Radiotherapy in patients with breast cancer and Li-Fraumeni syndrome — a narrative review

Li-Fraumeni syndrome (LFS) is a rare disorder that increases the risk of many cancers, including breast cancer (BC), leukemia, soft-tissue sarcomas, central nervous system tumors, and adrenocortical carcinomas. Several previous clinical observations have shown that families with LFS are at higher risk of secondary radiotherapy-induced malignancies. This review article summarizes the available information about secondary malignancies in LFS patients who were treated with radiation therapy. A total of two electronic databases (PubMed and Web of Science) were searched using key words that included ‘Li- Fraumeni Syndrome’, ‘breast cancer’, and ‘radiotherapy’ from their inception to February 2022. Studies reporting radiosensitivity, cancer, and radiotherapy-induced secondary neoplasms were summarized. The majority of the data that were found concerned radiotherapy in patients with BC with LFS, including radiotherapy-induced malignancy. According to recommendations, radiotherapy should be used with caution and adapted to minimize the risk of secondary malignant neoplasms. The potential risk of loco-regional recurrence without radiotherapy or the long-term risk of radiation-induced malignancies must be taken into account when considering adjuvant radiotherapy for LFS and BC patients.