Super-selective bladder arterial chemotherapy for muscle invasive bladder cancer.

Background: Bladder cancer is a common urinary malignancy. Muscle-invasive bladder cancer (MIBC) has high recurrence, poor prognosis, and limited treatments. Radical cystectomy is invasive. Super-selective bladder arterial chemotherapy is promising but lacks evidence. This study evaluated its efficacy and safety for MIBC. Methods: We retrospectively analyzed the data of the patients with MIBC who received super-selective bladder arterial chemotherapy with cisplatin and gemcitabine from January 2018 to September 2024. Treatment responses and adverse events were also assessed. Results: Twenty-five MIBC patients underwent 47 courses of super-selective bladder arterial chemotherapy, with a mean participant age of 63.8±13.5 years. The median overall survival (OS) for the cohort was 34.4 months, with 1-, 2- and 3-year survival rates of 75.4% [95% confidence interval (CI): 60.1-94.6%], 50.3% (95% CI: 33.8-74.8%) and 33.5% (95% CI: 19.1-58.9%), respectively. Eleven patients achieved partial response (PR), 9 patients had stable disease (SD), and 2 patients experienced progressive disease (PD). The overall response rate (ORR) and disease control rate (DCR) were 50.0% and 90.9%, respectively. Additionally, 56.0% of patients subsequently underwent surgical resection of bladder tumors after the interventional treatment. No serious complications were reported. Conclusions: Super-selective bladder arterial chemotherapy is feasible and well-tolerated for MIBC, with promising tumor response and downstaging efficacy. Larger prospective controlled trials are needed to confirm its clinical value in MIBC management.