Lymphangioleiomyomatosis: A new relative contraindication for breast conservation therapy

Evidence is overwhelming that breast conservation, which consists of lumpectomy and radiation, is equivalent to mastectomy for patients with early stage breast cancer. These 2 local therapy options are presented to patients with early stage breast cancer, and decisions are a personal choice after weighing the risks and benefits of both approaches. However, for some patients, breast conservation is not an option due to contraindications for radiation. Radiation oncology residents are taught to quickly cite the standard contraindications for breast conservation, including Li-Fraumeni syndrome and scleroderma, which are both rare syndromes. The U.S. registry of Li-Fraumeni patients includes only 400 patients, and the prevalence of scleroderma has been estimated at 276 cases per million population. Radiation for Li-Fraumeni syndrome is discouraged due to the high risk of secondary cancers in this population. Radiation in the setting of scleroderma can cause exaggerated fibrosis that extends to underlying viscera outside of the radiation portal with risk of treatmentrelated mortality, although reports vary with regard to the degree of radiation toxicity. Another rare syndrome that nearly exclusively affects women is lymphangioleiomyomatosis (LAM), with a prevalence of approximately 9 patients per million population. This rare multisystem disease can affect the lungs and cause lung cysts and spontaneous pneumothorax. We performed a thorough literature search and were not able to identify any studies or reports on the use of breast conservation treatment in a patient with LAM; thus, we herein present the first case report on this topic.