The Zap-X is a novel self-contained and self-shielded dedicated radiosurgery system developed and manufactured by ZAP Surgical Systems, Inc. of San Carlos, California. Intended for the stereotactic radiosurgery (SRS) treatment of benign and malignant intracranial and cervical spine lesions, this gyroscopically stabilized 3 megavolt (MV) linear accelerator (LINAC) provides a unique radiosurgical alternative for selected patients. Beginning in January 2019, a total of 38 metastatic lesions in 24 patients were treated in our facility. Radiation prescription doses ranged from 1500–1900 cGy (single fraction) to 2500 cGy (five fractions), with treatment volumes ranging from .04 to 15.3 cc. Daily treatment times averaged 45 minutes or less. Target coverage, dose homogeneity, and conformality were comparable to the existing Gamma Knife, CyberKnife and LINAC-based radiosurgery treatment systems in daily use at our facility. As with other frameless radiosurgery platforms, the Zap-X proved particularly useful in situations where either surgery or single-fraction radiosurgery was considered a less desirable treatment option; or when fractionated radiosurgery was thought to be radiobiologically advantageous. All treatments were completed without complication. At two months post-treatment, all lesions showed a complete or partial response to therapy based on MRI scan. None of our patients experienced treatment-related skin reaction, cognitive deficit, fatigue or steroid dependency. Among patients who had previously undergone Gamma Knife treatment, there was a clear preference for frameless radiosurgery. In our experience, the Zap-X delivery system offers a high-precision, patient-friendly and cost-effective alternative to traditional dedicated radiosurgical platforms.
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