Is it necessary to treat pelvic lymph nodes for muscle invasive bladder cancer?

You're correct that there is considerable variability in the target used in bladder radiotherapy. We performed a survey of radiation oncologists regarding bladder cancer radiotherapy patterns and found that ~60% use a "small pelvis," ~30% use a true whole pelvis, and ~10% treat the bladder only [1]....

The first I ever read about non-ENI (elective nodal irradiation) bladder RT was Sandler and Montie's experience in the JCO in 2004. They gave 60 Gy whole bladder only; no lymph node RT, no mid-tx cystoscopes, etc. It seemed like a very elegant way to approach things. They reported no LN failures in ...

Locoregional recurrences are lower compared with DM for Bladder Ca's. I've changed my approach from "treat them all" to select cases (depending the biology of the cancer, CT pelvic findings, etc.) If I don't see cancer in the bladder during the sim or after the first course (in bladder-preservation)...