Breast Cancer Research and Treatment

, Volume 162, Issue 3, pp 409–417 | Cite as

Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials

  • Luca F. ValleEmail author
  • Surbhi Agarwal
  • Kathleen E. Bickel
  • Haley A. Herchek
  • David C. Nalepinski
  • Nirav S. Kapadia



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.

Materials and methods

We searched MEDLINE (1966–2014), all seven databases of the Cochrane Library (1968–2014), EMBASE (1974–2014),, 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, I 2 = 0%), locoregional failure, (n = 8 trials; RR 0.86; 95% CI 0.63–1.16, I 2 = 0%), or survival (n = 4 trials; RR 1.00; 95% CI 0.85–1.17, I 2 = 0%). ART was associated with significantly less acute toxicity (n = 5 trials; RR 0.36; 95% CI 0.21–0.62, I 2 = 20%), but no difference in late cosmesis (RR 0.95; 95% CI 0.81–1.12, I 2 = 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.


Adjuvant radiation Breast conservation therapy Whole breast radiation Hypofractionation Hypofractionated radiotherapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.The Geisel School of Medicine at DartmouthHanoverUSA
  2. 2.The Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  3. 3.Duke Cancer InstituteDurhamUSA
  4. 4.Norris Cotton Cancer Center at Dartmouth Hitchcock Medical CenterLebanonUSA

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