{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:09:53Z","timestamp":1788952193984,"version":"build-2803163510"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Breast cancer (BC) is a common malignancy with increasing annual incidence. Radiotherapy shows favorable clinical efficacy in BC management, but limited randomized controlled trial data is a major limitation. Therefore, further validation of the optimal radiotherapeutic strategy for early-stage BC is required. This network meta-analysis evaluated radiotherapy regimens\u2019 effects on efficacy and cosmetic outcomes in early-stage BC, guiding clinical practice. A comprehensive literature search was conducted in PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials and cohort studies investigating radiotherapy approaches for early-stage BC. Data screening and extraction were independently performed using a standardized protocol. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle\u2013Ottawa Scale. The primary endpoint was ipsilateral breast recurrence (IBR), and secondary endpoints included locoregional recurrence, overall survival, disease-free survival, and cosmetic outcomes. Statistical analyses were performed using R 4.4.1 and STATA 18.0.\u00a0A total of 36 studies involving 32,655 patients and 9 interventions were included. The lowest IBR rate was observed in patients treated with hypofractionated whole-breast irradiation (HF-WBI) (surface under the cumulative ranking curve [SUCRA], 10.54%), followed by conventional fractionated whole-breast irradiation (CF-WBI) (SUCRA, 35.70%). Compared with CF-WBI, intraoperative electron radiotherapy (IOeRT) (odds ratio [OR], 4.19; 95% credible interval [CrI], 1.83\u201310.26), intraoperative radiotherapy (IORT) (OR, 1.75; 95% CrI, 1.06\u20132.87), and HF-WBI (OR, 0.78; 95% CrI, 0.56\u20130.99) demonstrated statistically significant differences. The best cosmetic outcomes were achieved with three-dimensional conformal radiotherapy (3D-CRT) (SUCRA, 14.43%), followed by intensity-modulated radiotherapy (IMRT) (SUCRA, 16.04%). Compared with CF-WBI, 3D-CRT (OR, 0.11; 95% CrI, 0.01\u20130.85), IMRT (OR, 0.13; 95% CrI, 0.01\u20130.72), and IOeRT (OR, 0.25; 95% CrI, 0.04\u20130.78) showed statistically significant improvements. Since evidence supporting cosmetic outcomes is limited, findings should be interpreted with caution. Among patients with early-stage BC, HF-WBI was associated with the lowest rate of postoperative ipsilateral recurrence, whereas CF-WBI was associated with the second-lowest rate. In terms of cosmetic outcomes, 3D-CRT and IMRT demonstrated favorable clinical efficacy. Additional randomized controlled trials are necessary to clarify the comparative advantages and limitations of CF-WBI, HF-WBI, 3D-CRT, and IMRT, thereby strengthening the evidence base for early-stage BC radiotherapy strategies.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identifier CRD420251173161.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1876930","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:14:26Z","timestamp":1788948866000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and cosmetic outcomes of radiotherapy modalities in early-stage breast cancer: a systematic review and network 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