Early postoperative complications and patient‑reported quality of life following breast‑conserving surgery with intraoperative radiotherapy: A prospective cohort study

The present study aimed to evaluate the incidence of short-term complications and health-related quality of life (HRQoL) in patients with breast cancer undergoing breast-conserving surgery (BCS) with intraoperative radiotherapy (IORT), and to identify associated influencing factors. The study prospectively analyzed clinical data from women who underwent BCS with IORT at Tianjin Medical University Cancer Institute and Hospital (Tianjin, China) between March 2021 and June 2023. Telephone follow-up was conducted within 3 months post-surgery to assess surgery- and radiotherapy-related complications. HRQoL was evaluated using the BREAST-Q BCS module and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. Statistical analyses were performed using SPSS 27.0. Among 102 enrolled patients, common complications included incision site sclerosis (84.3%), pain (58.8%) and skin indentation (44.1%). Severe complications such as infection (7.8%) and delayed healing (12.7%) were less frequent. Grade I-II acute radiation dermatitis occurred in 73.5% of patients. Univariate analysis revealed that larger applicator size was significantly associated with higher-grade skin toxicity, skin indentation and irritation (P<0.01). Older age was a risk factor for incision infection and delayed healing (P<0.05). Larger tumor size (T stage) adversely affected satisfaction with breasts and chest physical well-being scores (P<0.01). The study concluded that, in patients with early-stage breast cancer treated with BCS plus IORT, 3-month postoperative complications are predominantly mild localized tissue reactions with rare severe events. Applicator size, age and tumor stage are significantly associated with early complications and acute-phase QoL, informing preoperative counseling and perioperative management optimization. However, this study only reflects acute recovery outcomes; long-term follow-up of the cohort is ongoing to evaluate late toxicities, cosmetic results and sustained QoL.