Intraoperative radiotherapy (IORT) treatments produced fewer incidents of pain that were less severe than external-beam radiotherapy (EBRT) treatments for breast cancer, according to women enrolled in a clinical trial comparing the two treatments. These findings were reported in the February issue of the journal Breast.
Persistent pain following breast cancer treatment is a commonly reported side effect. Researchers at the Rigshospitalet of the University of Copenhagen retrospectively questioned 238 women about incidences and severity of pain they experienced after they completed radiotherapy treatments.
The women had enrolled in the Targeted Intraoperative Radiotherapy Versus Whole Breast Radiotherapy for Breast Cancer (TARGIT-A) clinical trial, in which they were randomly assigned to receive either IORT or EBRT treatments following a lumpectomy from March 2007 through December 2009 (Breast, February 2012, Vol. 21:1, pp. 46-49).
All the women were postmenopausal, with a median age of 65. They were administered a questionnaire in which they were asked about prevalence of pain. Patients who replied affirmatively were asked to specify the location of the pain and its intensity on a 0-10 numeric scale, with 0 equating no pain and 10 the worst imaginable pain. They also were asked about the frequency of pain.
Fewer women who received IORT treatment, representing 47% of the group, reported less persistent pain in the breast area and fewer incidents of pain than women who received conventional radiotherapy treatment.
Specifically, 24.6% of the IORT group experienced persistent pain in the breast area, side of chest, axilla, or arm compared with 33.9% in the EBRT group. The majority of patients in both groups reported experiencing light pain, although 50% of the EBRT group reported that the pain occurred each day as compared with 35.5% in the IORT group.
Interestingly, more than 41% of the women who received IORT treatment stated that they experienced headaches, and neck, shoulder, or low back pain. Only 26% of the EBRT group reported these side effects. While these are commonly reported by patients taking aromatase inhibitors, both groups had a similar number of patients taking this drug. Lead author Dr. Kenneth Given Anderson of the section for surgical pathophysiology and colleagues, had no explanation for this difference.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
