It is a post-operative treatment used for patients with high-risk, muscle-invasive bladder cancer to reduce the risk of recurrence in the pelvic area. (Photo: Freepik)
Bladder cancer is a major health challenge and despite advances in surgery and chemotherapy, one in three patients experiences a painful recurrence within a few years, which is often difficult to treat and affects quality of life. Now, for the first time, an India-led research study has shown that radiation therapy — which uses X rays to eliminate cancer cells — after surgery safely reduces the risk of relapse.
The study has been selected for the plenary session of the American Society for Radiation Oncology (ASTRO), the world’s largest radiation oncology conference. “About a quarter to a third of patients have relapses in the pelvis after bladder removal. So, when you see recurrences fall from one in four patients to less than one in ten, it’s a change you cannot ignore. That is a conversation we must now have with every high-risk patient after cystectomy (full or partial removal of bladder) because it directly translates into better quality of life and fewer untreatable relapses,” says Dr Vedang Murthy, professor of Radiation Oncology at Tata Memorial Centre (TMC) and principal investigator of the bladder adjuvant radiotherapy trial.
What is bladder adjuvant radiotherapy?
It is a post-operative treatment used for patients with high-risk, muscle-invasive bladder cancer to reduce the risk of recurrence in the pelvic area. Modern, precise radiation techniques spare surrounding organs. So it is a safe way to ensure local control and improve survival chances after a radical cystectomy, which is a major surgical procedure to remove the bladder, surrounding pelvic lymph nodes, and, in men, the prostate and seminal vesicles. For women, it may include the uterus, cervix, fallopian tubes, ovaries and the anterior vaginal wall.
What’s the trial all about
The Bladder Adjuvant Radiotherapy (BART) trial is the largest randomised trial in the world to evaluate the role of radiation therapy after bladder cancer surgery. These findings position radiation therapy as an important treatment option for patients.
The trial enrolled more than 150 patients across four cancer centres in India between 2016 and 2024. Results showed a marked reduction in potentially painful local cancer recurrences among patients who received radiation after surgery, without an increase in side effects. Patients remain at very high risk of a pelvic relapse after surgery, even when they receive chemotherapy. These recurrences are devastating and very hard to treat, yet historically most research has not focussed on local control.
Smaller studies suggested a role for radiation, but there was no high-level, modern randomized evidence. Hence the trial.
What challenges did you face in conducting a randomised phase III study and how were they addressed?
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The trial spanned several years and multiple centres across India. One major challenge was ensuring consistency in radiation planning and delivery across different centres. Data management and follow-up required close monitoring with electronic case report forms and regular site checks. These measures allowed researchers to maintain rigour and reliability across the study.
What are the most important takeaways for practising oncologists?
The key takeaway is that adjuvant pelvic radiotherapy after surgery can substantially improve pelvic control without causing toxicity. The second is that radiotherapy benefits high-risk patients. The third is that radiotherapy offers an immediately accessible and evidence-based way to improve outcomes compared to immunotherapy.
Radiation therapy is already widely accepted post-surgery for gynaecological cancers. Do you see radiation therapy evolving into a more personalized therapy approach for high-risk subgroups?
Gynaecologic oncology has shown us that with modern Intensity Modulated Radiation Therapy and image guidance are safe and effective for a complex anatomical region. If we apply those lessons in bladder cancer, adoption can be faster. Patients are often assumed to be destined for distant metastasis, when cancer cells spread from the original tumour to distant parts of the body, such as other organs or lymph nodes. So local treatments like radiotherapy have historically been ignored. However, our data shows these are precisely the patients who gain the most in pelvic control. This tells us radiotherapy should be part of a tailored strategy for the highest-risk groups. Over time, we can personalise this further.
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We need to move past historical fears, today’s radiotherapy is safer, more precise and entirely feasible in routine practice. Be it disease-free survival, cancer-specific survival and overall survival, we saw a consistent 12–15% absolute improvement with radiotherapy. The next stage should be about integrating radiotherapy with immunotherapy.
Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues .
Professional Background
Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature.
Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO.
Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives.
Awards and Recognition
Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.”
Recent Notable Articles (Late 2025)
1. Cancer & Specialized Medical Care
"Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease.
Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose.
2. Environmental Health (The "Breathless Pune" Series)
Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs.
"For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune.
3. Lifestyle & Wellness News
"They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions.
At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents.
4. Scientific Recognition & Infrastructure
For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics.
Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far.
Signature Beat: Health, Science & Women in Leadership
Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions.
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