How would you manage a medically inoperable patient with locally recurrent nest variant muscle invasive urothelial carcinoma s/p radical cystectomy years ago now involving the urethral anastomosis, sphincter and neo-bladder, status post TUR?

Given neo-bladder involvement, does the addition of chemotherapy to radiation carry too high a risk of fistulation? Would you plan for 5400 cGy to the neobladder involved area?

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How would you manage a medically inoperable patient with locally recurrent nest variant muscle invasive urothelial carcinoma s/p radical cystectomy years ago now involving the urethral anastomosis, sphincter and neo-bladder, status post TUR?

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