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Five hundred and ninety-one of 889 patients with T1 to T4 transitional cell carcinoma of the bladder had persistent or recurrent cancer after radical radiotherapy. Durable local control was significantly poorer for patients with grade 1 or T4 cancer before radiotherapy. Three hundred and twenty-two patients received additional surgical treatment: 21 1 were endoscopically managed and 11 1 had secondary cystectomy. The survival of patients with residual or recurrent cancer after radiotherapy was significantly improved by secondary local treatment (P< 0.0001 ). A comparison

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Local tumour control and survival is reported for 190 patients with T1 transitional cell cancer of the bladder who received a radical course of X-ray therapy. There was no difference in survival by the histological grade of the cancer but patients with grade 3 cancers had the highest probability of local control. After initial complete local tumour regression there was a similar probability of subsequent distant metastases irrespective of the grade of the cancer. Radical small field beam directed radiotherapy is commended for patients with T1/pT1 grade 3 transitional cell cancer of the bladder.