[Reflexions on techniques of preoperative radiotherapy in the treatment of carcinoma of the bladder. Initial results and discussion of a therapeutic protocol based upon histo-prognosis (author's transl)].

Basing their indications on the histo-prognosis of Opperman and Bittard in malignant tumours of the bladder, the authors decided to irradiate before cystectomy those bladder tumours in which the histo-prognostic index indicated that it was a local disease with metastatic potential with a spontaneous life expectancy of 18 to 30 months. Radiotherapy was given spread over 23 or 27 fractions providing a total of 46 Gy. Four to 6 weeks later, cystoprostatectomy with trans-ileal cutaneous ureterostomy was performed, before chemotherapy for one year. Amongst 11 patients treated, in 6 cases the bladder was completely "sterilised" from a histological standpoint. However there was persistence of tumour in 5 bladders with an increase in the histo-prognostic index. Amongst these 11 patients, with a minimum follow-up of 18 months, there has been a pelvic recurrence in two cases and three developed fatal metastases. In the opinion of the authors, these preliminary results represent an encouragement to continue along the same lines.