ZAP-X Radiosurgery: First experience of 50 consecutive cases in Korea

Abstract

Objective

On January 31, 2024, our institution became the first institution in Korea to implement ZAP-X radiosurgery. This study aimed to provide a detailed overview of our initial experience with ZAP-X radiosurgery.

Methods

Fifty consecutive patients underwent stereotactic radiosurgery using the ZAP-X system. Key parameters such as patient selection, treatment planning, and follow-up outcomes were evaluated.

Results

A total 50 of patients were enrolled in this study, including 20 (40.0 %) with metastatic brain tumors and 18 (36.0 %) with meningiomas. In those with metastatic brain tumors, local control failure occurred in only one patient (local control rate, 93.3 %; median follow-up period, 1.0 month). No other adverse effects occurred except for temporary partial alopecia in five patients.

The ZAP-X system showed key advantages such as superior dose conformity, reduced radiation leakage and scatter, and elimination of the need for a stereotactic frame. However, we also identified certain limitations to the system, such as its software’s current capabilities and the need for improved image quality.

Conclusion

The ZAP-X system offers a highly effective and accessible option for the radiosurgical management of intracranial lesions. It showed promising results in terms of local control and patient outcomes in the first cohort of 50 patients treated using the approach in Korea.