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.