Adjuvant Radiation Therapy for Positive Surgical Margins in Muscle-Invasive Bladder Cancer: A Case-Based Discussion

The standard of care for locally advanced bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy. The benefit of adjuvant radiation therapy (RT) in muscle-invasive bladder cancer (MIBC) remains controversial, mainly due to concerns about toxicity. Recent data suggest that adjuvant RT may reduce local recurrence rates in high-risk patients. Moreover, advances in radiotherapy techniques now allow for more precise treatment delivery with reduced toxicity. We describe here the case of a 67-year-old male with locally advanced MIBC who underwent neoadjuvant chemotherapy and radical cystectomy. Postoperative pathology reported positive surgical margins at the bladder neck with incidental prostate adenocarcinoma. Given these high-risk features, adjuvant pelvic RT was administered following multidisciplinary discussion. This case report highlights the importance of balancing the potential toxicities of adjuvant RT against its benefit in high-risk MIBC patients. Further research is necessary to establish more straightforward guidelines.