ZAP-X self-shielding gyroscopic radiosurgery: a scoping review of technical characteristics and early clinical experience.

BACKGROUND

ZAP-X gyroscopic radiosurgery is a self-shielding stereotactic radiosurgery (SRS) delivery platform that seeks to reduce operational requirements and improve accessibility over existing platforms. This scoping review consolidates emerging evidence to provide an overview of early institutional performance and patient satisfaction.

METHODS

A scoping review was conducted using the PRISMA scoping review checklist to December 20, 2025. Studies reporting clinical use of ZAP-X radiosurgery were included.

RESULTS

24 studies satisfied the inclusion criteria. Across all studies, 779 patient cases were included. The cohort had a weighted mean age of 60.2 years (range 13.4-92). 1,163 total lesions were treated, with malignant lesions representing 51.7%. Common treated lesions included intracranial metastasis (47.6%), schwannoma (23.9%), and meningioma (16.9%). Radiation delivery was characterized by a weighted mean prescription dose of 18.44 Gy, dose coverage of 97.3%, conformity index of 1.30, homogeneity index of 1.78, gradient index of 3.13, and delivery time of 38.6 min (range; 7-214 min). Mean follow-up was 10.7 months (range; 1-46 months). 245 cases reported tumor volume at last follow-up, of which 230 cases demonstrated local control (93.9%). Patient satisfaction was favorable in 426 of 441 reported survey responses (96.6%).

CONCLUSION

ZAP-X has demonstrated radiation delivery indices comparable to those from established radiosurgery platforms in early clinical use, although prospective studies with long-term follow-up and standardized outcome measures are needed to define efficacy relative to established systems. Given ZAP-X's potential to expand access to stereotactic radiosurgery, further investigation to clarify comparative utility and limitations may benefit patients in currently underserved areas.