Implanted Radiation Tiles Double Survival in Brain Metastasis Patients, Phase 3 Trial Shows
Key Insights
The ROADS Phase 3 trial demonstrated that cesium-131 collagen tile-based radiation therapy (TBRT) dramatically reduced surgical site recurrence to 1.3% compared to 15.4% with standard stereotactic radiation therapy.
Patients receiving TBRT achieved median overall survival of 42.5 months, more than double the 17.6 months seen with standard care.
The FDA-cleared GammaTile (search) treatment allows patients to complete cranial radiation in one day versus 32 days for conventional therapy, enabling faster return to systemic cancer treatments.
A groundbreaking multicenter Phase 3 clinical trial has demonstrated that implanting radioactive collagen tiles during brain surgery dramatically improves outcomes for patients with newly diagnosed brain metastases requiring surgical resection. The ROADS trial, led by researchers at The University of Texas MD Anderson Cancer Center, showed that cesium-131 collagen tile-based radiation therapy (TBRT) more than doubled overall survival compared to current standard of care.
Superior Tumor Control and Survival Outcomes
The randomized controlled trial, which enrolled 230 patients across 32 centers, compared TBRT using GammaTile (search) against standard-of-care postoperative stereotactic radiation therapy (SRT). Results presented at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting revealed striking differences in efficacy.
After one year, patients treated with TBRT had a 1.3% rate of recurrence at the surgical site compared to 15.4% of patients in the SRT arm. This dramatic improvement translates to patients and their doctors being much less likely to face the challenges of salvage procedures such as additional surgery or radiation.
Most significantly, median overall survival reached 42.5 months with TBRT – more than double the 17.6 months seen with standard SRT. The estimated 24-month overall survival was 61.7% for GammaTile (search) compared with 35.7% for SRT, representing a 41% reduction in risk of death.
"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," said Jeffrey Weinberg, M.D., professor of Neurosurgery at MD Anderson and co-lead investigator of the trial.
How Tile-Based Radiation Therapy Works
TBRT uses an FDA-cleared low-dose brachytherapy device developed by GT Medical Technologies. The small tiles, about the size of a postage stamp (2 cm x 2 cm), contain evenly spaced seeds filled with cesium-131 embedded in a collagen matrix that gets "wallpapered" to the surrounding cavity left after surgery.
This approach 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 is exposed to significant amounts of radiation.
Treatment Convenience and Safety Profile
A key advantage of TBRT is treatment timing. Implanting the radioactive tiles at the time of surgery guarantees that patients receive their treatment immediately, along with focal dose escalation. Patients receiving TBRT completed cranial radiation in a median of one day, compared with 32 days for those needing to schedule postoperative SRT, potentially allowing for 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," said Thomas Beckham, M.D., Ph.D., assistant professor of CNS Radiation Oncology at MD Anderson and co-lead investigator.
Importantly, there were no differences in serious treatment-related side effects between TBRT and SRT, confirming 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, further highlighting the safety of TBRT.
Addressing Current Treatment Challenges
Brain metastases affect up to 40% of all cancer patients and significantly impact survival and quality of life. The current standard treatment for patients who need surgery is SRT following surgical resection due to the risk that microscopic tumor cells in the resulting cavity will lead to recurrence. Without any radiation, recurrence in the cavity occurs 50-60% of the time.
Current treatment faces significant challenges. Studies show that SRT should occur within four weeks after treatment to maximize effectiveness, but many patients face complications after surgery, logistical and scheduling challenges, and interruptions to systemic therapy. These issues result in approximately 20% of patients failing to receive planned postoperative SRT, with observable compromise in outcomes.
Clinical Impact and Future Adoption
The superior efficacy of TBRT was achieved without increased toxicity or worsened quality of life. Functional status, quality of life, time to distant brain failure, adverse events, leptomeningeal disease and radiation necrosis were similar in both treatment arms.
"The randomized prospective data from 230 patients across 32 centers around the U.S. should give clinicians the confidence in offering GammaTile (search) for brain metastases needing surgical resection," explained Dr. Michael Garcia, Chief Medical Officer of GT Medical Technologies.
GammaTile (search) is currently FDA-cleared for newly diagnosed malignant and recurrent brain tumors and has been adopted by more than 150 leading centers across the United States. The researchers hope these results will accelerate TBRT guideline adoption and establish broader clinical rollout, with future work exploring its potential for treating other tumor types.