Longitudinal Patient-Reported Outcomes and Early Provider-Rated Cosmetic Associations Following Intraoperative Radiation Therapy in Early-Stage Breast Cancer

Background Intraoperative radiation therapy (IORT) is an accepted alternative to whole-breast irradiation for select patients undergoing breast-conserving surgery. While oncologic and cosmetic outcomes have been well described, longitudinal psychosocial outcomes and their relationship to cosmetic recovery remain incompletely characterized. Methods We conducted a prospective single-center cohort study of women with early-stage invasive ductal carcinoma undergoing lumpectomy with IORT between 2019 and 2025. Participants completed the externally validated Functional Assessment of Cancer Therapy–Breast (FACT-B version 4) questionnaire preoperatively and at 6, 12, and 24 months postoperatively. Cosmetic outcomes were independently assessed by both patients and surgeons. Associations between scar appearance and well-being domains were evaluated using non-parametric correlation analysis. Results 94 patients underwent IORT, with 88 (92.6%) completing at least one postoperative survey. Overall quality of life scores remained stable over time, with a modest improvement in emotional well-being at 12 months (mean change +1.68, 95% CI 0.45-2.91). No statistically significant changes were observed in physical, social, or functional domains. Patient-reported scar scores demonstrated transient worsening at 6 months with return toward baseline by 12 months, while provider-rated scar scores improved over time. At 6 months, worse provider-rated scar appearance was associated with lower physical (r = −0.403, P = 0.050) and social well-being (r = −0.441, P = 0.033). Conclusions Patient-reported quality of life remained stable following IORT, with modest improvement in emotional well-being. Early provider-rated cosmetic appearance demonstrated meaningful associations with physical and social well-being during survivorship, suggesting clinician-assessed cosmetic recovery may provide additional insights into postoperative recovery beyond self-assessment. These findings are descriptive and hypothesis-generating and warrant confirmation in comparative studies.