Hypofrctionated Radiotherapy For Early Breast Cancer Patients:A Systematic Review And Meta-Analysis

Background and purpose:Post-operative radiotherapy is one of the standard treatment for eraly breast cancer. However, The optimal fractionation schedule of radiotherapy remains controversial. The purpose of this study was to intercompared treatment outcomes in patients with early breast cancer treated with conventional radiotherapy and hypofractionated radiotherapy.We conducted a meta-analysis of randomized controlled trials(RCTs) compare the effects betweed conventional radiotherapy and hypofractionated radiotherapy.Methods:A comprehensive search of Pubmed,Cochrane Central Trials Registry,Medline,Web of Science and Chinese CNKI databas by two independent authors.Inclusion was restricted to randomized controlled trials in post-operative breast cancer patients.For the following end points:overall survival(OS),3-5-year and 10-year local relapse,distant relapse and change in breast appearance.Meta-analysis was performed by using Review Manager 5.0 and using odds ratio (OR) with the corresponding 95% confidence interval (CI) to represent result.Results:5 RCTs that involved a total of 8009 patients,the meta-analysis shown that compare with conventional radiotherapy,the hypofractionated radiotherapy was connected with almost an equivalent 3-5-year local relapse(OR= 0.98,95%CI:0.79-1.20,P= 0.82),10-year local relapse(OR=0.96, 95%CI:0.81-1.14, P= 0,65),distant relapse (OR=1.10,95%CI:0.75-1.62, P = 0.61) and OS(OR=1.08,95%CI:0.93-1.26, P= 0.32).Subgroup analysis about change in breast appearance,per fraction dose<3.3Gy group in hypofractionated (OR= 1.05,95%CI:0.74-1.49,P=0.79),However,per fraction dose≧ 3.3Gy group in hypofractionated radiotherapy increase the risk of change in beast appearance for the patients with early breast cancer(OR= 1.48,95%CI: 1.09-2.01,P= 0.01).Conclusion:Our study was a meta-analysis of trials to assessment the effectiveness and safety about post-operative breast cancer patients treated with hypofractionated radiotherapy.It showed that per fraction≧3.3Gy group in hypofractionated radiotherapy could be inferior to conventional radiotherapy in terms of preventing change in breast appearance for the patients with early breast cancer, however without compromising OS,distant relapse,3～5-year and 10-year local relapse.