Extended field chemoradiation in M1a bladder carcinoma: A case report.

Currently, the recommended management in stage IVA bladder cancer is platinum-based chemotherapy followed by maintenance immunotherapy in those with no evidence of disease progression. Consolidative surgery may be considered in selected cases after chemotherapy. However, consolidative radiotherapy and consolidative local treatment after second-line systemic therapy are rarely reported. We present the case of a 59-year-old man who was found to have muscle invasive urothelial carcinoma of the bladder with distant metastases limited to para-aortic nodes and offered consolidative extended field chemoradiation therapy encompassing bladder, pelvis, and para-aortic areas after an excellent response to second-line chemotherapy with paclitaxel and carboplatin. The patient is systemically well with no evidence of disease progression at 20 months of follow-up. Aggressive multimodality management involving consolidative radiation therapy may be attempted to improve the disease control in a small subset with stage IVA urothelial bladder carcinoma even after first-line systemic therapy, especially in the setting of nonaffordability to immune check point inhibitors.