OBJECTIVES: To evaluate short and long term effects of hypofractioned radiation therapy in women with early stage breast cancer, after undergoing breast conservative surgery.  METHODS: We searched for randomized controlled trials in Embase, Medline, Cochrane Library and Lilacs comparing unconventional versus conventional fractioning. The authors performed data extraction independently. Disagreements were resolved by consensus. Random-effects risk ratios (RR) were calculated comparing patients randomized to unconventional with those to conventional fractioning. Periods before and after five years of treatment were considered.  RESULTS: Five trials reported on 7.802 women. The studies were of medium to high quality. Unconventional fractionation did not affect, until five years and after five years, respectively: (1) local recurrence RR 0.90 (95% CI 0.68 to 1.18, P = 0.44) and RR 0.98 (95% CI 0.83 to 1.17, P = 0.86); (2) distant recurrence (RR) 1.04 (95% CI 0.73 to 1.46, P = 0.84) and RR 1.02 (95% CI 0.79 to 1.32, P = 0.88); (3) mortality RR 0.89 (95% CI 0.77 to 1.05, P = 0.16) and RR 0.96 (95% CI 0.89 to 1.08, P = 0.48); (4) disease-free survival RR 0.96 (95% CI 0.78 to 1.18, P = 0.69) and RR 0.96 (95% CI 0.84 to 1.09, P = 0.49); (5) cardiac ischemia RR 0.73 (95% CI 0.34 to 1.57, P = 0.42) and RR 0.61 (95% CI 0.33 to 1.15, P = 0.13); (6) rib fracture RR 1.02 (95% CI 0.25 to 4.20, P = 0.98) and RR 1.08 (95% CI 0.26 to 4.53, P = 0.91); (7) pulmonary fibrosis RR 2.42 (95% CI 0.50 to 11.71, P = 0.27) and RR 0.97 (95% CI 0.89 to 11.21, P = 0.07).  CONCLUSIONS: Using hypofractioned radiotherapy regimens does not affect any of the outcomes analyzed in women with early stage breast cancer, after undergoing breast conservative surgery.