Bladder cancer
Initial treatment of MIBC

Luis (69 years old)

Luis is 69 years old, and still happily runs a local jazz bar. He was diagnosed with high-grade non-muscle-invasive bladder cancer (NMIBC) without CIS and underwent induction with Bacillus Calmette-Guérin (BCG) (6/6 instillations). At follow-up cystoscopy 6 weeks after the last BCG cycle (e.g. 3 months after the start of BCG), a tumour was found at the bladder neck.

Assessment summary:

  • No relevant medical history
  • Maximal TURBT, visually complete
  • Pathological review:
    • pT2 UCa
    • Unifocal, no concomitant CIS
  • Transurethral biopsy of the prostatic urethra, pathological review:
    • No prostatic urethral involvement
  • Imaging: suggestive for cT2 cN0 cM0
  • Ultrasound: no hydronephrosis
  • eGFR: 66 ml/min
  • No peripheral neuropathy
  • No hearing impairment
  • ECOG PS: 1
  • Cardiac ejection fraction: 70%

Concurrent RT + cisplatin is planned.

Which of the following treatment options would you choose for this patient?