Comparative outcomes of hypofractionated versus conventional radiotherapy following mastectomy for breast cancer: A systematic review and meta-analysis.

Abstract

e12544 Background: Previous meta-analyses have compared hypofractionated versus conventional postmastectomy radiotherapy, but there have been new observational studies highlighting the need for an updated analysis. Our meta-analysis compares hypofractionated and conventional fractionated postmastectomy radiotherapy in breast cancer patients, with a focus on reconstruction-related complications. Methods: An updated systematic search of PubMed, Embase, Scopus, Web of Science and the Cochrane Library was performed from the last search date of the most recent eligible meta-analysis(i.e January 10, 2025) to January 20, 2026. Randomized controlled trials and retrospective cohort studies comparing hypofractionated and conventional fractionated radiotherapy after mastectomy were included. Outcomes of interest included overall complications, infection, capsular contracture, reconstruction failure, fat necrosis, hematoma, wound dehiscence and reoperation. Pooled odd ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I V2 for non-randomized studies. Results: The updated search identified 03 additional studies, expanding the evidence base to 14 studies including 4047 patients. HFRT was associated with complication rates comparable to CFRT, including major complications (OR = 0.81, 95% CI 0.53-1.23, p = 0.32), infections (OR = 0.93, 95% CI 0.55-1.56, p = 0.78) and capsular contracture (OR = 0.60, 95% CI 0.33-1.07, p = 0.08). No significant differences were observed for reconstruction failure, wound dehiscence, fat necrosis, reoperation or hematoma. Effect estimates were consistent with prior meta-analyses, with improved precision for several endpoints. Conclusions: This updated meta-analysis incorporating recent randomized and observational evidence supports the safety of HFRT comparable to CFRT, with respect to reconstruction-related complications, reinforcing its role as an alternative to conventional fractionation in appropriately selected patients.