Steven E. Finkelstein, MD, FACRO

Steven E. Finkelstein, MD, FACRO

Florida Cancer Affiliates / The US Oncology Network

Panama City, Florida

Steven E. Finkelstein, MD, FACRO, is a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida. He has served as a Co-Chair on the NRG Immunotherapy Committee, Co-Chair of the 2018-2019 ACRO Scientific Program Committee, and Chair of the SWOG Radiation STG Committee. He currently serves on the Board of Chancellors for ACRO. Dr. Finkelstein has also served as National Director of Translational Research Consortium (TRC), the cutting-edge therapy arm of 21st Century Oncology in Scottsdale, Arizona. Inspired by his grandmother, a cancer patient, he became a dedicated cancer surgeon who found that radiation therapy could sometimes do for his patients what surgery could not. Dr. Finkelstein received his medical degree from the University of Michigan Medical School. He served a residency in General Surgery at Washington University in Saint Louis, Missouri, and was Chief Resident in Radiation Oncology at the Moffitt Cancer Center in Tampa, Florida. Dr. Finkelstein also served fellowships in Biologic Immunotherapy, Clinical Cancer, and Surgical Oncology at the Surgery Branch of the National Cancer Institute in Bethesda, Maryland. He is a member of the American College of Radiation Oncology, the American Medical Association, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the Radiological Society of North America, and the Radiation Therapy Oncology Group.


Talks by Steven E. Finkelstein, MD, FACRO

Role of ADT with Radiation

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the role of androgen deprivation therapy (ADT) with radiation therapy (RT) in patients with prostate cancer. Dr. Finkelstein first discusses the definitive setting, explaining optimal durations for the addition of ADT to RT under various circumstances. For example, when local control with RT alone is good, ADT is never given; when the risk of local failure is high, ADT is given for 3-6 months as a radiation sensitizer; and when the risk of distant disease is high, ADT treatment is given for 2-3 years. Dr. Finkelstein goes on to illustrate data that show ADT does not improve survival in men receiving RT for low-risk disease, short-term ADT improves survival in men receiving RT for intermediate-risk disease, and ADT was effective in improving survival for patients with “modern” high- and intermediate-risk disease. Dr. Finkelstein discusses dose escalation in RT and cites an ongoing study examining 1520 patients who received either 79.2 Gy alone or 79.2 Gy plus 6 months of ADT, with the primary endpoint being overall survival (OS), asserting that the study will be seminal once the results have been published. He then reviews the current summary recommendations in the definitive setting: for low-risk (NCCN definition) and low-intermediate-risk patients, the recommendation is surveillance, brachytherapy (BT), or external beam radiation therapy (EBRT) with no recommendation for ADT; for high-intermediate risk patients, the recommendation is EBRT +/- BT with 4-6 months of ADT (GnRH agonist); and for high-risk (NCCN definition) patients, the recommendation is EBRT +/- BT with 24 months of ADT(GnRH agonist). Dr. Finkelstein then introduces Kevin D. Healey, a research intern and medical student level two, who delivers the second part of the presentation, focusing on the salvage setting. Mr. Healey presents research from the GETUG-AFU 16 trial, examining short-term ADT combined with RT as salvage treatment after radical prostatectomy for prostate cancer: a 112-month follow-up of a phase 3, randomized trial. He concludes that salvage RT combined with short-term ADT significantly reduced the risk of biochemical or clinical progression and death compared with salvage RT alone. Further, the results of the trial confirm the efficacy of ADT plus RT as salvage treatment in patients with increasing PSA concentration after radical prostatectomy for prostate cancer. Dr. Finkelstein then concludes the presentation with the current summary recommendations for the salvage setting, including adding a 6-month course of ADT (LHRHa) to salvage RT in men with no or minimal comorbidity, given the near halving of progression and the possible reduction in mortality due to prostate cancer.

