Purpose Conventional treatment of early breast cancer involves breast conserving surgery (BCS) with or without sentinel lymph node biopsy, and adjuvant external beam radiotherapy (EBRT). Intra-operative radiotherapy (IORT) has advantages such as targeted radiation, patient compliance, and decreased toxicity. The study assessed the impact of histopathological variables on recurrence in IORT breast cancer patients. Methodology A prospective registry of early breast cancer patients undergoing BCS and IORT (Xoft Axxent eBx) was set up in 2017. IORT eligibility was evaluated with a risk-adapted approach. Exclusion criteria were patients who underwent mastectomy or did not undergo IORT. Data on patient demographics, tumour characteristics, and recurrence rates were collected. Results 101 patients (mean 66 years) were included. Mean tumour size was 15mm (range 7-23mm). Post-operatively, 5.94% had lymph node metastasis; 9.9% underwent adjuvant EBRT. At median 48-month follow-up, 2.97% had local recurrence, 0.99% locoregional recurrence, and 0.99% distant recurrence. Multivariate analysis identified statistical significance in size and Ki67. An increase in size of 1cm was associated with an increased risk of recurrence of 13.4% (95% confidence interval (CI) 1.9% - 28.5%, p <0.05). Ki67 was significantly related with recurrence rates in univariate analysis (p=0.027), and approached significance in multivariate analysis (p=0.081). Univariate analysis of tumour grade was insignificant (p=0.56). Conclusion Risk-adapted IORT resulted in low recurrence. However, we recommend IORT as a promising approach in carefully selected early breast cancer patients with relatively small tumour size and low Ki67 <20%. More studies with larger sample sizes are needed.