How would you approach locally advanced bladder cancer in a patient on hemodialysis?

It depends on "locally advanced" setting; resectable or unresectable tumor?

If resectable and not metastatic may consider radical cystectomy and LN dissection in good surgical candidates; however bladder preservation approach can be considered in well selected patients, e.g. small unifocal tumors without extensive variant histology, multifocal/extensive CIS or hydronephrosis; multidisciplinary tumor board warranted, ideally in center with expertise.

If unresectable/metastatic consider systemic the...