Clinical Trial: Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY)

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY): A Multi-Center International Randomized Controlled Trial Comparing Alternative Antibiotic Regimens in Patients Undergoing Tumor Resections W

Brief Summary: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial is the first ever international multi-center randomized controlled trial in bone cancer surgery. In order to avoid amputation for bone cancer in the leg, complex limb-saving operations are performed. However, infections with devastating complications following surgery are common. Surgeons from across the world will randomize patients to receive either short- or long-duration antibiotic regimens after surgery with the goal of identifying the best regimen to reduce these infections.

Detailed Summary: Long-bone sarcomas were historically managed with amputation. In the current era of osteosarcoma management, amputations are generally avoided by complex surgeries in which the malignancy is removed and the limb is reconstructed with advanced surgical techniques. This process of limb salvage is possible with improvements in chemotherapeutic regimens, advanced imaging techniques and surgical innovations such as modular metallic implants. However, the risk for surgical complications is high due to the complexity of the surgeries themselves. The most common and devastating complication is a surgical site infection. Background work and data from our pilot study indicates that infection rates approach 15%. Multiple surgical attempts at eradication of the infection fail in 50% of these cases, resulting in amputation. Published guidelines for post-operative antibiotic prophylaxis following many standard and less complex elective surgical procedures dictate that prophylactic antibiotics be discontinued after 24 hours. However, the most effective duration of treatment in sarcoma surgery has not previously been examined. Given the limitations of the evidence, it has not been possible for orthopaedic oncologists to draw firm conclusions and, therefore, clinical practice is highly varied, particularly with respect to antibiotic duration. Our international, multi-center randomized controlled trial will determine whether a 5-day regimen of post-operative prophylactic antibiotics in comparison to a standard 24-hour regimen decreases the rate of surgical site infections after limb salvage surgery within 1-year follow-up.
Sponsor: McMaster University

Current Primary Outcome: Surgical Site Infections [ Time Frame: 1 year ]

the development of a surgical site infection according to the criteria established by the Center for Disease Control (CDC)


Original Primary Outcome: number of infections [ Time Frame: 1 year ]

the development of deep infection at the surgical site involving the prosthesis


Current Secondary Outcome:

  • Functional Outcome and Quality of Life [ Time Frame: 1 year ]
    as measured by the Musculoskeletal Tumor Society (MSTS) functional score (1987 and 1993 versions) and the Toronto Extremity Salvage Score (TESS) questionnaires
  • Antibiotic-Related Complications [ Time Frame: 1 year ]
    examples of antibiotic-related complications include gastrointestinal infections, fungal infections, etc.
  • Rate of Re-Operation [ Time Frame: 1 year ]
    re-operation may be required if patients develop a surgical site infection
  • Oncologic Recurrence and/or Metastases [ Time Frame: 1 year ]
  • Mortality [ Time Frame: 1 year ]


Original Secondary Outcome:

  • functional outcome and quality of life as measured by the MSTS-93 and TESS questionnaires [ Time Frame: 1 year ]
  • number of antibiotic-related complications [ Time Frame: 1 year ]
    examples of antibiotic-related complications: gastrointestinal infections, fungal infections, etc.


Information By: McMaster University

Dates:
Date Received: November 15, 2011
Date Started: January 2013
Date Completion: December 2019
Last Updated: March 14, 2016
Last Verified: March 2016