Summary: Implanting radioactive collagen tiles at the time of brain surgery significantly outperforms current standard care for patients with newly diagnosed brain metastases. Results from the ROADS trial show that tile-based radiation therapy (TBRT) markedly improves local tumor control, reduces surgical-site recurrence to almost zero, and more than doubles median overall survival compared with standard postoperative stereotactic radiation therapy (SRT).
By delivering a focused, low-dose brachytherapy treatment immediately after tumor removal, this approach eliminates treatment delays and targets residual microscopic cancer cells before they can regrow.
Key Facts
- Substantial survival benefit: In the randomized ROADS trial, patients receiving cesium-131 collagen tiles had a median overall survival of 42.5 months versus 17.6 months for those who received standard postoperative SRT.
- Near-elimination of local recurrence: One year after surgery, only 1.3% of TBRT patients experienced tumor recurrence at the surgical site, compared with 15.4% in the SRT group.
- How the tiles work: The FDA-cleared device uses postage-stamp-sized collagen tiles embedded with evenly spaced cesium-131 seeds. Surgeons place these tiles along the cavity surface left by tumor removal to deliver a uniform, localized radiation dose where microscopic disease most commonly remains.
- Removing logistical delays: Standard postoperative SRT typically begins a median of 32 days after surgery, creating a window when treatment can be missed; about 20% of patients do not receive their planned postoperative SRT. TBRT delivers radiation intraoperatively, ensuring treatment is completed on day one.
- Comparable toxicity: The ROADS trial found no increase in serious treatment-related side effects or radiation necrosis with TBRT compared with standard SRT, indicating that improved control did not come at the cost of greater harm.
- Faster return to systemic therapy: Because TBRT completes cranial radiation during the initial operation, most patients avoid the multiweek delay associated with outpatient radiation and can resume systemic cancer treatments sooner.
Source: MD Anderson
Overview of the ROADS trial
A multicenter Phase 3 randomized trial led by researchers at The University of Texas MD Anderson Cancer Center evaluated cesium-131 collagen tile-based radiation therapy (TBRT) versus standard postoperative stereotactic radiation therapy (SRT) for patients with newly diagnosed brain metastases who required surgical resection. The trial, co-led by Jeffrey Weinberg, M.D. (Neurosurgery) and Thomas Beckham, M.D., Ph.D. (CNS Radiation Oncology), is the first randomized comparison of this implantable brachytherapy device against contemporary postoperative SRT.
ROADS showed dramatic improvements in both local control and overall survival. One year after resection, local recurrence at the surgical site was 1.3% in the TBRT group versus 15.4% in the SRT group. Median overall survival, a key secondary endpoint, was 42.5 months with TBRT compared with 17.6 months with standard SRT.
Mechanism and practical advantages of TBRT
TBRT employs an FDA-cleared low-dose brachytherapy device produced by GT Medical Technologies, Inc. The collagen tiles—about the size of postage stamps—contain cesium-131 seeds embedded in a collagen matrix. Placed along the resection cavity, the tiles produce a uniform, localized radiation dose concentrated on the cavity surface where microscopic tumor cells commonly persist. The radiation is delivered over several weeks, with rapid dose fall-off that minimizes exposure to surrounding healthy brain tissue.
Because the radiation is delivered intraoperatively, TBRT eliminates the typical recovery-and-scheduling delay required for postoperative SRT. Standard care often requires a median of 32 days to begin radiation, during which recovery complications or logistical barriers can prevent about one in five patients from ever receiving their planned radiation. TBRT ensures treatment delivery at the time of surgery, avoiding that gap and reducing the risk of early regrowth.
Safety and tolerability
Importantly, the ROADS trial reported no meaningful difference in serious treatment-related adverse events between the TBRT and SRT arms. Rates of radiation necrosis, an important late complication of brain radiation, were essentially equivalent, supporting TBRT’s safety profile while delivering superior tumor control and survival outcomes.
Clinical and logistical implications
Completing cranial radiation during the initial surgery reduces delays in restarting systemic cancer treatments and removes a major logistical barrier for patients. Investigators and clinicians note that faster recovery from the acute phase of brain metastasis treatment and earlier resumption of systemic therapy may contribute to improved overall outcomes. Study authors hope these results will accelerate guideline adoption and broader clinical implementation of TBRT, and future research will explore its role across different tumor types and clinical settings.
Current standard of care context
For many patients with advanced solid tumors, brain metastases may require surgical resection when lesions are large or symptomatic. The current standard after surgery is postoperative stereotactic radiation therapy aimed at eradicating microscopic disease in the cavity; without any radiation, cavity recurrence rates are historically high. SRT is effective but requires outpatient planning and delivery, usually within weeks after surgery, which can introduce delays and interruptions in systemic therapy.
The ROADS results suggest TBRT could change that paradigm for eligible patients by combining resection and targeted radiation into a single operative session, improving convenience, reducing missed treatments, and strengthening local and overall disease control.
Funding: The study was sponsored by GT Medical Technologies, Inc.
Key Questions Answered
A: Postoperative stereotactic radiation typically requires wound healing, radiation planning, and outpatient scheduling. These steps create a median 32-day delay during which recovery complications or logistical barriers can prevent patients from receiving the planned therapy, leading to an estimated 20% failure to complete postoperative radiation.
A: The tiles use localized brachytherapy with cesium-131 seeds embedded in a collagen matrix. Their radiation dose falls off quickly with distance, concentrating treatment at the cavity surface where residual tumor cells reside while sparing surrounding healthy brain tissue.
A: The trial demonstrates major changes in both short-term and long-term outcomes: TBRT 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 completing radiation during the initial surgery and maintaining comparable safety.
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: Image credited to Neuroscience News
Original Research: Findings presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.