A phase III randomized trial presented at the 2026 ASCO Annual Meeting found that implanted tile-based radiation therapy significantly reduced local recurrence and improved overall survival compared with postoperative stereotactic radiotherapy (SRT) in patients undergoing surgical resection of large brain metastases (Abstract LBA2000). The findings suggest that delivering radiation immediately at the time of surgery may overcome limitations associated with the delay required before standard postoperative radiation can begin.
“Patients undergoing tumor resection currently face an inherent gap in care: Radiation is delayed for weeks after surgery, which not only can result in worse local control, but can also delay systemic treatment,” said lead study author Jeffrey S. Weinberg, MD, of The University of Texas MD Anderson Cancer Center, Houston. “Patients needed a better option that could result in better outcomes and easier logistics.”
Study Details
The multicenter, phase III ROADS trial enrolled 204 patients with newly diagnosed brain metastases measuring 2 to 7 cm in diameter that required surgical resection. Patients were randomly assigned to receive either cesium-131–containing collagen tiles implanted into the surgical cavity immediately following tumor removal (n = 103) or standard postoperative SRT administered 2 to 4 weeks after surgery (n = 101). The study’s primary objectives included surgical bed recurrence and overall survival.
Key Takeaways
After a median follow-up of 12.9 months (interquartile range = 5.9–22.8 months), the implanted tile approach demonstrated substantial improvements in local disease control. Surgical bed recurrence occurred in only 1% of patients treated with tile-based radiation compared with 12% of those who received postoperative SRT, representing a 94% reduction in the risk of local recurrence. Median time to surgical bed recurrence was 17.4 months in the SRT group; in the tile group, a median could not be calculated because more than half of patients remained free of recurrence at the time of analysis (hazard ratio [HR] = 0.06, 95% confidence interval [CI] = 0.01–0.46, P = .007).
The benefit extended to recurrence-free survival. Median surgical bed recurrence–free survival was 10.9 months in the control group, whereas the median had not yet been reached among patients receiving implanted radiation (HR = 0.48, 95% CI = 0.30–0.76, P = .002).
Investigators also observed a significant overall survival advantage. Tile-based radiation was associated with a 41% reduction in the risk of death compared with SRT. Estimated 2-year overall survival rates were 61.7% in the tile group vs 35.7% in the control group. Researchers suggested that earlier resumption of systemic therapy after surgery may have contributed to the survival benefit.
Grade 3 or higher adverse events occurred in 18.1% of patients treated with implanted tiles and 19.3% of those receiving SRT. Rates of leptomeningeal disease and radiation necrosis were also similar between the treatment groups.
Further analyses from ROADS will examine neurocognitive outcomes, including effects on memory, attention, and other aspects of cognitive function, as well as interactions with systemic cancer therapies.
DISCLOSURE: For full disclosures of the study authors, visit coi.asco.org.
