Brachytherapy Combined with Neoadjuvant Chemotherapy in Locally Advanced Bladder Cancer: A Single-Center Retrospective Study

A retrospective review was undertaken to assess the feasibility, safety, and therapeutic efficacy of brachytherapy in the management of locally advanced bladder cancer. Clinical records were examined for 86 individuals diagnosed with locally advanced bladder cancer who received care in the Department of Urology Surgery at Shanxi Provincial Cancer Hospital from January 2015 through June 2019. Depending on the treatment modality administered, subjects were assigned to either a study arm (n = 45) or a control arm (n = 41). The study arm underwent brachytherapy involving intraoperative placement of radioactive particles alongside neoadjuvant chemotherapy (NAC), while the control arm was given NAC only. Radical cystectomy (RC) with pelvic lymph node dissection was performed in both arms. Subsequent postoperative pathological assessment verified that subjects across both arms bore urothelial carcinoma staged at pT3–pT4. The predefined endpoints included 3-year rates of locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), overall survival (OS), and therapy-emergent adverse events. An evaluation of the safety and effectiveness of interstitial radioactive particle insertion for locally advanced bladder cancer was conducted. Follow-up ranged from 9 to 42 months. The study arm achieved a substantially higher 3-year LRFS (88.9%) relative to the control arm (60.9%) (P = .003). Three-year DMFS did not differ meaningfully between the study arm (71.1%) and the control arm (73.2%) (P = .945). No significant statistical distinction was observed for 3-year DFS or OS when comparing the two arms (DFS: study arm 64.4% versus control arm 51.2%, P = .073; OS: study arm 66.7% versus control arm 58.5%, P = .180). Within the study arm, particle displacement at the local site was observed in three subjects between the 1-week and 1-month postoperative time points, yet no consequent complications occurred. Blood-related toxicities (anemia, leukocytopenia, and thrombocytopenia), hepatic and renal impairment, vomiting, diarrhea, and generalized weakness constituted the principal adverse events, all of which subsided upon symptomatic management. The frequency of major adverse events did not differ significantly between the two arms. When measured against NAC monotherapy, the combination of brachytherapy with NAC confers a notable extension in LRFS among individuals with locally advanced urothelial bladder carcinoma who have undergone RC plus pelvic lymph node dissection. This operative strategy enhances LRFS, enables the formulation of more individualized therapeutic regimens, and improves overall treatment outcomes. Moreover, the approach is both safe and efficacious, yielding only a limited spectrum of adverse effects.