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Peer-reviewedCC BYJournal of applied clinical medical physics

Treatment plan quality comparison between ZAP-Axon® Krylov optimizer and Leksell Gamma Knife® Lightning optimizer for brain metastasis.

  • Yongsook C Lee1,2
  • Alexander Maslowski3
  • Rupesh Kotecha1,2,4
  • Ranjini Tolakanahalli1,2
  • D Jay Wieczorek1,2
  • Matthew D Hall1,2
  • Minesh P Mehta1,2
  • Michael W McDermott4,5
  • Alonso N Gutierrez1,2
5 affiliations
  1. 1Department of Radiation Oncology, Herbert Wertheim Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.
  2. 2Department of Oncological Sciences, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
  3. 3ZAP Surgical Systems, Inc., San Carlos, California, USA.
  4. 4Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.
  5. 5Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida, USA.
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Abstract

Purpose

This study compares stereotactic radiosurgery (SRS) treatment plan quality between the recently launched ZAP-Axon® Krylov optimizer and the Leksell Gamma Knife® (LGK) Lightning optimizer for brain metastasis (BM).Methods

Thirty (n = 30) patients who were previously treated with LGK SRS or fractionated SRS were selected and divided into three groups: large post-operative resection cavities of BM (BMlg, postop), large intact BM (BMlg, intact) and small intact BM (BMsm, intact). Based on our institutional planning guidelines, the 30 clinical cases were replanned using ZAP-Axon Krylov and LGK Lightning optimizers without manual adjustments. Statistical analysis was performed to compare plan quality metrics (Paddick conformity index [PCI], gradient index [GI], target coverage [TC], prescribed isodose line [Rx IDL], and treatment time/scaled beam-on-time [sBOT] [min]) between the two optimizers.Results

For the BMlg, postop group, mean values of PCI, GI, TC, Rx IDL, and treatment time/sBOT (min) for Krylov versus Lightning plans were 0.91 versus 0.91, 2.48 versus 2.56, 99.5% versus 99.7%, 51.1% versus 53.7% and 37.4 min versus 36.5 min, respectively. All metrics except for the Rx IDL (%) were not statistically significantly different. For the BMlg, intact group, corresponding values were 0.93 versus 0.93, 2.42 versus 2.57, 99.5% versus 99.7%. 51.5% versus 53.0% and 35.9 min versus 36.3 min. While GI was statistically significantly different (p <0.05) between the two optimizers, the rest of the metrics were not. For the BMsm, intact group, corresponding values were 0.71 versus 0.64, 3.10 versus 3.26, 99.5% versus 99.5%, 61.9% versus 53.0% and 8.1 min versus 19.8 min. In this group, PCI and treatment time/sBOT were statistically significantly different (p <0.05), whereas GI and Rx IDL were not.Conclusion

Without manual adjustments, ZAP-Axon Krylov plans were comparable to LGK Lightning plans for large BM lesions, but the Krylov optimizer outperformed the Lightning optimizer for small BM lesions.

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Cite

BibTeXRIS
BibTeX
@article{lee2026treatment,
  title = {{Treatment plan quality comparison between ZAP-Axon® Krylov optimizer and Leksell Gamma Knife® Lightning optimizer for brain metastasis.}},
  author = {Yongsook C Lee and Alexander Maslowski and Rupesh Kotecha and Ranjini Tolakanahalli and D Jay Wieczorek and Matthew D Hall and Minesh P Mehta and Michael W McDermott and Alonso N Gutierrez},
  journal = {Journal of applied clinical medical physics},
  year = {2026},
  month = nov,
  doi = {10.1002/acm2.70851},
  url = {https://europepmc.org/article/MED/42967581},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Treatment plan quality comparison between ZAP-Axon® Krylov optimizer and Leksell Gamma Knife® Lightning optimizer for brain metastasis.
AU  - Yongsook C Lee
AU  - Alexander Maslowski
AU  - Rupesh Kotecha
AU  - Ranjini Tolakanahalli
AU  - D Jay Wieczorek
AU  - Matthew D Hall
AU  - Minesh P Mehta
AU  - Michael W McDermott
AU  - Alonso N Gutierrez
PY  - 2026
DA  - 2026/11/01
JO  - Journal of applied clinical medical physics
DO  - 10.1002/acm2.70851
UR  - https://europepmc.org/article/MED/42967581
AB  - Purpose  This study compares stereotactic radiosurgery (SRS) treatment plan quality between the recently launched ZAP-Axon® Krylov optimizer and the Leksell Gamma Knife® (LGK) Lightning optimizer for brain metastasis (BM).Methods  Thirty (n = 30) patients who were previously treated with LGK SRS or fractionated SRS were selected and divided into three groups: large post-operative resection cavities of BM (BMlg, postop), large intact BM (BMlg, intact) and small intact BM (BMsm, intact). Based on our institutional planning guidelines, the 30 clinical cases were replanned using ZAP-Axon Krylov and LGK Lightning optimizers without manual adjustments. Statistical analysis was performed to compare plan quality metrics (Paddick conformity index [PCI], gradient index [GI], target coverage [TC], prescribed isodose line [Rx IDL], and treatment time/scaled beam-on-time [sBOT] [min]) between the two optimizers.Results  For the BMlg, postop group, mean values of PCI, GI, TC, Rx IDL, and treatment time/sBOT (min) for Krylov versus Lightning plans were 0.91 versus 0.91, 2.48 versus 2.56, 99.5% versus 99.7%, 51.1% versus 53.7% and 37.4 min versus 36.5 min, respectively. All metrics except for the Rx IDL (%) were not statistically significantly different. For the BMlg, intact group, corresponding values were 0.93 versus 0.93, 2.42 versus 2.57, 99.5% versus 99.7%. 51.5% versus 53.0% and 35.9 min versus 36.3 min. While GI was statistically significantly different (p <0.05) between the two optimizers, the rest of the metrics were not. For the BMsm, intact group, corresponding values were 0.71 versus 0.64, 3.10 versus 3.26, 99.5% versus 99.5%, 61.9% versus 53.0% and 8.1 min versus 19.8 min. In this group, PCI and treatment time/sBOT were statistically significantly different (p <0.05), whereas GI and Rx IDL were not.Conclusion  Without manual adjustments, ZAP-Axon Krylov plans were comparable to LGK Lightning plans for large BM lesions, but the Krylov optimizer outperformed the Lightning optimizer for small BM lesions.
SN  - 1526-9914
ER  -