How would you treat a patient with biopsy-proven recurrent urothelial bladder cancer with M1a disease (limited to retroperitoneal nodal disease)?

NCCN guidelines suggest systemic therapy only or concurrent chemoradiotherapy. What is your approach?

Answer from: Medical Oncologist at Academic Institution

Systemic therapy with either clinical trial, or chemotherapy (ideally cisplatin-based or carboplatin/gemcitabine if cisplatin-unfit), or immune checkpoint inhibitor (if it is first line treatment setting and cisplatin-unfit, options include either pembrolizumab or atezolizumab, if either 'PD-L1 high...

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Radiation Oncologist at Baylor College of Medicine-Houston
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How would you treat a patient with biopsy-proven recurrent urothelial bladder cancer with M1a disease (limited to retroperitoneal nodal disease)?

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