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Updates in Radiation Oncology: A View From ACRO

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the American College of Radiation Oncology (ACRO) and their goals for leadership, education, advocacy, and recognition in their field. He explains that they want to be the most inclusive physician-driven organization in radiation oncology and want to drive professional and personal development for their members. He then outlines ACRO’s leadership-focused committees and their accomplishments. Dr. Finkelstein states that ACRO’s education goals are being reached by providing cutting-edge educational programming at a reasonable cost. He then lists the involved committees and shares some of the accomplishments of the organization in education, including free self-assessment modules sufficient to reach maintenance of certification requirements and inclusion of administrators in a business track during conferences. Dr. Finkelstein then explains that, through advocacy, ACRO aims to make the practice of radiation oncology better for physicians. He discusses ACRO’s advocacy-oriented committees, and then cites the development of an alternative payment model, and addressing widespread concern with the eviCore treatment guidelines as some of ACRO’s advocacy-based accomplishments. Dr. Finkelstein then looks at ACRO’s progress in getting recognition for radiation oncology, explaining that recognizing professional success helps advance practice excellence. He goes over some of ACRO’s accomplishments in this area, including the development of a comprehensive physics review and a robust and modern virtual medical chart review that eliminates reviewer bias. He concludes with a list of 10 reasons why a practice should undergo accreditation that includes improving practice quality by external review, ensuring that the most up-to-date question and answer techniques and standards as well as the most up-to-date policies are in place, and more.

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Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy

Steven E. Finkelstein, MD, FACRO, radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses 3 unique cases of recurrence after robotic-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy and their clinical management from a radiation oncology perspective. He introduces the first case of a patient with a PSA of 5.4 ng/mL and a Gleason score of 5+4 at the time of initial diagnosis. Dr. Finkelstein states that the recurrence became apparent once the patient’s PSA rose from .15 to .9 and a negative bone scan led to the initially planned treatment of post-prostatectomy radiotherapy (XRT). He explains that next-generation imaging (NGI) was then ordered and showed increased tracer uptake in an area of the left pelvis, leading the patient to begin a course of intensity-modulated radiation therapy and daily image-guided radiation therapy (IGRT). Dr. Finkelstein then moves on to the second patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 initially and whose recurrence was identified once their post-treatment PSA rose from .25 to 1. He describes how a negative bone scan led to initially planning a post-prostatectomy XRT, but when NGI found a sclerotic lesion in the middle right iliac bone, his treatment changed to stereotactic body radiation therapy (SBRT). Dr. Finkelstein then introduces the final patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 and whose recurrence was identified once their post-treatment PSA of .25 increased to 1. He states that, again, a negative bone scan led to planning post-prostatectomy XRT for the patient. NGI proved that XRT would have been insufficient by identifying a sclerotic lesion in the middle right iliac bone and 5 other bone metastases. Dr. Finkelstein concludes by noting that, due to NGI, the patient also received SBRT.

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Update on New Approaches Combining Brachytherapy with Immunotherapy

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the process of combining brachytherapy with immunotherapy, highlighting the need for better applicators. He begins the presentation by describing radical prostatectomy, external beam radiation (EBRT), cryotherapy, and brachytherapy, and then reviews data on each of their relapse-free survival results. A trial found that when comparing EBRT with surgery against EBRT with brachytherapy, treatment with EBRT in combination with brachytherapy has a higher rate of PSA progression-free survival, and including ADT increases the rate even more. Dr. Finkelstein then considers the “cogwheels of cancer practice,” i.e., the idea that the combination of guidelines, management, bias, patient preference, marketing, reimbursement, payer, and task force systems sometimes takes more precedence in treatment choice than data. He goes on to describe brachytherapy in detail, noting that it uses precisely-delivered radiation sources to treat cancer within patients through small applicators that are unable to apply additional therapeutic agents. He cites this shortcoming as support for a need for applicators for additional therapeutic approaches. Dr. Finkelstein continues with a detailed overview of radiation-driven immunotherapy. He discusses a study showing that radiation can induce unique cellular expression of MHC Class I adhesion molecules, costimulatory molecules, heat shock proteins, inflammatory mediators, immunomodulatory cytokines, and death receptors. He concludes with a discussion of “Immuno-Site,” an applicator designed to provide simple, effective, and isolated localized radiation therapy, including brachytherapy and immunotherapy simultaneously.

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Metastasis-Directed Therapy: Radiation Oncology Updates and Perspective

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses metastasis-directed therapy (MDT) as a potential treatment option for oligometastatic prostate cancer. He reviews typical management of metastatic cancer and describes how MDT can minimize the toxicity of systemic therapy, then addresses future treatment options with stereotactic ablative radiotherapy (SABR). Radiation and other local therapies are used for palliation of metastases but can also alter the course of tumor development. Dr. Finkelstein explains that MDT can be particularly beneficial in oligometastatic prostate cancer if the metastases are at a point where both the primary tumor and metastases can be treated together and likely cured. Lastly, he concludes that MDT via SABR could be employed concurrently with other treatments such as androgen deprivation therapy (ADT), chemotherapies, and radiopharmaceuticals, and that further research is necessary.

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