Would you offer neoadjuvant chemotherapy prior to trimodality therapy in a fit patient who refuses surgery for muscle-invasive bladder cancer?

Unfortunately, this is a question without a clear answer at this time. Trimodality therapy, consisting of maximal TURBT, chemotherapy, and radiation, appears to have equivalent outcomes and has NCCN Category 1 recommendations for patients with MIBC. We do not routinely do neoadjuvant chemotherapy fo...