“When bladder cancer recurs in the pelvis, treatment options are limited and survival is often measured in months.
Muscle-invasive bladder cancer is a particularly aggressive form of the disease.
This is the challenge we set out to address.”Radiation cuts recurrence riskThe BART trial enrolled 153 patients, who had undergone surgery for bladder cancer.
Also Read | Strain of common cold virus can help cure bladder cancer: StudyAlternative to immunotherapyThe significance of the study extends beyond India.
“Immunotherapy has demonstrated meaningful improvements in disease-free survival among high-risk bladder cancer patients, particularly in developed healthcare systems.
A major clinical trial led by Tata Memorial Hospital (TMH), Mumbai, and conducted across four Indian cancer centres over eight years has found that radiation therapy after bladder removal surgery can reduce the risk of cancer returning to the pelvis by more than half.
The findings of the Bladder Adjuvant Radiotherapy (BART) trial were recently published in the ‘Journal of Clinical Oncology,’ one of the world’s leading cancer research journals. “When bladder cancer recurs in the pelvis, treatment options are limited and survival is often measured in months. Our study shows that radiation after bladder removal surgery can significantly reduce the risk of pelvic recurrence with manageable side effects,” said Dr Vedang Murthy, professor, Department of Radiation Oncology, Tata Memorial Centre, and lead investigator of the BART trial.
A difficult cancer to treat
Bladder cancer is among the most difficult and expensive cancers to diagnose and treat. According to the International Agency for Research on Cancer (IARC), it is the ninth most common cancer worldwide. More than six lakh people were diagnosed with the disease globally in 2022. In India, data from the Global Cancer Observatory (2022) estimates around 22,548 new cases and 12,353 deaths annually, making it the country’s 17th most common cancer. The disease disproportionately affects men, with tobacco consumption among the major risk factors.
Muscle-invasive bladder cancer is a particularly aggressive form of the disease. Standard treatment typically involves chemotherapy followed by surgical removal of the bladder and surrounding organs, including the prostate in men or uterus in women, along with nearby lymph nodes. Patients then undergo reconstructive procedures to create an alternative pathway for urine after bladder removal.
“Patients go through extensive treatment, yet nearly two-thirds develop recurrent disease within three years,” said Dr Murthy. “Some recurrences occur in distant organs such as the lungs or bones. However, in roughly a quarter of high-risk patients, the cancer returns in the pelvis where the bladder was originally located. These relapses are especially devastating because there are very few effective treatment options once they occur. This is the challenge we set out to address.”
Radiation cuts recurrence risk
The BART trial enrolled 153 patients, who had undergone surgery for bladder cancer. Half the participants received radiation therapy to the pelvis after surgery, while the remaining patients were placed under observation.
“The results were clear. Radiation reduced the risk of cancer returning to the pelvis by more than 50 per cent,” Dr Murthy said. “This provides strong evidence that radiation can prevent local recurrence in high-risk patients.” He added that advances in radiation technology have made treatment more precise and safer.
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In the trial, fewer than five per cent of patients experienced severe side effects, while most treatment-related symptoms were temporary and improved after therapy ended.
Also Read | Strain of common cold virus can help cure bladder cancer: Study
Alternative to immunotherapy
The significance of the study extends beyond India. While immunotherapy drugs such as nivolumab and pembrolizumab have shown benefits in reducing recurrence, their high cost remains a major barrier in many parts of the world.
“Immunotherapy has demonstrated meaningful improvements in disease-free survival among high-risk bladder cancer patients, particularly in developed healthcare systems. However, these drugs are prohibitively expensive for most patients, not only in India but across Asia, Africa and Latin America,” said Dr Murthy.
“When immunotherapy is unavailable or unaffordable, our research shows that radiation can offer an effective, safe and relatively affordable alternative to reduce recurrence and potentially improve survival.”
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Radiation therapy typically requires patients to visit a treatment centre five days a week for about six weeks. While this can be logistically demanding, the treatment is available at most cancer centres across India.
Dr Murthy emphasised that patients should have detailed discussions with their radiation oncology team before starting treatment. “It is important to understand the expected benefits, possible bowel-related side effects and whether radiation is the right option for an individual’s specific situation,” he said.
