Surgery and tile-based radiation therapy versus surgery and stereotactic radiation for newly diagnosed brain metastases (ROADS): a randomized, open-label, phase 3 trial
In brief
Cesium tiles cut surgical-bed recurrence hazard by 94% after metastasis surgery
In this randomized phase 3 trial, patients receiving cesium-131 tiles after brain metastasis surgery had a 94% lower hazard of surgical-bed recurrence than those receiving postoperative stereotactic radiation; median time to recurrence was not reached with tiles versus 17.4 months with stereotactic radiation. Overall adverse events were similar, but median follow-up was 12.9 months, leaving longer-term outcomes to be seen.
- Journal
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology (Q1)
- Published
- 28 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jeffrey S Weinberg, Brandon S Imber, Vincent DiNapoli, Nelson S Moss, Kimberly B Hoang, Fen Wang, et al.
- PMID
- 42804720
- DOI
- 10.1200/JCO-26-01894
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (paper of the day, 29 September 2026): R+TBRT significantly improved surgical‑bed recurrence
- Picked for Radiation Oncology (paper of the day, 29 September 2026): Tile-based vs stereotactic RT for brain metastases
Abstract
PURPOSE: Post-operative stereotactic radiation (SRT) is the standard-of-care for resected brain metastases. Implantation of cesium-131 collagen tiles (tile-based radiation therapy, TBRT) initiates focal radiation immediately after resection, potentially offering therapeutic and logistical advantages. ROADS: a randomized, open-label, non-inferiority, phase 3 trial (NCT04365374) compared the safety and efficacy of resection with TBRT (R+TBRT) to resection with SRT (R+SRT) for patients with a newly diagnosed brain metastasis indicated for surgical resection. PATIENTS AND METHODS: Across 32 United States centers, patients were pre-operatively randomized 1:1 to resection R+TBRT or R+SRT. Any non-resected brain metastases received SRT post-operatively. Co-primary outcomes were time-to-surgical bed recurrence (SBR) and surgical bed recurrence-free survival (SB-RFS). Outcomes were analyzed using Cox proportional hazards models with stratification factors as covariates. Multiplicity was controlled by hierarchical testing. Analyses used the pre-specified modified intent-to-treat (mITT) population (patients who underwent surgery, had pathologic confirmation of brain metastasis, and had follow-up information). RESULTS: From April 2021 through August 2025, 230 patients were randomized (115 per arm); 204 of whom (103 R+TBRT, 101 R+SRT) comprised the mITT population. Median follow-up was 12.9 months. Median time-to-SBR was not reached (R+TBRT) versus 17.4 months (R+SRT) (hazard ratio [HR]: 0.06; 95% confidence interval [CI]: 0.01-0.46; p=0.0070). SB-RFS was improved with R+TBRT, with a median of not reached versus 10.9 months (R+SRT) (HR: 0.48; 95% CI: 0.30-0.76; p=0.0021). Overall adverse events did not appear to differ: 83 patients (79.0%, 95% CI: 70.0-86.4) (R+TBRT) versus 67 patients (80.7%, 95% CI:70.6-88.6) (R+SRT). CONCLUSION: For patients with newly diagnosed brain metastases requiring resection, R+TBRT significantly improved SBR and SB-RFS, demonstrating both non-inferiority and superiority.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.