title: Effect of Immunotherapy Status on Outcomes in Patients With Metastatic Melanoma to the Spine.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  We performed a retrospective study of patients treated at our institution over the last 3 years to assess predictive value of immunotherapy exposure on overall survival (OS) of patients with metastatic melanoma to the spine in an effort to better inform surgical decision making.
  
  
  BACKGROUND
  Modern management of metastatic melanoma includes adjuvant targeted therapies and immunomodulators that have shown to significantly improve OS.
  
  
  METHODS
  Baseline characteristics were recorded for patients, including performance scores, use of adjuvant therapies, progression-free survival (PFS), and OS. Pre-procedural imaging was reviewed to assign Spinal Instability Neoplastic Score (SINS) and epidural spinal cord compression (ESCC) classification. Kaplan-Meier survival analysis was performed.
  
  
  RESULTS
  We identified 18 patients with metastatic melanoma to the spine treated between 2012 and 2015. Instrumented fixation was performed for median SINS 12. Eleven patients undergoing surgery were noted to have ESCC classification of at least 2. Median OS for the entire group was 117 days. Univariate analysis revealed that prior immunotherapy treatment was associated with significantly shorter survival following surgery (median survival 98 vs. 315 days for patients previously on immunotherapies compared to those who were not). Meanwhile, neither BRAF mutation status nor treatments targeting these pathways were associated with this prognostic effect.
  
  
  CONCLUSIONS
  Progressive metastatic spine disease following immunotherapy may herald a particularly aggressive time point and recognizing this natural history is critical for appropriate multimodal planning.
  
  
  METHODS
  4.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Ganesh M
authors.initials: GM
authors.lastname: Shankar
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Grannan
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Boston, MA.
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
mesh_terms: D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy; D008545:Melanoma / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary / Q000628:therapy*; D016896:Treatment Outcome