Background: Trimodality BPT in MIBC includes a maximal transurethral resection followed by concurrent chemoradiotherapy as an alternative to cystectomy in appropriately selected patients, or as a potential treatment in non-cystectomy candidates. Several chemotherapy regimens are used in BPT, but little is known about current practice patterns. This report describes chemotherapy utilization patterns and associated outcomes with BPT in MIBC. Methods: Data were collected from the Retrospective International Study of Cancers of the Urothelial Tract (RISC), a database of 3,024 consecutive patients from 29 international academic centers from 2005 to 2013. Patients with clinical T2-T4aN0M0 urothelial cancer of the bladder were included. Results: 269 patients received BPT. Compared with the 1,448 patients who received radical cystectomy, BPT patients were older (p = 0.01), less likely to have ECOG performance status of 0 or 1 (p < 0.01), and more likely to have clinical T4a disease (p < 0.01). 41% of BPT patients received concurrent chemotherapy with radiation. Patients receiving chemotherapy were younger (p = 0.01) and less likely to have T3 or T4 disease (p < 0.01) compared to patients who received radiotherapy alone. 25% of patients treated with chemotherapy received cisplatin only and 21% received carboplatin only. Additional regimens included gemcitabine alone (8%), paclitaxel (8%), 5-FU+mitomycin (5%), as well as others. Chemotherapy-treated patients had an adjusted HR for death of 0.89 (95% CI 0.61-1.29) compared to those who received radiotherapy alone after controlling for age, clinical T stage, and Charlson comorbidity index (median overall survival 26.5 vs 26.2 months, p = 0.37). There were no significant differences in survival among chemotherapy regimens. Only 10 patients (4%) eventually underwent cystectomy after BPT. Conclusions: A minority of patients undergoing BPT receive concurrent chemotherapy. The choice of chemotherapy used varies widely in clinical practice, with no clear standard. Salvage cystectomy is rarely performed. Continued research is needed on the comparative effectiveness among chemotherapy regimens in BPT.