Transarterial interventional therapy for bladder cancer: a narrative review

Bladder cancer remains clinically challenging due to high recurrence rates, risk of progression, and the morbidity of current standard treatments. Transarterial interventional therapies — including intra-arterial chemotherapy (IAC), balloon-occluded arterial infusion (BOAI), transcatheter arterial chemoembolization (TACE), and transcatheter arterial embolization (TAE) — have been increasingly investigated as locoregional approaches in bladder cancer management. IAC shows encouraging outcomes across adjuvant, neoadjuvant, and bladder-preservation settings; BOAI has been associated with favorable outcomes in bladder-preservation protocols for organ-confined muscle-invasive disease; and TAE has been used as a palliative strategy for refractory malignant hematuria, with emerging application as a preoperative adjunct. Evidence for TACE remains preliminary. Given the distinct therapeutic goals of these approaches, reported outcomes should be interpreted according to the specific clinical setting. Across all techniques, available data derive predominantly from retrospective single-center studies with heterogeneous protocols, limiting generalizability. Accordingly, these approaches may currently be viewed as complementary or investigational options in selected patients, while their role relative to established standards of care requires further evaluation. This review summarizes the technical principles, clinical applications, current evidence, and future directions of transarterial interventional therapy for bladder cancer.