RT.
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Answer from: Radiation Oncologist at Academic Institution
I would consider this stage IVB given the presence of bone invasion. I would recommend a staging MRI of the spine to rule out spinal cord invasion.
If there is no evidence of cord compression and the bony disease is limited to the anterior vertebral body, it is reasonable to treat the patient with ...
Answer from: Radiation Oncologist at Academic Institution
Agree this would be IVB but would consider it a sort of oligometastatic state.
Depending on anticipated organ dosimetry, I might start with chemoIO to shrink the disease. I would also incorporate the vertebral body into my CTV to account for microscopic spread (similar to spine SBRT volume ...