Researchers Use Collagen Tiles to Stop Brain Cancer Recurrence

Summary: Implanting radioactive collagen tiles during brain surgery dramatically outperforms the current standard of care for patients with newly diagnosed brain metastases. The ROADS trial reveals that tile-based radiation therapy (TBRT) drastically improves local tumor control, reduces the risk of surgical-site recurrence to near-zero, and more than doubles median overall survival compared to standard postoperative stereotactic radiation therapy (SRT).

By delivering targeted, low-dose brachytherapy immediately upon tumor removal, this technique successfully eliminates logistical treatment delays and prevents residual cancer cells from proliferating.

Key Facts

A Massive Survival Leap: In the landmark ROADS trial, patients treated with the radioactive collagen tiles achieved a median overall survival of 42.5 months, more than doubling the 17.6 months observed in the standard postoperative SRT group.
Near-Elimination of Recurrence: One year following surgical resection, patients treated with TBRT experienced a staggering 1.3% rate of tumor recurrence at the surgical site. In sharp contrast, patients in the standard SRT arm faced a 15.4% recurrence rate, meaning the tile system drastically protects patients from the trauma of salvage brain surgeries or emergency radiation.
The “Wallpapered” Matrix Mechanics: TBRT utilizes an FDA-cleared low-dose brachytherapy device featuring postage-stamp-sized collagen tiles embedded with evenly spaced cesium-131 seeds. Surgeons essentially “wallpaper” these tiles directly to the raw cavity surface left behind immediately after a tumor is cut out, ensuring an even, highly localized dose escalation across the tissue where microscopic cancer cells typically hide.
Overcoming the 32-Day Logistical Roadblock: Standard postoperative SRT requires patients to heal from surgery, navigate scheduling hurdles, and undergo outpatient radiation planning, resulting in a median timeline of 32 days before treatment begins. Shockingly, this delay causes roughly 20% of standard patients to never receive their planned radiation at all. The TBRT tile system completely bypasses this barrier, guaranteeing 100% treatment delivery on day one, right on the operating table.
Pruning Toxic Side Effects: Despite delivering an immediate and highly effective dose of focal radiation, the ROADS trial confirmed that the improved clinical outcomes did not increase toxicity. Rates of serious treatment-related side effects and radiation necrosis, a critical late-stage risk of brain radiation, remained virtually identical between the tile and standard radiation groups.
Expedited Return to Systemic Therapy: Because patients treated with the collagen tiles complete their entire cranial radiation protocol in a single day rather than waiting weeks for outpatient scheduling, they get past the roadblock of a brain metastasis diagnosis much faster. This expedited timeline allows them to return to their systemic cancer therapies earlier, protecting the rest of their body from cancer progression.

Source: MD Anderson

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

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 3 trial comparing cesium-131 collagen tile-based radiation therapy (TBRT) against standard-of-care postoperative stereotactic radiation therapy (SRT).

Weinberg presented the trial results today at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting.

This shows neurons. — Implanting cesium-131 embedded collagen tiles directly into a brain tumor cavity immediately following surgery slashes local recurrence to 1.3% and more than doubles median overall survival. Credit: Neuroscience News

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, a dramatic improvement meaning patients and their doctors were much less likely to face the challenges of salvage procedures such as additional 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?

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 that essentially gets “wallpapered” to the surrounding 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 the course of 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.

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, confirming that improved outcomes did not come at the cost of increased toxicity. Importantly, 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.

Notably, patients receiving TBRT were able to complete cranial radiation faster, most in just one day, compared with a median of 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,” 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 these results will accelerate TBRT guideline adoption and establish broader clinical rollout. Future work can determine how widely TBRT reshapes metastasis care and explore its potential for treating other tumor types.

What is the current standard of care for brain metastases?

Many patients with different advanced solid tumors can develop brain metastasis, which can significantly impact their treatment and prognosis. The current standard treatment for patients who need surgery (typically due to larger or symptomatic brain metastases) 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.

Therefore, SRT is used as a highly focused, dose-escalated treatment to destroy those remaining tumor cells while sparing healthy tissue. Studies have shown that SRT should occur within four weeks after treatment to maximize its effectiveness, but many patients can 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, with observable compromise in outcomes.

The current results suggest that TBRT could offer a new standard of care for the patients that improves upon logistical challenges with SRT and boosts disease control in the brain, the authors explained.

Funding: The study was sponsored by GT Medical Technologies, Inc.

Key Questions Answered:

Q: Why is the current standard of care for brain metastases causing one in five patients to completely miss their radiation treatment?

A: Because the current standard requires a dangerous, month-long waiting period. After a surgeon removes a brain tumor, patients are scheduled for external stereotactic radiation therapy (SRT) to kill off remaining microscopic cells. However, due to surgical recovery complications, complex scheduling, and logistical hurdles, it takes a median of 32 days to start. This delay results in about 20% of patients never getting their planned radiation, causing their cancer outcomes to plummet.

Q: How does a postage-stamp-sized collagen tile deliver radiation safely without destroying healthy brain tissue?

A: By using localized brachytherapy, which features a incredibly fast “dose fall-off.” The collagen tiles are embedded with evenly spaced seeds of cesium-131. When surgeons wallpaper these tiles into the empty cavity left by the removed tumor, the seeds release a low-dose therapeutic radiation over several weeks. Because the radiation travels only a tiny distance before losing its power, it completely blankets the immediate surface where stray cancer cells hide while leaving the surrounding healthy brain untouched.

Q: What makes the results of the ROADS trial a “massive difference” rather than just a minor medical update?

A: Because it literally rewrites the timeline and survival expectations for advanced cancer patients. Instead of spending weeks traveling to a hospital for radiation treatments, tile-treated patients complete their entire cranial radiation protocol in just one day during their initial surgery. This single shift cut the one-year tumor recurrence rate from 15.4% down to a tiny 1.3%, and more than doubled the patients’ median overall survival from 17.6 months to a stunning 42.5 months.