Proximal FEmur Reconstruction or Internal Fixation fOR Metastases (PERFORM) Trial
NCT ID: NCT06863129
Last Updated: 2025-11-10
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
334 participants
INTERVENTIONAL
2025-02-01
2030-06-01
Brief Summary
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1. Does removing and replacing part of the bone work better than just stabilizing it with metal hardware?
2. Does removing and replacing the bone help reduce problems like cancer coming back or the metal hardware breaking?
Researchers will compare two treatments: using metal rods and plates to stabilize the bone (internal fixation) versus removing part of the bone and possibly replacing the hip joint (resection and reconstruction) to see if the second option causes fewer problems.
Participants will:
* Be randomly assigned to one of two groups (internal fixation or resection and reconstruction).
* Have one of the two surgeries based on which group they're in.
* Go to follow-up appointments with the study doctor at 2 weeks, 6 weeks, 4 months, 6 months, 9 months, and 12 months after surgery.
Detailed Description
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MBD afflicts the majority of patients with advanced stage carcinomas and is the most common oncologic disease of the skeleton. The proximal femur is the most commonly affected location in the appendicular skeleton and is a source of significant morbidity affecting patient mobility and quality of life.
Stabilization of an impending or actual fracture of the proximal femur resulting from MBD has historically been achieved with internal fixation using intramedullary nails, plates and screws. This approach is meant to provide enough stability to ambulate without pain for the remainder of the cancer patient's life. However, many patients with metastatic cancer are experiencing longer life spans due to advances in systemic treatment options. Therefore, the traditional methods of stabilizing bones in the setting of MBD may no longer be meeting the standard of outcomes required for patients who can now live for years with their disease. Internal fixation, which is by nature a palliative surgery, results in disease relapse in nearly 20% of patients, most often due to local MBD recurrence. Alternatively, complete resection of the affected bone followed by reconstruction with an endoprosthesis, although more invasive and conferring higher surgical risks than an internal fixation procedure, reduces the risk of cancer recurrence at the surgical site to approximately 3%, thereby avoiding the deleterious effects on patient function and quality of life. However, the evidence supporting the use of resection and endoprosthetic reconstruction of the proximal femur, although promising, is retrospective and methodologically weak, resulting in a gap in the necessary evidence to change practice.
The PERFORM trial will aim to determine if resection and endoprosthetic reconstruction improves patient-important outcomes compared to internal fixation in patients with MBD of the proximal femur.
THe Methods Centre and proposed clinical sites collectively possess the methodological, logistical and clinical expertise required to successfully carry out the PERFORM trial. Ultimately, this trial has the potential to effect significant changes in orthopaedic oncology clinical practice and improve the oncologic, functional, and quality of life outcomes of patients with cancers that have metastasized to their proximal femur. While the introduction of a more invasive yet more durable procedure would represent a paradigm shift in the approach to this patient population, the challenge investigators confront is to support this practice change with high-quality, concrete evidence.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Resection and Reconstruction
If a participant is randomized to the Resection and Reconstruction treatment arm, a proximal femoral resection or hip arthroplasty will be carried out as per standard surgical practice. The type of endoprosthesis used for reconstruction will be at the treating surgeon's discretion. Acetabular reconstruction (if any), the surgical approach, and the intra-operative use of cement and other adjuvants for disease control will also be at the discretion of the treating surgeon.
Resection and reconstruction
Resection and reconstruction
Internal Fixation
If the participant is randomized to the Internal Fixation treatment arm, the surgery will involve the stabilization of the remaining bone with either an intramedullary nail, plate or screw fixation. All standard surgical principles of stable internal fixation will be followed. The type of fixation, the surgical approach, and the intra-operative use of cement and other adjuvants for disease control will be at the treating surgeon's discretion.
Internal Fixation
Internal Fixation
Interventions
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Internal Fixation
Internal Fixation
Resection and reconstruction
Resection and reconstruction
Eligibility Criteria
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Inclusion Criteria
* Lesions in the proximal femur (femoral neck, intertrochanteric region, subtrochanteric region, and combinations thereof)
* Low or intermediate risk for perioperative morbidity and/or mortality
* No more than 75% and no less than 25% bone loss
* Mutual (patient and physician) decision to perform surgical management of an impending or realized pathologic fracture due to MBD of the proximal has been made.
Exclusion Criteria
* Lesion with any femoral head involvement
* High risk for perioperative morbidity and/or mortality
* Multidisciplinary decision that resection of the entire lesion would be indicated
18 Years
ALL
No
Sponsors
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Canadian Cancer Society (CCS)
OTHER
Michelle Ghert, MD
OTHER
Responsible Party
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Michelle Ghert, MD
Professor
Principal Investigators
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Michelle Ghert, MD
Role: PRINCIPAL_INVESTIGATOR
McMaster University
Locations
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Parkview Packnett Family Cancer Institute
Fort Wayne, Indiana, United States
Good Samaritan Regional Medical Center
Corvallis, Oregon, United States
Oregon Health and Science University Hospital
Portland, Oregon, United States
Cliniques Universitaires Saint-Luc
Brussels, , Belgium
Hospital de Clínicas de Porto Alegre
Porto Alegre, Rio Grande do Sul, Brazil
AOU Città della Salute e della Scienza CTO hospital
Torino, To, Italy
Countries
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Central Contacts
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Facility Contacts
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Ashley Romine
Role: primary
Nicholas Tedesco, MD
Role: primary
Anthony Franklin
Role: backup
Rebecca Smith
Role: primary
Kim Henquin
Role: primary
Julie Cerutti Pestilho
Role: primary
Simone De Meo
Role: primary
References
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Axelrod D, Gazendam AM, Ghert M. The Surgical Management of Proximal Femoral Metastases: A Narrative Review. Curr Oncol. 2021 Sep 28;28(5):3748-3757. doi: 10.3390/curroncol28050320.
Provided Documents
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Document Type: Study Protocol
Other Identifiers
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GHRT03
Identifier Type: -
Identifier Source: org_study_id