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Abstract Our study addresses bladder only radiotherapy concurrent with chemotherapy and demonstrate its effectiveness in patients with non metastatic negative lymph node MIBC based on comparable oncologic outcomes as regard response rate, disease free survival, progression free survival, locoregional relapse free survival, distant metastatsis free survival and overall survival with better radiotherapy toxicity profile when compared with whole pelvis radiotherapy. Therefore, bladder only radiotherapy may be considered as an attractive alternative to whole pelvis radiotherapy in appropriately selected patients. Based on our results, elective pelvic lymph node irridation during bladder preservation in clinically negative lymph node MIBC may not impact survival outcomes but large randomized trials are further needed to prove this finding. Furthermore, new imaging modalities are needed to improve clinical staging, which may help select the appropriate radiation volume for trimodality therapy. |