Introduction Clinical trial enrollment has declined globally due to the COVID-19 pandemic. This underscores the importance of structured methods to continue critical medical research safely and efficiently. Methods We report the impact of a phased trial reopening strategy, remote research staffing, and telemedicine on cancer trial enrollment at one of the largest Radiation Oncology academic cancer centers. In Phase 1, trials investigating definitive therapeutic benefit were opened, followed by trials not increasing patient exposure or pulmonary toxicity risk in Phase 2. During Phase 2.5, multicenter trials reopened and limited research staff were allowed on-site. Results Despite initial enrollment declines during the early pandemic, the percentage of new patients enrolling in clinical trials from March to August 2020 was 8.8%, and represented an 10.5% relative increase from 2019. Monthly accrual enrollment from March to August 2019 ranged from 42-71 compared to enrollment during COVID-19 from 23-73 patients (p<0.001). Conclusions Through a phased approach to trial reopening and adaptive techniques, the Division of Radiation Oncology maintained cancer trial accrual during the COVID-19 pandemic. The experience may help centers maintain accrual, preserve clinical trial integrity, and minimize risk to patients and staff.

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2-19.23, p=0.016) and lympho vascular invasion(LVI) (OR=4.29, CI 1.91-29.41, p=0.026) remained as independant predictors of ALNI. Conclusions Based on these results, we suggest that clinical axillary nodal status, pathologic tumor stage, and LVI are predictive factors for ALNM in Tunisian women with early breast cancer.