Strengths and Weaknesses of the Evidence

Overall the evidence included in the systematic review was based on six randomised controlled trials which were considered to be of high quality.

All trials were randomised, with the methods of randomisation considered high quality. The trials were open label and not blinded. Survival outcomes by intention-to-treat analysis were reported by most trials and limited numbers of patients were lost to follow-up (less than 5%). All trials had standardised assessment of outcomes and had well matched population characteristics between treatment arms at baseline.

All reported outcomes need to be considered in the context of the range of hypofractionated radiotherapy regimens that were evaluated. Although 50 Gy in 25 fractions was used as a control arm in all trials, seven different hypofractionated radiotherapy regimens were investigated.