Systematic review and meta-analysis finds hypofractionated whole-breast irradiation comparable to conventional fractionation in early-stage breast cancer

$Systematic review and meta-analysis finds hypofractionated whole-breast irradiation comparable to…$

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Frontiers in Medicine Published May 13, 2026 Medically reviewed May 13, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider HFRT as a potential option for early-stage breast cancer, but interpret results cautiously due to high between-study variability.

This systematic review and meta-analysis evaluated hypofractionated whole-breast irradiation (HFRT) versus conventional fractionated radiotherapy (CFRT) in patients with early-stage breast cancer. The analysis included 5,495 patients across multiple studies with a follow-up of 5 years.

For the primary outcome of disease-free survival (DFS), there were no significant differences between HFRT and CFRT (RR = 1.01; 95% CI 0.96–1.06; P = 0.83). Similarly, the incidence of lymphedema showed no significant difference (RR = 1.19; 95% CI 0.94–1.51; P = 0.15). For acute radiation dermatitis, a fixed-effects model showed a statistically significant difference favoring HFRT (RR = 1.62; 95% CI 1.20–2.18; P = 0.002), but this was not significant in the random-effects model (RR = 1.43; 95% CI 0.51–4.01; P = 0.50).

The authors noted substantial heterogeneity across studies (I² = 90%) and high between-study variability, which limits the certainty of the pooled estimates. They caution that results should be interpreted with caution given this variability.

Despite these limitations, the authors suggest HFRT could be a promising therapy option for early-stage breast cancer, with a trend toward reduced acute skin toxicity. However, the high heterogeneity warrants further well-designed studies to confirm these findings.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundBreast cancer is one of the most frequent cancers globally, and radiotherapy plays an important key role in reducing the chance of recurrence following breast-conserving surgery. As an alternative to traditional fractionated radiotherapy (CFRT), hypofractionated whole-breast irradiation (HFRT) has gained popularity since it provides similar oncological results over shorter treatment periods. Nevertheless, the comparative effectiveness and safety profile of hypofractionated versus conventional fractionation schedules remains an area of ongoing evaluation.AimTo compare the efficacy and safety of HFRT versus CFRT in patients with breast cancer, with particular emphasis on disease-free survival and treatment-related toxicity.MethodsA comprehensive search of PubMed, Cochrane Library, Scopus, Web of Science, and Embase was conducted through December 2024. Randomized controlled trials (RCTs) and comparative studies evaluating HFRT versus CFRT in early-stage breast cancer. Key outcomes assessed included disease-free survival (DFS) and treatment-related toxicities, particularly lymphedema and acute radiation dermatitis. The Mantel–Haenszel method to calculate risk ratios (RRs) with 95% confidence intervals (CI) was used.ResultsEight studies comprising 5,495 breast cancer patients were identified. The meta-analysis demonstrated no significant differences in disease-free survival (DFS) in 5 years (RR = 1.01, 95% CI 0.96–1.06; P = 0.83). Similarly, no significant difference was observed in the incidence of lymphedema between HFRT and CFRT (RR = 1.19, 95% CI 0.94–1.51; P = 0.15). Regarding acute radiation dermatitis, a statistically significant difference favoring HFRT was observed under the fixed-effects model (RR = 1.62, 95% CI 1.20–2.18; P = 0.002). However, due to substantial heterogeneity across studies (I² = 90%), a random-effects model was applied, which demonstrated no statistically significant difference between treatment groups (RR = 1.43, 95% CI 0.51–4.01; P = 0.50). These results should be interpreted with caution given the high between-study variability.ConclusionHFRT demonstrated comparable oncological outcomes to CFRT, with a trend toward reduced acute skin toxicity, indicating that it could be a promising therapy option for early-stage breast cancer. Standardizing radiation treatments and evaluating long-term toxicity and patient-reported results should be the goals of future research. Also, the observed variability across studies warrants cautious interpretation of the pooled estimates, particularly for outcomes demonstrating substantial heterogeneity.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025631012.