Researchers suggest tile-based radiation therapy as standard of care to lower risk of recurrence in brain metastases

by University of Texas MD Anderson Cancer Center

edited by Sadie Harley, reviewed by Andrew Zinin

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A multicenter clinical trial led by researchers at The University of Texas MD Anderson Cancer Center found that implanting collagen tiles during brain surgery to deliver targeted radiation therapy improved tumor control, lowered the risk of recurrence and improved overall survival compared with the current standard of care for patients with newly diagnosed brain metastases who need surgery.

The ROADS trial, co-led by Jeffrey Weinberg, M.D., professor of neurosurgery, and Thomas Beckham, M.D., Ph.D., assistant professor of CNS radiation oncology, is the first randomized controlled Phase III trial comparing GammaTile cesium-131 collagen tile-based radiation therapy (TBRT) with standard-of-care postoperative stereotactic radiation therapy (SRT).

The study was published in the Journal of Clinical Oncology. The results were also presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.

After one year, patients treated with TBRT had a 1.3% rate of recurrence at the surgical site, compared with 15.4% of patients in the SRT group. That meant patients and their doctors were much less likely to face the need for additional procedures, such as 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.

"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," Weinberg said. "From a patient standpoint, we're showing that there's almost four times the length of local control and an increase in overall survival. It's not just a little difference. It's a massive difference."

What is tile-based radiation therapy and how does it work?

GammaTile TBRT uses a Food and Drug Administration (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. The tiles are essentially "wallpapered" to the cavity left after surgery.

This ensures that radiation is evenly distributed across the cavity surface, where most remaining microscopic tumor cells are located. The seeds disperse low-dose therapeutic radiation over several weeks while limiting exposure to healthy tissue. The dose fall-off from brachytherapy is very fast, meaning very little healthy brain tissue 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, indicating that improved outcomes did not come at the cost of increased toxicity. The rate of radiation necrosis, an important late risk for patients treated with radiation for brain metastases, was nearly identical between the two groups.

Patients receiving TBRT were able to complete cranial radiation faster, most in just one day, compared with a median of 32 days for those who needed to schedule postoperative SRT. That could allow an earlier return to systemic cancer treatments.

"These results are dramatically better than the current alternatives and provide improved patient convenience by getting them over the roadblock of a brain metastasis diagnosis 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 weren't expecting to this magnitude."

The researchers hope the results will accelerate adoption of TBRT in treatment guidelines and lead to broader clinical use. Future work can determine how widely TBRT reshapes metastasis care and explore its potential for treating other tumor types.

The current standard of care for brain metastases

Many patients with different advanced solid tumors can develop brain metastases, which can significantly affect their treatment and prognosis. The current standard treatment for patients who need surgery, typically because of larger or symptomatic brain metastases, is SRT after surgical resection. Without radiation, microscopic tumor cells left in the resulting cavity cause recurrence 50%–60% of the time.

SRT is a highly focused, dose-escalated treatment used to destroy those remaining tumor cells while sparing healthy tissue. Studies have shown that SRT should occur within four weeks after surgery to maximize its effectiveness. But many patients face complications after surgery, logistical and scheduling challenges, and interruptions to systemic therapy. In addition to causing delays, these issues result in approximately 20% of patients failing to receive planned postoperative SRT, compromising outcomes.

The current results suggest that TBRT could offer a new standard of care that reduces the logistical challenges of SRT and improves disease control in the brain, the authors said.

Publication details

Jeffrey S. Weinberg et al, Surgery and tile-based radiation therapy versus surgery and stereotactic radiation for newly diagnosed brain metastases (ROADS): a randomized, open-label, phase 3 trial, Journal of Clinical Oncology (2026). DOI: 10.1200/jco-26-01894

Journal information: Journal of Clinical Oncology

Key medical concepts

Brain MetastaseOverall Survival

Clinical categories

OncologyNeurology Provided by University of Texas MD Anderson Cancer Center Who's behind this story?

Sadie Harley

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