We treated 25 patients who had muscle invasive pure squamous cell carcinoma of the bladder with preoperative radiation and cystectomy. At operation the tumors in 10 patients (40%) were downstaged--3 of 5 from stage T2, 3 of 4 from stage T3a and 4 of 16 from stage T3b, while 6 patients (24%) had no residual tumor (pT0). The actuarial 5-year survival rate for all patients was 50%. Disease recurred in the pelvis in 7 patients, none of whose tumors had been downstaged (6 died of cancer). Median survival of patients with a pelvic recurrence was 9 months and without recurrence it was 86.7 months (p = 0.03). No patient whose tumor was downstaged had a recurrence or died of bladder cancer. We conclude that irradiation before cystectomy in patients with squamous cell bladder cancer may protect against pelvic recurrence, which is the predominant cause of death. Because effective adjuvant chemotherapy is not available to treat squamous cell carcinoma as it is for transitional cell carcinoma, we recommend irradiation before cystectomy for locally advanced squamous cell carcinoma of the bladder.