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InfectionPhase 3PARITYNCT01479283

Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY)

A Phase 3 study testing 24-Hour Prophylactic Cefazolin* Antibiotic Regimen and 5-Days Prophylactic Cefazolin* Antibiotic Regimen in people with Infection and Bone Neoplasms, run by McMaster University at 54 sites in 12 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial 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. Read more about this study

Who is it for?
Ages 12 years and older
Conditions the study is for
Infection, Bone Neoplasms
What is being tested?
24-Hour Prophylactic Cefazolin* Antibiotic Regimen and 5-Days Prophylactic Cefazolin* Antibiotic Regimen
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
602 participants
Where
54 sitesin 12 countries
Study dates
Jan 2013to Mar 2021
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 12 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • primary bone malignancies or aggressive benign bone tumors of the femur or tibia, soft-tissue sarcomas which have invaded the femur or tibia, or oligometastatic bone disease of the femur or tibia in a patient expected to live at least one year post-operatively; and
  • treatment by surgical excision and endoprosthetic replacement of the femur or tibia.

Who cannot join

  • current known Methicillin-resistant Staphylococcus Aureus (MRSA) colonization;
  • current known Vancomycin Resistant Enterococcus (VRE) colonization;
  • documented anaphylaxis or angioedema to penicillin or cefazolin (Ancef);
  • current surgical procedure is a revision surgery for implant failure or infection;
  • prior local infection within the surgical field of the affected limb;
  • current known immunologically-deficient disease conditions (not including recent chemotherapy);
Show all 10Show fewer
  • known renal insufficiency with estimated creatinine clearance (eGRF) of less than 54 mL/min;
  • reconstruction to include structural allograft;
  • enrolled in a competing study; and
  • weight of less than or equal to 45 kg (for sites using cefuroxime only).

Trial locations and contacts

54 sites in 12 countries.

