We assessed the effectiveness of intra-arterial MVAC chemotherapy or a combination of intra-arterial chemotherapy and external beam radiotherapy based on diagnostic images and histological (transurethral) examination in 15 cases with T2-3NOM0 between January 2003 and September 2005. When the clinical response was assessed one month after the treatments, a complete response (CR) was achieved in 20% (1/5) and 50% (5/10) by intra-arterial MVAC chemotherapy and a combination of intra-arterial chemotherapy and external beam radiotherapy, respectively. Total radical cystectomy was required on one patient during the follow-up period of 4-26 months. Although our result showed that the combination of external beam radiation therapy and intraarterial cisplatin effectively contributed to the preservation of the bladder with localized invasive bladder cancer, radical cystectomy is required when CR is not achieved after this treatment.