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The displacement of tumor bed walls during oncoplastic breast surgery (OBS) decreases the accuracy of using surgical clips as the sole surrogate for tumor bed location. This highlights the need for better communication of OBS techniques to radiation oncologists. To facilitate OBS practice and investigate clip placement reliability, a realistic silicone-based breast phantom was constructed with components emulating a breast parenchyma, epidermis, areola, nipple, chest wall, and a tumor. OBS was performed on the phantom and surgical clips were placed to mark the tumor bed. The phantom was imaged with CT, MRI, and ultrasound (US). The parenchyma's signal-to-noise ratio (SNR) and clips to parenchyma's contrast-to-noise ratio (CNR) were measured. The phantom's CT Hounsfield Unit (HU), relative electron density (RED), and mass density were determined. 6 and 10 MV photon beam attenuation measurements were performed in phantom material. The Young's Modulus and ultimate tensile strength (UTS) of the phantom parenchyma and epidermis were measured. Results showed that the breast phantom components were visible on all imaging modalities with adequate SNR and CNR. The phantom's HU is 130±10. The RED is 0.983. Its mass density is 1.01±0.01 g cm −3 . Photon attenuation measurements in phantom material were within 1% of those in water. The Young's Moduli were 13.4±4.2 kPa (mechanical) and 30.2±4.1 kPa (US elastography) for the phantom parenchyma. The UTS' were 0.05±0.01 MPa (parenchyma) and 0.23±0.12 MPa (epidermis). We conclude that the phantom's imaging characteristics resemble a fibroglandular breast's and allow clear visualization of high-density markers used in radiation therapy. The phantom material is suitable for dose measurements in MV photon beams. Mechanical results confirmed the phantom's similarity to breast tissue. The phantom enables investigation of surgical clip displacements pre-and post-OBS, and is useful for radiation therapy quality assurance applications.

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery.  OPS has led to some challenges with adjuvant radiation, particularly when accurate tumour bed (TB) delineation is needed for focused radiation (i.e. accelerated partial breast radiation or boost radiation).  Currently, there on no guidelines on tumour bed localization for adjuvant targeted radiation after OPS. Methods: A modified-Delphi method was used to establish consensus amongst a panel of 20 experts in surgical and radiation oncology at the Canadian Locally Advanced Breast Cancer National Consensus (LABCNC) Group and in subsequent online surveys. Results: The main recommendations are as follows: 1) Surgical clips are necessary and should, at a minimum, be placed along the four side walls of the cavity plus one to four clips at the posterior margin if necessary; 2) Operative reports should include pertinent information to help guide the radiation oncologists; 3) Breast surgeons and radiation oncologists should have a basic understanding of OPS techniques and work on “speaking a common language”; and 4) Careful consideration is needed when determining the value of targeted radiation, like boost, in higher level OPS procedures with extensive tissue rearrangement. Conclusion: The panel developed a total of six recommendations on TB delineation for more focused radiation therapy after OPS, with over 80% agreement on each statement.  These are summarized along with the corresponding evidence and/or expert opinion.

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

Background: The outbreak of the COVID-19 pandemic has led to unprecedented disruptions to global cancer care delivery. We conducted this multidisciplinary survey to gain insights into the real-life impact of the pandemic as perceived by cancer patients.Methods: Cancer patients at various stages of their cancer journeys were surveyed with a questionnaire constructed by a multidisciplinary panel of oncologists, clinical psychologists, occupational therapists, physiotherapists and dieticians. The 64-question survey covered patient's concerns on cancer care resources, treatment provision and quality, changes in health-seeking behaviour; the impact of social isolation on physical wellbeing and psychological repercussions.