Effectiveness and Safety of Hypofractionated Radiotherapy in Patients With Ductal Carcinoma In Situ (DCIS)

To synthesize the available evidence on the oncologic outcomes, toxicity, and cosmesis of hypofractionated whole-breast irradiation (HF-WBI) in patients with ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS).

A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase, and Web of Science were searched from inception until July 12, 2025. We included studies of DCIS patients treated with BCS followed by HF-WBI (fraction size > 2.0 Gy). Both comparative studies (against conventional fractionation [CF]) and single-arm studies reporting outcomes for HF-WBI alone were included. Pooled incidence rates for outcomes from single-arm studies and pooled hazard ratios (HRs) or odds ratios (ORs) from the limited comparative studies were calculated using random-effects models.

Nineteen studies were included. Local control and overall survival were excellent and equivalent between HF-WBI and CF-WBI. The pooled HR for local recurrence comparing ultrahypofractionation to CF was 0.89 (95% CI 0.64-1.24). HF-WBI significantly reduced the odds of acute dermatitis (OR 0.22, 95% CI 0.13-0.35). Late toxicities were infrequent (e.g., telangiectasia: 2%, 95% CI 0%-5%). Good/excellent cosmesis was reported in 90% (95% CI 84%-94%) of patients.

HF-WBI is a safe and effective treatment for DCIS, achieving oncologic outcomes equivalent to CF while offering improved tolerability, reduced acute skin toxicity, and excellent cosmetic results. These benefits, combined with increased convenience and potential cost savings, support the integration of HF-WBI into standard practice for DCIS.