Tile-Based Radiation Outperforms Postoperative Stereotactic Radiation Therapy in Resected Brain Metastases

According to findings from a phase III trial reported by Weinberg et al in the Journal of Clinical Oncology , intraoperative tile-based radiation therapy with cesium-131 significantly improved surgical bed control compared with postoperative stereotactic radiation therapy in patients undergoing resection of newly diagnosed brain metastases. The study also found improved surgical bed recurrence–free survival with tile-based radiation therapy, without apparent increases in radiation necrosis, neurocognitive decline, or deterioration in quality of life.

The investigators conducted the ROADS trial (ClinicalTrials.gov identifier NCT04365374 ) as a prospective, randomized, open-label, noninferiority phase III trial at 32 U.S. centers to compare resection plus postoperative stereotactic radiation therapy, the standard of care following resection of brain metastases, with resection plus tile-based radiation therapy, which delivers focal radiation immediately after resection through permanently implanted collagen tiles containing cesium-131 sources.