Palliative Intra‐Arterial Chemotherapy Without Radiotherapy for Elderly Patients With Muscle‐Invasive Bladder Cancer: A Single‐Center Retrospective Comparison With Radical Cystectomy and Best Supportive Care

Background Muscle‐invasive bladder cancer (MIBC) in elderly patients poses a significant treatment challenge owing to the high invasiveness of radical cystectomy (RC) and limited tolerability of systemic therapies. Intra‐arterial chemotherapy (IAC), traditionally used in combination with radiotherapy, has shown potential as a local tumor control strategy. However, evidence of its use without concurrent radiation remains limited. Objective This study evaluated the clinical efficacy of palliative IAC (P‐IAC) without radiotherapy in elderly patients with MIBC and compared outcomes between RC and best supportive care (BSC). Methods This retrospective study analyzed 137 patients ≥ 70 years old with MIBC who were treated at a single institution between 2010 and 2025. The patients were categorized into three groups: P‐IAC ( n = 43), RC ( n = 51), and BSC ( n = 43). Outcomes included the overall survival (OS), symptom‐free survival (SFS), and treatment‐related adverse events. Results The P‐IAC group demonstrated a significantly longer SFS ( p < 0.001) and OS ( p = 0.01) compared with the BSC group and no statistically significant difference in OS compared with the RC group ( p = 0.08). Notably, approximately 67% of patients with P‐IAC remained free of major clinical events at 60 months although the sample size was limited. Many patients achieved bladder preservation without urinary diversion. Adverse events were manageable, with no treatment‐related mortality. Conclusion P‐IAC without radiotherapy offers a promising treatment alternative for elderly patients with MIBC who are unfit for RC or systemic therapy. It provides both oncologic benefits and quality‐of‐life preservation, warranting further prospective validation and protocol standardization.