Top Line: Does adjuvant radiation improve disease control in patients with high risk bladder cancer?
The Study: In few disease sites do we encounter more belligerence to radiation than bladder cancer (ok, maybe lymphoma). And despite its risk of distant failure, local recurrence of bladder cancer can be a major problem. BART was a phase 3 trial that randomized high risk bladder cancer patients to adjuvant RT or observation after chemotherapy and radical cystectomy. Most (90%) received some form of chemo (71% neoadjuvant, 20% adjuvant). The trial included 153 patients with muscle invasive urothelial carcinoma who had at least one high risk feature including T3-4, N1-3, positive margin, or fewer than 10 nodes dissected. Adjuvant RT consisted of 50.4 Gy in 28 fractions to the cystectomy bed and pelvic nodes. At 2 years, the primary endpoint of locoregional recurrence free survival was significantly higher after adjuvant RT (87.1% v 76%). There were numeric improvements in DFS (71.6% v 58.7%), bladder cancer specific survival (79.6% v 65%), and OS (70.4% v 57.4%), though these did not quite reach statistical significance. Distant metastasis was the most common pattern of failure (31%), but a close second was locoregional failure in the observation arm (25.6%). This was significantly reduced in the RT arm (just 7.9% locoregional failure). A previous publication showed that RT caused mild, transient GI effects without significantly increasing the risk of serious adverse events.
TBL: BART showed that adjuvant radiation significantly reduced the risk of locoregional recurrence for patients with bladder cancer and high risk features after chemotherapy and radical cystectomy without increasing serious adverse effects. | Murthy, J Clin Oncol 2026
The Study: In few disease sites do we encounter more belligerence to radiation than bladder cancer (ok, maybe lymphoma). And despite its risk of distant failure, local recurrence of bladder cancer can be a major problem. BART was a phase 3 trial that randomized high risk bladder cancer patients to adjuvant RT or observation after chemotherapy and radical cystectomy. Most (90%) received some form of chemo (71% neoadjuvant, 20% adjuvant). The trial included 153 patients with muscle invasive urothelial carcinoma who had at least one high risk feature including T3-4, N1-3, positive margin, or fewer than 10 nodes dissected. Adjuvant RT consisted of 50.4 Gy in 28 fractions to the cystectomy bed and pelvic nodes. At 2 years, the primary endpoint of locoregional recurrence free survival was significantly higher after adjuvant RT (87.1% v 76%). There were numeric improvements in DFS (71.6% v 58.7%), bladder cancer specific survival (79.6% v 65%), and OS (70.4% v 57.4%), though these did not quite reach statistical significance. Distant metastasis was the most common pattern of failure (31%), but a close second was locoregional failure in the observation arm (25.6%). This was significantly reduced in the RT arm (just 7.9% locoregional failure). A previous publication showed that RT caused mild, transient GI effects without significantly increasing the risk of serious adverse events.
TBL: BART showed that adjuvant radiation significantly reduced the risk of locoregional recurrence for patients with bladder cancer and high risk features after chemotherapy and radical cystectomy without increasing serious adverse effects. | Murthy, J Clin Oncol 2026