A radical cystectomy + extended pelvic lymph node dissection is the treatment of choice for patients with muscle invasive bladder cancer (MIBC). Despite this aggressive treatment the outcome is poor, as ultimately, 30% of the patients with >=pT3 tumours will develop a pelvic recurrence, with a 1- and 2-years survival of 8% and 3% respectively, and median survival of <4 months. A more aggressive therapeutic approach by combining treatments (either being given concomitantly, preoperatively or postoperatively) is indicated to improve the outcome. The role of postoperative chemotherapy is debatable. Preoperative chemotherapy (POC) improves overall survival but not locoregional relapse free survival. Local recurrences are of importance as they are debilitating and associated with developing metastases.