A meta-analysis of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer

Objective: To compare the efficacy between hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer by a meta-analysis. Methods: The controlled clinical trials of comparing hypofractionated radiotherapy versus conventionally fractionated radiotherapy in post-mastectomy breast cancer were searched from PubMed, EMbase, Cochrane Library, Wanfang database, VIP, CNKI, and CBM databases. The obtained data were analyzed using RevMan 5.3 and Stata 14.0 software. The differences between two groups were estimated by calculating the odds ratio (OR) with 95% confidence interval (CI). Results: A total of 19 controlled clinical trials involving 2652 post-mastectomy breast cancer patients were selected in this meta-analysis according to the inclusion and exclusion criteria. The meta-analysis results demonstrated that no statistical significance was observed in the tumor-free survival (OR = 1.10, 95% CI: 0.78-1.56, P = 0.59), overall survival (OR = 1.18, 95% CI: 0.92-1.53, P = 0.19), locoregional recurrence (OR = 1.01, 95% CI: 0.68-1.51, P = 0.96), distant metastasis (OR = 1.14, 95% CI: 0.82-1.59, P = 0.43), skin toxicity (OR = 1.01, 95% CI = 0.80-2.16, P = 0.96), cardiac toxicity (OR = 1.17, 95% CI: 0.71-1.93, P = 0.53) and pulmonary toxicity (OR = 0.78, 95% CI: 0.44-1.37, P = 0.38) between two groups. Conclusions: Hypofractionated radiotherapy and conventionally fractionated radiotherapy post-mastectomy yield similar clinical efficacy, both of which are safe and efficacious radiotherapy patterns. However, the findings remain to be validated by large-scale randomized clinical trials with long-term follow-up of the advanced stage complications. (authors)