Is there evidence to support bladder preservation therapy in node positive bladder cancer?

Although there aren’t randomized data suggesting the superiority of trimodality therapy (TMT) over any other treatment for N+ bladder cancer, I think most feel that it is the standard of care as alluded to in the question. Broadly speaking, patients and providers have two options: radical therapy or systemic therapy alone. In general, the rates of locoregional recurrence/progression after chemotherapy alone are quite significant (Dimopoulos et al., PMID 8308966), which may provide one rationale ...