A multicenter clinical trial led by investigators at the University of Texas MD Anderson Cancer Center found that implanting collagen wafers during brain surgery to deliver targeted radiation therapy dramatically improved tumor control, reduced the risk of recurrence, and improved overall survival compared with the current standard of care for patients with newly diagnosed brain metastases requiring surgery.
The ROADS trial, led by Jeffrey Weinberg, MD, professor of Neurosurgery, and Thomas Beckham, MD, Ph.D., assistant professor of CNS Radiation Oncology, is the first Phase 3 randomized controlled trial comparing postoperative cesium-131 collagen plate therapy versus standard cesium-131 collagen-based radiation therapy. (SRT). Weinberg presented the trial results today at the 2026 American Society of Clinical Oncology (ASCO) annual meeting.
After one year, patients treated with TBRT had a 1.3% recurrence rate at the site of surgery compared with 15.4% of patients in the SRT arm, a dramatic improvement that meant patients and their doctors were far less likely to face the challenges of salvage procedures, such as additional surgery or radiation. Median overall survival, a key secondary endpoint of the trial, was 42.5 months with TBRT – more than double the 17.6 months seen with standard SRT.
Implantation of radioactive tiles at the time of surgery guarantees that patients receive their treatment immediately, along with focal dose escalation, thus having a significant effect on local tumor control. From a patient perspective, we show that there is almost a fourfold increase in the duration of local control and an increase in overall survival. It’s not just a small difference. It’s a huge difference.”
Jeffrey Weinberg, MD, Professor of Neurosurgery, University of Texas MD Anderson Cancer Center
What is tile radiation therapy and how does it work?
TBRT uses an FDA-cleared low-dose brachytherapy device developed by GT Medical Technologies, Inc. The small tiles, about the size of a postage stamp, contain evenly spaced seeds filled with cesium-131, embedded in a collagen matrix that essentially leaves the gap after surgery.
This ensures that the radiation is evenly distributed over the surface of the cavity, where most of the remaining tiny tumor cells are. The seeds diffuse low-dose therapeutic radiation over several weeks while limiting exposure to healthy tissue. The dose fall-off from brachytherapy is very rapid, meaning that very little of the healthy brain is exposed to significant amounts of radiation.
What happened to patients treated with TBRT during the ROADS trial?
There were no differences in serious treatment-related side effects between TBRT and SRT, confirming that the improved outcomes did not come at the cost of increased toxicity. Importantly, the rate of radiation necrosis, an important late risk for patients treated with radiation for brain metastases, was almost identical between the two groups, further underscoring the safety of TBRT.
Notably, patients who received TBRT were able to complete cranial radiation more quickly, most in a single day, compared to a median of 32 days for those who needed to schedule postoperative SRT, potentially allowing earlier return to systemic cancer treatments.
“These results are dramatically better than current alternatives and provide improved patient comfort by getting them over the hurdle of diagnosing brain metastases more quickly,” Beckham said. “At the end of the day, being able to get them over that roadblock and back to managing their cancer overall seems to positively impact more than just their surgical outcome, which is really exciting and something we didn’t expect at this magnitude.”
The researchers hope these results will accelerate TBRT guideline adoption and create wider clinical rollout. Future work may determine how broadly TBRT reshapes the care of metastases and explore its potential for treating other tumor types.
What is the current standard of care for brain metastases?
Many patients with different advanced solid tumors may develop brain metastasis, which can significantly affect their treatment and prognosis. The current standard treatment for patients requiring surgery (usually due to larger or symptomatic brain metastases) is SRT after surgical resection because of the risk that microscopic tumor cells in the resulting cavity will lead to recurrence. Without any radiation, cavity recurrence occurs in 50-60% of cases.
Therefore, SRT is used as a highly focused dose-escalation therapy to destroy these remaining cancer cells while sparing healthy tissue. Studies have shown that SRT should occur within four weeks of treatment to maximize its effectiveness, but many patients may experience post-surgical complications, logistical and scheduling challenges, and interruptions of systemic therapy. In addition to causing delays, these issues result in approximately 20% of patients failing to receive planned postoperative SRT, with observable compromise in outcomes.
The current results suggest that TBRT could provide a new standard of care for patients that improves the logistical challenges with SRT and enhances disease control in the brain, the authors explained.
