A multicenter clinical trial led by researchers at The University of Texas MD Anderson Cancer Center found that implanting collagen tiles and delivering targeted radiation therapy during brain surgery dramatically improves tumor control, lowers the risk of recurrence, and improves overall survival compared to the current standard of care for patients with newly diagnosed brain metastases requiring surgical resection.
The ROADS trial, co-led by Jeffrey Weinberg, MD, professor of neurosurgery, and Thomas Beckham, MD, assistant professor of central nervous system radiation oncology, is the first randomized controlled Phase III trial comparing cesium-131 collagen tile-based radiation therapy (TBRT) with the standard of care postoperative stereotactic radiation therapy (SRT). Dr. Weinberg presented the study results today at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.
After 1 year, the recurrence rate at the surgical site for patients treated with TBRT was 1.3%, compared with 15.4% for patients in the SRT group. This was a dramatic improvement and meant that patients and their doctors were far less likely to face salvage procedures such as additional surgery or radiation therapy. Median overall survival, the study’s key secondary endpoint, was 42.5 months with TBRT, more than double the 17.6 months seen with standard SRT.
Implanting radioactive tiles at the time of surgery ensures that patients receive immediate treatment while also increasing the local dose, which has a meaningful impact on local tumor control. From a patient perspective, we found an almost four-fold increase in local control duration and improved overall survival. It’s not just a slight difference. That’s a big difference. ”
Jeffrey Weinberg, MD, Professor of Neurosurgery, University of Texas MD Anderson Cancer Center
What is tile-based radiation therapy and how does it work?
TBRT uses a Food and Drug Administration (FDA)-approved low-dose brachytherapy device developed by GT Medical Technologies, Inc. The tiny tiles, about the size of a postage stamp, contain evenly spaced seeds filled with cesium-131 embedded in a collagen matrix, essentially “wallpapering” the surrounding cavity left after surgery.
This distributes the radiation evenly across the cavity surface where most of the remaining microscopic tumor cells reside. The seeds distribute low doses of therapeutic radiation over several weeks while limiting exposure to healthy tissue. Dose reduction with brachytherapy is so rapid that a healthy brain is exposed to very little radiation.
What happened to patients treated with TBRT during the ROADS trial?
There were no differences in severe treatment-related side effects between TBRT and SRT, confirming that improved outcomes do not come at the expense of increased toxicity. Importantly, the incidence of radiation necrosis, an important late risk for patients treated with radiation therapy for brain metastases, was similar in both groups, further underscoring the safety of TBRT.
Of note, compared to the median 32 days for patients who need to be scheduled for postoperative SRT, patients receiving TBRT can complete cranial radiation more quickly, with most completing it in just 1 day, potentially allowing for an earlier return to systemic cancer treatment.
“These results are dramatically better than current alternatives and will improve patient convenience by overcoming the hurdles in diagnosing brain metastases sooner,” Beckham said. “At the end of the day, it appears that if we can overcome the obstacles and get back to managing the cancer as a whole, we can have a positive impact that goes beyond just the surgical outcome. This is really exciting and something we never expected to see.”
The researchers hope these results will accelerate the adoption of TBRT guidelines and establish broader clinical deployment. Future studies will determine how broadly TBRT reshapes metastatic treatment and may explore its potential in the treatment of other tumor types.
What is the current standard treatment for brain metastases?
Many patients with various advanced solid tumors can develop brain metastases, which can significantly impact treatment and prognosis. The current standard of care for patients requiring surgery (usually due to larger or symptomatic brain metastases) is surgical resection followed by SRT, as microscopic tumor cells within the resulting cavity are at risk of causing recurrence. Without radiation, there is a 50-60% chance that tooth decay will recur.
Therefore, SRT is used as a highly focused, dose-escalating treatment to destroy remaining tumor cells while sparing healthy tissue. Studies have shown that SRT should be performed within 4 weeks of treatment to maximize its effectiveness, but many patients may face postoperative complications, logistical and scheduling issues, and interruption of systemic therapy. These issues not only cause delays, but approximately 20% of patients do not receive their planned postoperative SRT, leading to a clear compromise in outcome.
The authors explained that the results suggest that TBRT may improve the logistical challenges of SRT and provide patients with a new standard of care that enhances disease control in the brain.
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University of Texas MD Anderson Cancer Center