54 sites in 12 countries

United States34 sites
  • Albany Medical Center

    Albany, New York, 11206

  • Emory Orthopaedics and Spine Center

    Atlanta, Georgia, 30329

  • University of Maryland Medical Center

    Baltimore, Maryland, 21201

  • Sinai Hospital of Baltimore

    Baltimore, Maryland, 21215

  • Franklin Square Medical Center

    Baltimore, Maryland, 21237

  • Johns Hopkins Hospital

    Baltimore, Maryland, 21287

  • Massachusetts General Hospital

    Boston, Massachusetts, 02114

  • Boston Children's Hospital

    Boston, Massachusetts, 02115

  • Beth Israel Deaconess Medical Center

    Boston, Massachusetts, 02215

  • Cincinnati Children's Hospital

    Cincinnati, Ohio, 45229

  • The Cleveland Clinic - Hillcrest Hospital

    Cleveland, Ohio, 44195

  • Wexner Medical Center

    Columbus, Ohio, 43210

  • SUNY Upstate University Hospital

    East Syracuse, New York, 13057

  • University of Connecticut Health Center

    Farmington, Connecticut, 06030

  • University of Florida Health Shands Hospital

    Gainesville, Florida, 32611-2727

  • Hartford Hospital

    Hartford, Connecticut, 06106

  • Holden Comprehensive Cancer Center

    Iowa City, Iowa, 52242

  • Dartmouth-Hitchcock Medical Center

    Lebanon, New Hampshire, 03756

  • University of Arkansas for Medical Sciences

    Little Rock, Arkansas, 72205

  • Ronald Reagan UCLA Medical Center

    Los Angeles, California, 90404

  • Medical College of Wisconsin - Froedtert Hospital

    Milwaukee, Wisconsin, 53226

  • University of Minnesota Medical Center

    Minneapolis, Minnesota, 55454

  • Vanderbilt Medical Center

    Nashville, Tennessee, 37232-8774

  • Memorial Sloan-Kettering Cancer Center

    New York, New York, 10065

  • The Rothman Institute at Jefferson

    Philadelphia, Pennsylvania, 19107

  • University of Pittsburgh Medical Center

    Pittsburgh, Pennsylvania, 15213

  • Oregon Health & Science University Hospital

    Portland, Oregon, 97239

  • Long Island Jewish Medical Center | Northwell Health

    Queens, New York, 11040

  • Stanford University Hospital and Clinics

    Redwood City, California, 94063

  • UC Davis Comprehensive Cancer Center

    Sacramento, California, 95817

  • Huntsman Cancer Institute

    Salt Lake City, Utah, 84112

  • University of California San Francisco Medical Center

    San Francisco, California, 94118

  • Saint Louis University Hospital

    St Louis, Missouri, 63110

  • Montefiore Medical Center

    The Bronx, New York, 10467

Other trials in United States

Canada8 sites
  • Foothills Medical Centre

    Calgary, Alberta, T2N 5A1

  • Juravinski Hospital and Cancer Centre

    Hamilton, Ontario, L8V 5C2

  • Maisonneuve-Rosemont Hospital

    Montreal, Quebec, H1T4B3

  • McGill University Health Centre

    Montreal, Quebec, H3G 1A4

  • Ottawa Hospital

    Ottawa, Ontario, K1H 8L6

  • Hôtel-Dieu de Québec

    Québec, Quebec, G1R 2J6

  • Mount Sinai Hospital

    Toronto, Ontario, M5G 1X5

  • Vancouver General Hospital

    Vancouver, British Columbia, V5Z 4E6

Other trials in Canada

Brazil2 sites
  • Hospital de Clínicas de Porto Alegre

    Porto Alegre

  • Instituto de Ortopedia e Traumatologia

    São Paulo

Other trials in Brazil

Netherlands2 sites
  • University Medical Center Groningen

    Groningen

  • Leiden University Medical Center

    Leiden, South Holland, 2333

Other trials in Netherlands

Argentina1 site
  • Hospital Universitario Austral

    Pilar, Buenos Aires, 1629

Other trials in Argentina

Australia1 site
  • Royal Adelaide Hospital

    Adelaide, South Australia, 5000

Other trials in Australia

Austria1 site
  • LKH - Universitätsklinikum Graz

    Graz

Other trials in Austria

Egypt1 site
  • Children's Cancer Hospital Egypt

    Cairo

Other trials in Egypt

India1 site
  • All India Institute of Medical Sciences

    New Delhi, National Capital Territory of Delhi

Other trials in India

Singapore1 site
  • Singapore General Hospital

    Singapore

Other trials in Singapore

South Africa1 site
  • Grey's Hospital

    Pietermaritzburg

Other trials in South Africa

Spain1 site
  • Hospital Universitari Vall d'Hebron

    Barcelona, 08035

Other trials in Spain

About this study

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 With Endoprosthetic Replacements

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.

Read the detailed description

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.

Being tested
24-Hour Prophylactic Cefazolin* Antibiotic Regimen, 5-Days Prophylactic Cefazolin* Antibiotic Regimen
Keywords
Infection, Bone Neoplasms, Prosthesis, Anti-Bacterial Agents, Randomized
Medical subject headings
Infections, Bone Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • 24-Hour Prophylactic Cefazolin* Antibiotic RegimenDrug

    Also called ANCEF ®

    Pre-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin within 60 minutes prior to the procedure. No other pre-operative antibiotics will be administered.

    Intra-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 3-4 hours. No other intra-operative antibiotics will be administered.

    Post-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 8 hours for 24 hours followed by IV saline for 4 days. No other post-operative antibiotics will be administered.

  • 5-Days Prophylactic Cefazolin* Antibiotic RegimenDrug

    Also called ANCEF ®

    Pre-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin within 60 minutes prior to the procedure. No other pre-operative antibiotics will be administered.

    Intra-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 3-4 hours. No other intra-operative antibiotics will be administered.

    Post-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 8 hours for 5 days. No other post-operative antibiotics will be administered.

Study groups in NCT01479283
Study groupRoleWhat they receive
Short-Arm Antibiotic RegimenActive comparatorIntervention: 24-Hour Prophylactic Cefazolin* Antibiotic Regimen *or another cephalosporin with equivalent gram-positive coverage in centers where cefazolin is not routinely used or not approved for use
Receives: Drug: 24-Hour Prophylactic Cefazolin* Antibiotic Regimen
Long-Arm Antibiotic RegimenExperimentalIntervention: 5-Days Prophylactic Cefazolin* Antibiotic Regimen *or another cephalosporin with equivalent gram-positive coverage in centers where cefazolin is not routinely used or not approved for use
Receives: Drug: 5-Days Prophylactic Cefazolin* Antibiotic Regimen

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Surgical Site Infections

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

    Measured: 1 year

Secondary outcomes (5)
  1. Functional Outcome and Quality of Life

    as measured by the Musculoskeletal Tumor Society (MSTS) functional score (1987 and 1993 versions) and the Toronto Extremity Salvage Score (TESS) questionnaires

    Measured: 1 year

  2. Antibiotic-Related Complications

    examples of antibiotic-related complications include gastrointestinal infections, fungal infections, etc.

