This multi-institutional retrospective analysis compared standard-dose bladder radiotherapy (55 Gy/20 or 64 Gy/32) with a simultaneous integrated boost (up to 60 Gy/20 or 70 Gy/32) in 107 patients undergoing trimodality therapy for muscle-invasive bladder cancer. After a median follow-up of 23 months, dose escalation dramatically reduced 2-year invasive intravesical recurrence (5.5% vs. 27.5%; adjusted SHR 0.20, p=0.035), while metastasis-free survival or overall survival. Reinforcing this strategy, 14 of 16 invasive recurrences in the standard-dose cohort arose at the original tumor site. In the context of dramatically evolving systemic therapy, this may become an excellent dose-escalated organ-preserving approach for those with clinically persistent disease post-neoadjuvant enfortumab vedotin plus pembrolizumab. | Chan, Adv Radiat Oncol 2026
