Safety and feasibility of outpatient administration of targeted alpha therapies: A systematic review and meta-analysis of radiation exposure and waste management.

e23183 Background: Targeted alpha therapies offer potent antitumor efficacy but are traditionally administered in specialized inpatient settings due to radiation safety concerns. Evaluating real-world radiation exposure, waste management, and regulatory compliance is essential to determine the feasibility of safely decentralizing these treatments to outpatient and community oncology centers. Methods: We systematically searched major databases for clinical trials and real-world studies evaluating outpatient administration of targeted alpha therapies. Pooled safety analyses were performed using Stata version 18.0, and risk of bias was assessed using the ROBINS-I tool. Results: A total of 11 studies were included, comprising 1,842 patients, of whom 614 received targeted alpha therapy and 307 served as controls; remaining studies were single-arm safety cohorts. The pooled mean post-discharge external dose rate was 0.04 µSv/h at 1 m (95% CI: 0.02–0.07) and 0.03 µSv/h at 2 m (95% CI: 0.01–0.05), with most measurements below detector thresholds. The pooled estimated annual caregiver/public exposure was 0.06 mSv (95% CI: 0.03–0.09), well below regulatory limits. The pooled proportion of patients meeting regulatory discharge criteria was 100% (95% CI: 98–100). Occupational whole-body exposure was minimal, with higher relative extremity exposure during administration that remained within safety limits. Conclusions: Outpatient targeted alpha therapy demonstrated negligible radiation exposure and full regulatory compliance, supporting safe delivery in community oncology settings.