    Measured: 1 year

  3. Rate of Re-Operation

    re-operation may be required if patients develop a surgical site infection

    Measured: 1 year

  4. Oncologic Recurrence and/or Metastases

    Measured: 1 year

  5. Mortality

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Nov 2011 (estimated)
  2. Study startJan 2013
  3. Primary completionMar 2021
  4. Study completionMar 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
602 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01479283
Sponsor's protocol ID
GHRT01
Acronym
PARITY
Status last verified
Mar 2021
First submitted
15 Nov 2011
Last updated
11 Mar 2021
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided

Publications

  • Hasan K, Racano A, Deheshi B, Farrokhyar F, Wunder J, Ferguson P, Holt G, Schwartz H, Petrisor B, Bhandari M, Ghert M. Prophylactic antibiotic regimens in tumor surgery (PARITY) survey. BMC Musculoskelet Disord. 2012 Jun 7;13:91. doi: 10.1186/1471-2474-13-91.

    PubMed 22676321
  • Ghert M, Deheshi B, Holt G, Randall RL, Ferguson P, Wunder J, Turcotte R, Werier J, Clarkson P, Damron T, Benevenia J, Anderson M, Gebhardt M, Isler M, Mottard S, Healey J, Evaniew N, Racano A, Sprague S, Swinton M, Bryant D, Thabane L, Guyatt G, Bhandari M; PARITY Investigators. Prophylactic antibiotic regimens in tumour surgery (PARITY): protocol for a multicentre randomised controlled study. BMJ Open. 2012 Nov 28;2(6):e002197. doi: 10.1136/bmjopen-2012-002197. Print 2012.

    PubMed 23194956
  • Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res. 2013 Jun;471(6):2017-27. doi: 10.1007/s11999-013-2842-9. Epub 2013 Feb 12.

    PubMed 23404421
  • Evaniew N, Nuttall J, Farrokhyar F, Bhandari M, Ghert M. What are the levels of evidence on which we base decisions for surgical management of lower extremity bone tumors? Clin Orthop Relat Res. 2014 Jan;472(1):8-15. doi: 10.1007/s11999-013-3311-1. Epub 2013 Oct 1.

    PubMed 24081669
  • Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) Investigators; Ghert M, Schneider P, Guyatt G, Thabane L, Velez R, O'Shea T, Randall RL, Turcotte R, Wilson D, Wunder JS, Baptista AM, Cheng EY, Doung YC, Ferguson PC, Giglio V, Hayden J, Heels-Ansdell D, Khan SA, Sampath Kumar V, McKay P, Miller B, van de Sande M, Zumarraga JP, Bhandari M. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial. JAMA Oncol. 2022 Mar 1;8(3):345-353. doi: 10.1001/jamaoncol.2021.6628.

    PubMed 34989778
  • Schneider P, Heels-Ansdell D, Thabane L, Ghert M; PARITY Investigators. Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY): a multi-center randomized controlled study comparing alternative antibiotic regimens in patients undergoing tumor resections with endoprosthetic replacements-a statistical analysis plan. Trials. 2021 Mar 22;22(1):223. doi: 10.1186/s13063-021-05147-2.

    PubMed 33752752
  • Gazendam A, Bozzo A, Schneider P, Giglio V, Wilson D, Ghert M. Recruitment patterns in a large international randomized controlled trial of perioperative care in cancer patients. Trials. 2021 Mar 20;22(1):219. doi: 10.1186/s13063-021-05149-0.

    PubMed 33743753

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing 24-Hour Prophylactic Cefazolin* Antibiotic Regimen and 5-Days Prophylactic Cefazolin* Antibiotic Regimen in people with Infection and Bone Neoplasms, run by McMaster University at 54 sites in 12 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 11 Mar 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 54 sites in United States, Canada, Brazil, Netherlands, Argentina and 7 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Surgical Site Infections (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01479283, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2021.

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