Surgery and Tile-Based Radiation Therapy Versus Surgery and Stereotactic Radiation for Newly Diagnosed Brain Metastases: A Randomized, Open-Label, Phase III Trial.

In a randomized phase III trial in 204 surgically treated patients with newly diagnosed brain metastases, R + TBRT markedly prolonged surgical bed recurrence outcomes versus R + SRT (HR 0.06 for time-to-SBR).

• Why it matters: Postoperative stereotactic radiation is standard after resection, but immediate focal delivery via cesium-131 collagen tiles could improve recurrence control and simplify logistics.
• What they did: Across 32 US centers, patients were randomized 1:1 to resection plus TBRT or resection plus SRT, with any nonresected lesions receiving postoperative SRT; co-primary outcomes were time-to-surgical bed recurrence and surgical bed recurrence-free survival.
• The result: Median time-to-SBR was not reached with R + TBRT versus 17.4 months with R + SRT (P = .0070), and SB-RFS was longer (not reached vs 10.9 months; P = .0021) with similar overall adverse events.

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