Trimodal therapy comprising maximal transurethral resection of bladder tumor followed by radiation therapy with sensitizing chemotherapy is an alternative treatment option for muscle-invasive bladder cancer. This approach has shown comparable results to those with neoadjuvant chemotherapy followed by radical cystectomy in retrospective analyses for selected patients. Efforts to improve oncological outcomes of bladder-preserving strategies have converged on adding perioperative immunotherapy as a fourth treatment modality to the current trimodal design.
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