Comparison of hypofractionation and conventional fractionation in postmastectomy radiotherapy after immediate breast reconstruction: A systematic review and meta-analysis of complications
Bibliographic record
Abstract
BACKGROUND: The optimal radiotherapy regimen following mastectomy and immediate breast reconstruction remains under active investigation. In particular, the safety of moderate hypofractionation (HF) compared to conventional fractionation (CF) for postmastectomy radiotherapy (PMRT) has not been clearly established. Given the growing adoption of HF in breast cancer treatment, a thorough synthesis comparing complication outcomes is essential to guide clinical practice. METHODS: A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL up to January 10, 2025. Studies comparing HF (2.4-2.7 Gy/fraction) and CF (1.8-2.0 Gy/fraction) in patients undergoing immediate breast reconstruction with PMRT were included. Studies involving partial breast irradiation or accelerated fractionation were excluded. Risk of bias was assessed using RoB 2 and ROBINS-I V2; certainty of evidence was evaluated using GRADE. A random-effects meta-analysis was performed, estimating pooled odds ratios (ORs) with 95 % confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023471267). RESULTS: Eleven studies (n = 3611), including three randomized controlled trials, were included. HF and CF demonstrated similar risks of major complications (OR: 0.83; 95 % CI: 0.51-1.35; p = 0.45; n = 5). No significant differences were observed for infection, wound dehiscence, or hematoma among photon-based studies. HF was associated with a lower risk of capsular contracture (OR: 0.38; 95 % CI: 0.15-0.99; p = 0.05; n = 5). Only one study evaluated quality of life, reporting no difference in physical well-being. CONCLUSIONS: HF offers a safety profile comparable to CF following breast reconstruction and may be preferred due to its reduced treatment burden and a potentially lower risk of capsular contracture.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.038 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".