{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:45:37Z","timestamp":1792633537187,"version":"4.5.0"},"reference-count":0,"publisher":"American Society of Clinical Oncology (ASCO)","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["J Clin Oncol"],"abstract":"\n PURPOSE<\/jats:title>\n \n 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 (\n NCT04365374<\/jats:ext-link>\n ) 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.\n <\/jats:p>\n <\/jats:sec>\n \n PATIENTS AND METHODS<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n 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\u20130.46; 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\u20130.76; p=0.0021). Overall adverse events did not appear to differ: 83 patients (79.0%, 95% CI: 70.0\u201386.4) (R+TBRT) versus 67 patients (80.7%, 95% CI:70.6\u201388.6) (R+SRT).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n For patients with newly diagnosed brain metastases requiring resection, R+TBRT significantly improved SBR and SB-RFS, demonstrating both non-inferiority and superiority.<\/jats:p>\n <\/jats:sec>","DOI":"10.1200\/jco-26-01894","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:00:06Z","timestamp":1790625606000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":2,"title":["Surgery and tile-based radiation therapy versus surgery and stereotactic radiation for newly diagnosed brain metastases (ROADS): a randomized, open-label, phase 3 trial"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5587-6673","authenticated-orcid":false,"given":"Jeffrey S.","family":"Weinberg","sequence":"first","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1281-5915","authenticated-orcid":false,"given":"Brandon S.","family":"Imber","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"DiNapoli","sequence":"additional","affiliation":[{"name":"Mayfield Brain & Spine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0930-1681","authenticated-orcid":false,"given":"Nelson S.","family":"Moss","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly B.","family":"Hoang","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen","family":"Wang","sequence":"additional","affiliation":[{"name":"University of Kansas, Lawrence, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Mohiuddin","sequence":"additional","affiliation":[{"name":"AdventHealth Orlando, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7918-5153","authenticated-orcid":false,"given":"Akshitkumar M.","family":"Mistry","sequence":"additional","affiliation":[{"name":"University of Louisville, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1694-4229","authenticated-orcid":false,"given":"Michael A.","family":"Garcia","sequence":"additional","affiliation":[{"name":"Banner MD Anderson Cancer Center, Gilbert, Arizona"},{"name":"University of Arizona College of Medicine \u2013 Phoenix, Phoenix, Arizona"},{"name":"GT Medical Technologies, Inc., Tempe, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-851X","authenticated-orcid":false,"given":"Hussein","family":"Tawbi","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesh V.","family":"Patel","sequence":"additional","affiliation":[{"name":"HMH-Jersey Shore University Medical Center, Neptune, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong","family":"Pham","sequence":"additional","affiliation":[{"name":"Virginia Mason Medical Center, Seattle, 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Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO-26-01894","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:00:07Z","timestamp":1790625607000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO-26-01894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":0,"alternative-id":["10.1200\/JCO-26-01894"],"URL":"https:\/\/doi.org\/10.1200\/jco-26-01894","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"assertion":[{"value":"2026-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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