Patient preferences regarding intraoperative versus external beam radiotherapy for early breast cancer and the impact of socio-demographic factors

  • Saskia SpaichEmail author
  • Sophie Krickeberg
  • Svetlana Hetjens
  • Frederik Wenz
  • Axel Gerhardt
  • Marc Sütterlin
Gynecologic Oncology



Patient comfort and preference have steadily gained attention in radio-oncologic treatment of breast cancer. Therefore, the purpose of this investigation was to further explore patient preferences in choosing between intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT).


We prospectively analysed data of 101 women, who were candidates for breast-conserving surgery with adjuvant radiotherapy. A two-part video was shown to patients: an educational section about EBRT/IORT, followed by a preference elicitation section focusing on additional accepted risk (AAR) of recurrence after either treatment. Furthermore, participants completed a questionnaire to identify factors that influence patient preference of radiation modality.


The data demonstrate that 42.5% of patients would accept additional risk of recurrence for IORT versus 9% AAR for EBRT, while 48.5% of patients would not accept any additional risk, yet would choose IORT over EBRT if risks of recurrence were equivalent. When combining patient preferences and the results from the questionnaire, no single socio-economic/-demographic factor was found to significantly correlate with AAR of IORT.


Our study confirms the existence of subgroups of breast cancer patients who would accept an additional risk of recurrence associated with choice of radiation modality to receive a single dose of IORT as adjuvant radiotherapy for breast cancer instead of EBRT over several weeks; yet our data fail to identify a single factor significantly associated with these patient preferences and, therefore, helpful for individualised decision-making processes.


Intraoperative radiotherapy (IORT) Breast cancer Breast-conserving surgery Patient preference External beam whole breast radiotherapy (EBRT) Shared decision-making 

List of Abbreviations


Additional accepted risk


Breast-conserving surgery


External beam whole breast radiotherapy


Intraoperative radiotherapy


Authors contributions

SS: project development, data management, data analysis, provision of study patients, manuscript writing, final approval of manuscript. SK: data collection, data analysis, provision of study patients, final approval of manuscript. SH: data analysis, final approval of manuscript. FW: project development, administrative support, provision of study patients, final approval of manuscript. AG: project development, data analysis, administrative support, provision of study patients, final approval of manuscript. MS: project development, data analysis, administrative support, provision of study patients, final approval of manuscript, supervision.

Compliance with ethical standards

Conflict of interest

Carl Zeiss Meditec supports radiobiological research in the Department of Radiation Oncology (Frederik Wenz). Marc Sütterlin reports reception of lecture fees in regard to IORT. The remaining authors declare that they have no competing interests.

Informed consent

All patients provided informed consent.

Ethical approval

The ethical approval for this study was obtained through Ethics Committee II, Heidelberg University, Medical Faculty Mannheim (2013-591N-MA).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyUniversity Medical Centre Mannheim, Heidelberg UniversityMannheimGermany
  2. 2.Department of Gynaecology and ObstetricsMannheimGermany
  3. 3.Department of Medical Statistics and BiomathematicsUniversity Medical Centre Mannheim, Heidelberg UniversityMannheimGermany
  4. 4.Department of Radiation OncologyUniversity Medical Centre Mannheim, Heidelberg UniversityMannheimGermany

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