How would you treat a bladder cancer with rectal invasion with radiation?

In general, it may be difficult to achieve durable control with chemoRT alone for such a locally advanced T4 cancer such as this, and the patient may be better served with neoadjuvant chemo, restaging, and cystectomy, if this is feasible.

If he is not a candidate/refuses cystectomy, would treat the same way as you would without rectal invasion, but, contour the rectal invasion as part of your GTV. We treat T4 prostate cancer with rectal invasion routinely, which goes to higher doses compared to ...