<h3>Purpose/Objective(s)</h3> Bladder-sparing chemoradiation therapy (CRT) is a definitive first-line treatment option for muscle-invasive bladder cancer (MIBC). There is considerable variability in radiotherapy target volumes in the United States, and ongoing cooperative trials support either bladder only or bladder plus pelvic nodal treatment. Whether the addition of pelvic lymph node treatment impacts outcomes is unknown. <h3>Materials/Methods</h3> We identified 2,566 patients in the National Cancer Database with cT2-4N0M0 urothelial cell carcinoma of the bladder treated with definitive-intent CRT following maximal transurethral resection of bladder tumor from 2004 to 2016. Patients were included if total radiation dose was ≥40 Gy and chemotherapy was initiated within 30 days of radiation. We excluded those who were post-cystectomy, node-positive, or metastatic; who had variant histology, history of prior malignancy, or received palliative-intent therapy. The exposure of interest was bladder only (BO) versus bladder plus pelvic lymph node (BPN) radiation. Annual use from 2004 to 2016 was compared using Cochran-Armitage test for trend. Overall survival (OS), defined from the date of diagnosis, was compared using Kaplan-Meier, log-rank test, and multivariable Cox proportional hazard analysis. Final multivariable model, developed via backward selection with an alpha level of 0.1 for removal, included age, race, diagnosis year, comorbidity score, insurance provider, education level, geographic region, and T stage. Sensitivity analysis tested an interaction term for T stage. <h3>Results</h3> We identified 719 patients treated with BO and 1,847 patients treated with BPN CRT. Median (IQR) dose to pelvic nodes was 45 Gy (39.6-50); median (IQR) dose to bladder (in both groups) was 64.8 Gy (59.4-64.8). There was a significant increase in use of pelvic nodal treatment from 2004 to 2016 (65.4 to 76.8%, p <.0001 for trend). With a median follow up of 6.2 years, there was no difference in survival between groups: 5-year and 10-year OS 28.4% (95% CI 24.8-32.1%) in the BO group versus 31.9% (95% CI 29.5-34.3%) in the BPN group, and 11.5% (95% CI 8.4-15.2%) in the BO group versus 14.0% (95% CI 11.7-16.6%) in the BPN group, respectively (log-rank p=.19). On multivariable analysis, there was no significant association between pelvic nodal coverage and OS (adjusted HR 0.93, 95% CI 0.84-1.03, p=.17). No differential effect by T stage was observed (T3-4 versus T2, interaction p=.41). <h3>Conclusion</h3> These hypothesis-generating results suggest that routine inclusion of pelvic nodal coverage is not needed for patients undergoing definitive CRT for node-negative MIBC. Use of pelvic nodal treatment, however, has continued to increase in the United States. Prospective investigation with adverse event, quality of life, and cancer-specific endpoints is warranted.