Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials.
Breast conservation therapy (BCT) for early-stage breast cancer involves lumpectomy followed by whole breast radiotherapy, which can involve either standard fractionation (SRT) or accelerated fractionation (ART). This systematic review and meta-analysis was performed to determine whether any benefit exists for ART or SRT.



We searched MEDLINE (1966-2014), all seven databases of the Cochrane Library (1968-2014), EMBASE (1974-2014), clinicaltrials.gov, ISRCTN, WHO ICTRP, and meeting abstracts in the Web of Science Core Collection (1900-2014). RCTs comparing SRT to ART among women undergoing BCT with stage T1-T2 and/or N1 breast cancer or carcinoma in situ were included. Follow-up was 30 days for acute toxicity, or three years for disease control and late toxicity.



13 trials with 8189 participants were included. No differences were observed in local failure (n = 7 trials; RR 0.97; 95% CI 0.78-1.19, I2= 0%), locoregional failure, (n = 8 trials; RR 0.86; 95% CI 0.63-1.16, I2= 0%), or survival (n = 4 trials; RR 1.00; 95% CI 0.85-1.17, I2= 0%). ART was associated with significantly less acute toxicity (n = 5 trials; RR 0.36; 95% CI 0.21-0.62, I2= 20%), but no difference in late cosmesis (RR 0.95; 95% CI 0.81-1.12, I2= 54%).



ART use does not reduce disease control or worsen long-term cosmetic outcome, and may decrease the risk of acute radiation toxicity as compared to SRT.
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA. lfvalle@fulbrightmail.org.
Luca F
0000-0002-5781-4174
LF
Valle
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Surbhi
S
Agarwal
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Kathleen E
KE
Bickel
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
Haley A
HA
Herchek
Duke Cancer Institute, Durham, NC, USA.
David C
DC
Nalepinski
The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.|The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.|Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
Nirav S
NS
Kapadia
D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D016017:Odds Ratio; D017594:Publication Bias; D000069473:Radiation Dose Hypofractionation; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
Adjuvant radiation; Breast conservation therapy; Hypofractionated radiotherapy; Hypofractionation; Whole breast radiation