Selection criteria
Patients’ suitability for a conservative approach was determined by a combination of imaging, digital and cysto-urethroscopic examination under anaesthesia and histology. An initial MDT reviewed the pathology, diagnostic and re-assessment imaging for tumour size, location and extent, histological subtype/fusion status and lymph node involvement. Likely candidates underwent examination under anaesthesia jointly by the surgeons and oncologists. The vesical extent of the tumour was specifically assessed histologically by endoscopic biopsies mapped to different sites in the bladder, using a cysto-urethroscopic or percutaneous approach (described below). All patients were discussed at National Advisory Panel. Involvement of more than a third of the bladder above the trigone or tumour size greater than 5 cm following induction chemotherapy and surgery (if required), lymph node or distant metastases were contra-indications for a conservative procedure. There were three forms of CS-BT: partial cystectomy of the vesical component and brachytherapy (PC+BT), percutaneous endoscopic polypectomy and brachytherapy (PEP+BT) or interstitial HDR-BT alone.