background: Muscle-invasive bladder cancer is common in Egypt. Trimodality chemoradiation post transurethral resection of bladder tumor proved high benefits. Our aim is to show our institute’s experience in using gemcitabine concurrent with radiotherapy post-TURB in an old frail group of patients diagnosed with MIBC regarding efficacy and tolerability.Aim of work:to show the safety and efficacy of using low-dose weekly gemcitabine as a radiosensitizer concurrent with radiotherapy post-TURBT in an old frail group of patients diagnosed with MIBC and unfit for radical surgery. Methods: This prospective study included 47 patients diagnosed with de novo MIBC in the period between October 2016 and October 2020. Patients who qualified underwent maximal TURBT followed by radiation therapy with 65 GY in two phases concomitant weekly gemcitabine (100 mg/m2). Results: The median age was 65.9 years. Males were more common (80.9%) than females. The Median follow-up was 24 months. A complete response was achieved in 34 patients (72.3%). Salvage cystectomy was done for 3 patients who did not achieve CR. chemotherapy was given to another 5 patients of those who did not achieve CR (gemcitabine plus cisplatin /carboplatin). While 5 patients refused any further treatment, only for follow-up regimens. Survival: Median PFS and OS were 40 months and 42 months, respectively. Threeyear progression-free survival (PFS) and overall survival (OS) were 66.6% and 75.4%, respectively. Conclusions: Chemoradiation with low dose Gemcitabine is well tolerated and effective post-TURT. It provides an alternative organ-preserving strategy in invasive TCC for old fragile patients.