title: Systematic review and meta-analysis comparing hypofractionated with conventional fraction radiotherapy in treatment of early breast cancer.
abstract: BACKGROUND
  The purpose of this meta-analysis is to evaluate the efficacy and safety of altered radiation fraction size on outcomes for early breast cancer patients.
  
  
  METHODS
  A search of MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library and ClinicalTrials.gov was conducted. Quality of the randomized controlled trials (RCTs) or non-RCTs were evaluated according to Cochrane's risk of bias tool or Methodological Index for non-Randomized Studies (MINORS). Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis was applied according to different fraction dose and sensitivity analysis was performed according to RCTs or non-RCTs.
  
  
  RESULTS
  23 studies were included in this systematic review. Meta-analysis demonstrated hypofractionation radiotherapy (HFRT) was associated with decreased grade 2/3 acute skin reactions compared with conventional fraction RT (CFRT), either 2.5-3.0 Gy per fraction or 5.0-6.5 Gy per fraction. HFRT with 2.5-3.0 Gy per fraction significantly decreased moderate/marked photographic changes in breast appearance compared with CFRT [RR = 0.80, 95% CI (0.70, 0.91), P = 0.001], while HFRT with more than 3.0 Gy per fraction significantly increased moderate/marked photographic changes [RR = 1.21, 95% CI (1.06, 1.38), P = 0.004]. In addition HFRT cost one-third lower than CFRT. Regarding to local regional recurrence, distant metastasis, overall survival, disease free survival, excellent/good cosmetic comes, symptomatic radiation pneumonitis, ischemic heart disease and symptomatic rib fracture, there was no significant difference between two arms.
  
  
  CONCLUSIONS
  Based on available evidence, HFRT with 2.5-3.0 Gy per fraction should be the better choice for treatment of early breast cancer patients.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Zhi-Rui
authors.initials: ZR
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Xin
authors.initials: X
authors.lastname: Mei
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Xing-Xing
authors.initials: XX
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Zhao-Zhi
authors.initials: ZZ
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Jing
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China. Electronic address: stephanieyxl@hotmail.com.
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Rd, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Rd, Shanghai, 200032, PR China. Electronic address: guoxm1800@163.com.
authors.forename: Xiao-Mao
authors.initials: XM
authors.lastname: Guo
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D011379:Prognosis; D018714:Radiotherapy, Adjuvant
keywords: Breast cancer; Hypofractionation; Meta-analysis; Radiotherapy