Brain Tumor Surgery Without the Knife Proving to be Just What the Doctor Ordered

Cost-Saving Robotic Tech Bringing World-Class Care to >90% of Cancer Patients Who Currently Lack Access

Today, up to four million brain tumor patients globally lack access to what many consider a critical standard of care: stereotactic radiosurgery (SRS) – a completely non-invasive one-day outpatient procedure that’s painless and has proven outcomes equivalent and often superior to costly and painful invasive surgical procedures. 

A new robotic technology recently introduced by ZAP Surgical, the ZAP-X® Gyroscopic Radiosurgery® platform, has effectively wiped out many of the obstacles that have historically stunted wide-spread availability of SRS. Fine-tuned to deliver only cranial radiosurgery, clinicians hope to set new standards in brain tumor care with this novel design.  Since the first patient treatment just four years ago, the company’s cost-reducing, value-focused innovations have landed an astounding 55 system installations and orders in its production queue. 

A large round machine in a room

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The ZAP-X® Gyroscopic Radiosurgery® treatment suite at the European Radiosurgery Center Munich, Germany 

While complex leading-edge technologies have historically been introduced only into the well-funded academic medical centers, many of these ZAP-Xs are finding their way to settings entirely new and unique: forward-thinking outpatient centers as well as small to mid-size community hospitals in suburban and rural areas. Accordingly, they’re reaching new patients far beyond the large inpatient hospital. 

Historical Costs & Complexities Put Care Out of Reach

At its core, access to all therapeutic radiation, in particular radiosurgery, has suffered from the greatly disparate funding that has gone into cancer pharmaceuticals. Yet radiation has proven to be an equally fundamental and highly cost-effective modality for cancer care.

Dedicated cranial radiosurgery was first introduced more than 50 years ago. Lacking the modern innovations of today, radiation beams were produced by hundreds of unique Cobalt-60 sources – a practice still commonly in effect. Hosting these radioactive isotopes introduces myriad costs to already struggling healthcare systems. 

Meanwhile, with just a single radioactive source being the coveted core for a terrorist’s “dirty bomb”, an increasing number of countries such as Switzerland are actively banning access to Cobalt-60, eventually rendering such SRS systems obsolete, and thus furthering the scarcity of SRS care.

Enter the Exceedingly Complicated Work-Around

With the ability to deliver world-class SRS out of reach for many providers, hospital executives occasionally turn to their radiation oncology colleagues to deliver SRS using radiotherapy technology, devices originally designed to treat cancers of the breast, lung, and prostate. Optimized for delivering low-dose radiation over dozens of treatments that often span several months, such systems are specialized for procedures very distinct from high-precision, high-dose, and surgical-like cranial radiosurgery. To accommodate the extraordinary demands of SRS, these multi-purpose systems are often retrofitted with complex add-ons, occasionally with untoward effect.

As poignantly described in The New York Times articles “A Pinpoint Beam Strays Invisibly, Harming Instead of Healingand “Making a Complex Machine Even More Complex”,,, “as the devices became more versatile and complex”, SRS retrofitted radiotherapy systems “have figured in scores of errors and overdoses”. The retrospective design and tangled complexity of components, compounded by a common belief that such one-size-fits-all devices provide inferior care, many clinicians and hospital executives have chosen to simply refer eligible patients elsewhere. Or even worse, forgo optimal treatment.

“Multi-purpose systems can theoretically deliver the full spectrum of radiotherapy techniques anywhere in the body, from head to toe. But versatility often comes at the expense of precision and accuracy, which may impact tumor control and unwanted dose to the healthy brain. Contrary to the goals of value-based medicine, these compromises can negatively influence patient outcome,” said John R. Adler, M.D., CEO and founder of ZAP Surgical, inventor of the ZAP-X® and CyberKnife®, and Emeritus Dorothy & TK Chan Professor of Neurosurgery and Radiation Oncology at Stanford University. “Multi-purpose radiotherapy devices are akin to a Swiss army knife. Despite their versatility, you'll never find a surgeon using one in the operating room. Specialized procedures, especially when treating the brain, require specialized tools.” 

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John R. Adler, M.D., CEO and founder of ZAP Surgical, inventor of the CyberKnife® system, and Emeritus Dorothy & TK Chan Professor of Neurosurgery and Radiation Oncology at Stanford University

Reducing Financial Burdens to Finally Make Modern Care Accessible

The FDA and CE-cleared ZAP-X platform first began patient treatments in 2019 and was designed from the ground up to deliver the highest quality SRS while simultaneously addressing both the cost and complexity constraints of the past. Its innovations have opened a new world of high-standard SRS delivery in places previously thought inconceivable, thereby reaching large and underserved patient populations. 

Using state-of-the-art linear accelerator technology, the ZAP-X delivers radiosurgery without the historical need for live radioactive sources, thus eliminating the recurring $1M expense to replace and secure live radioactive sources. And as access to Co-60 becomes increasingly scarce, ZAP-X future-proofs the hospital’s SRS investment indefinitely.

ZAP-X is also applauded for its pioneering vault-free design, which eliminates the requirement for 2-3M pounds of high-density concrete and steel for shielded radiation bunker construction, and $1M to $3M in infrastructure expense.

Reaching New and Underserved Populations for the First Time

World-renowned for their advanced development in the field of robotic radiosurgery, MedStar Georgetown Cancer Center recently improved SRS patient access and reduced cost-of-care with ZAP-X by expanding radiosurgery beyond their main Washington D.C. campus to a satellite hospital in suburban Clinton, Maryland (population 39,000). 

In parallel, Bonafatius Hospital, a small community healthcare provider in Lingen, Germany (population 55,000) brought first-time access to world-class radiosurgery to their local community. Prior to ZAP-X, the nearest SRS facility was more than 2.5 hours away.

But perhaps most intriguing is Utsunomiya Neurospine Center in Japan. Located within the Utsunomiya bullet train station complex, the UNC team ushered in a new era of patient access with ZAP-X, offering patients from across Japan state-of-the-art SRS treatments without having to enter the congested city center. In addition to elevating patient convenience, the team significantly reduced the cost-of-care by taking outpatients out of the busy and costly inpatient hospital, while also greatly expanding their patient catchment area.  

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The ZAP-X® Gyroscopic Radiosurgery® treatment suite  at the Utsunomiya Neurospine Center, Utsunomiya bullet train station complex, Japan 

“Historically, access to state-of-the-art radiosurgery has been almost exclusively concentrated among the most well-funded academic hospitals in large urban areas – the MD Andersons, Amsterdam UMCs, and Mayo Clinics of the world, so geographically inaccessible to the majority of those who might benefit,” said Mark Arnold, Senior Vice President of ZAP Surgical. “By reducing total costs for the most advanced SRS, ZAP is laser focused on changing that paradigm and pursuing its mission of democratizing advanced radiosurgery for the masses, and developing SRS centers of excellence in entirely new settings.”

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