How do you manage a muscle-invasive bladder cancer patient who received neoadjuvant cisplatin-based chemotherapy but has a positive margin post-operatively?

While no trial has tested adjuvant RT plus nivolumab in margin-positive post-cystectomy bladder cancer, and this remains an extrapolation, I would consider adjuvant pelvic RT as radiation alone (cystectomy bed/pelvic nodes 45–50.4 Gy, boost the involved margin to 54–60 Gy), consistent with how NCCN ...