Summary: Implanting radioactive collagen tiles during brain surgery significantly outperforms the current standard of care for patients with newly diagnosed brain metastases. Results from the ROADS trial show that tile-based radiation therapy (TBRT) substantially improves local tumor control, reduces surgical-site recurrence to near zero, and more than doubles median overall survival compared with standard postoperative stereotactic radiation therapy (SRT).
By delivering targeted, low-dose brachytherapy at the moment of tumor removal, this approach removes treatment delays and prevents residual microscopic cancer cells from repopulating the surgical cavity.
Key facts
- Large survival benefit: In the randomized ROADS trial, patients who received cesium-131 collagen tiles achieved a median overall survival of 42.5 months, compared with 17.6 months for those treated with standard postoperative SRT.
- Near-elimination of local recurrence: One year after resection, the surgical-site recurrence rate was 1.3% with TBRT versus 15.4% with postoperative SRT, greatly reducing the need for salvage brain surgery or emergency radiation.
- How the tiles work: TBRT uses postage-stamp-sized collagen tiles embedded with cesium-131 seeds. Surgeons place these tiles directly against the cavity surface after tumor removal, producing a uniform, localized dose across the area where microscopic disease most often remains.
- Removing the treatment delay: Standard postoperative SRT typically begins around 32 days after surgery because of healing, planning, and scheduling. About 20% of patients never receive their planned SRT. TBRT is delivered immediately in the operating room, ensuring all patients receive radiation without delay.
- No increase in major toxicity: The trial found similar rates of serious treatment-related adverse events and radiation necrosis between TBRT and SRT groups, indicating the improved tumor control did not come at the cost of increased harm.
- Faster return to systemic therapy: Because TBRT completes cranial radiation during the index surgery, systemic cancer treatments can often resume sooner, helping manage disease outside the brain.
Source: MD Anderson
Overview
A multicenter, randomized Phase 3 trial led by The University of Texas MD Anderson Cancer Center evaluated cesium-131 collagen tile-based radiation therapy (TBRT) against the current standard of postoperative stereotactic radiation therapy (SRT) for patients with newly diagnosed brain metastases requiring surgical resection. The ROADS trial was co-led by Jeffrey Weinberg, M.D., professor of Neurosurgery, and Thomas Beckham, M.D., Ph.D., assistant professor of CNS Radiation Oncology. Results were presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.
At one year, the surgical-cavity recurrence rate was 1.3% for patients treated with TBRT compared with 15.4% for those who received postoperative SRT. Median overall survival, a key secondary endpoint, was 42.5 months with TBRT versus 17.6 months with SRT.
Expert perspective
“Implanting the radioactive tiles at the time of surgery guarantees that patients receive their treatment immediately, along with focal dose escalation, thereby having meaningful impact on local tumor control,” said Dr. Weinberg. He added that the magnitude of benefit—extended local control and improved overall survival—is substantial and clinically meaningful.
What is tile-based radiation therapy and how does it work?
TBRT uses an FDA-cleared low-dose-rate brachytherapy device. Each small collagen tile contains evenly spaced cesium-131 seeds and is placed to line the interior surface of the surgical cavity. The implanted seeds emit therapeutic radiation over several weeks, concentrating dose on the cavity where residual microscopic disease is most likely while sparing surrounding healthy brain tissue due to rapid dose fall-off.
Clinical outcomes and safety
The ROADS trial reported no meaningful differences in serious treatment-related adverse events between TBRT and the standard SRT approach. Importantly, rates of radiation necrosis, a critical late toxicity, were nearly identical between groups. Most patients treated with TBRT completed their cranial radiation in a single day during surgery, in contrast to a median wait of 32 days for postoperative SRT, which can delay or disrupt systemic cancer treatment.
Dr. Beckham noted that faster, reliable completion of cranial radiation appears to improve not only local surgical outcomes but also the broader management of patients’ systemic disease, an effect larger than anticipated.
The investigators hope these findings will encourage guideline changes and wider clinical adoption of TBRT. Further research will evaluate how broadly TBRT can reshape care for brain metastases and whether similar approaches might benefit other tumor types.
Current standard of care
For patients who require surgery for brain metastases—typically larger or symptomatic lesions—postoperative stereotactic radiation therapy (SRT) is commonly used to treat the surgical cavity and reduce recurrence risk. Without any radiation, recurrence rates in the cavity can reach 50–60%. Although SRT is highly focused and effective when delivered promptly, surgical recovery, scheduling challenges, and interruptions to systemic therapy can delay treatment and result in a significant proportion of patients missing planned radiation.
Funding: The study was sponsored by GT Medical Technologies, Inc.
Key Questions Answered:
A: The standard approach requires a recovery and planning window that typically spans several weeks. Surgical complications, complex scheduling and other logistical hurdles delay SRT initiation—a median of about 32 days in practice—and about 20% of patients never receive the planned treatment.
A: The tiles use low-dose-rate brachytherapy with cesium-131 seeds. Radiation intensity drops off rapidly with distance, so placing the tiles against the cavity surface concentrates dose where microscopic cells remain while minimizing exposure to adjacent healthy brain.
A: Because TBRT changed both short-term and long-term outcomes: it reduced one-year local recurrence from 15.4% to 1.3% and more than doubled median overall survival from 17.6 to 42.5 months, while providing treatment immediately during the index surgery.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by staff.
About this brain cancer research news
Author: Julie Nagy
Source: M. D. Anderson
Contact: Julie Nagy – M. D. Anderson
Image: The image is credited to Neuroscience News
Original research: Findings were presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.