Brachytherapy-based
radiotherapy has been applied for decades in the curative treatment for solitary, ≤ 5 cm
bladder tumors. This review provides a historical perspective of this organ sparing approach. A systematic search of the published literature between 1900 and 2019 was performed on the subject of bladder
brachytherapy using PubMed, with digitally retrievable articles being supplemented with articles from the personal collection of the authors. The articles were divided into consecutive time periods, each reflecting the impact of authors on the development of
brachytherapy treatment: the time of pioneers, early innovators, modifiers, and recent innovators. Three case-controlled studies comparing
brachytherapy-based
organ-sparing treatment with
cystectomy, demonstrated similarity between the two approaches in terms of disease-free and overall survival, whereas
brachytherapy-based approach offered the advantage of at least 80% chance of bladder preservation. The overview was organized in a chronological order, starting from the evolution of
brachytherapy from
radium, followed by remote afterloading and dose-rate adjustments, and closing with modern era of high-dose-rate and image-guided
brachytherapy. Importantly, we demonstrated how essential and beneficial for the patients is a close collaboration between radiation oncologists and urologists, and how adopting a modern surgical development, i.e. the laparoscopic implantation technique, which later became robot-assisted, contributed to the success of this multidisciplinary
brachytherapy treatment. We concluded that this highly effective
brachytherapy method with very limited toxicity deserves more worldwide popularity.