How would you manage a non-surgical poorly differentiated neuroendocrine tumor of unknown primary with a bulky nodal conglomerate causing pain?  

This is a question that could have many reasonable answers. Depending on PS, site, symptoms, and overall onc plan - many standard palliative regimens could be deployed, including more aggressive palliative if this were the only (known) site of disease and more durable local control is intended. Also...