# ECOG-ACRIN E3311

Source: https://onco.cc/trials/ecog-e3311/  
OnCo record `ecog-e3311` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

E3311 showed that after robotic surgery for HPV-positive throat cancer, patients at intermediate risk could safely have a lower radiotherapy dose, with about 95 in 100 free of progression at two years, so surgery-first de-escalation became a recognised option.

## Summary

E3311 enrolled 519 patients with HPV-positive oropharyngeal cancer suitable for transoral surgery. After resection and neck dissection they were assigned by pathology: low-risk patients had no further treatment, intermediate-risk patients were randomised to 50 Gy or the standard 60 Gy of radiotherapy, and high-risk patients (extranodal extension or positive margins) had 66 Gy with cisplatin.

Reported by Robert Ferris in the Journal of Clinical Oncology in 2022, two-year progression-free survival was 96.9 percent with observation, 94.9 percent with 50 Gy, 96.0 percent with 60 Gy and 90.7 percent in the high-risk chemoradiation arm. Swallowing scores were good and the reduced-dose arm had less toxicity. Transoral surgery was safe in experienced hands, with low rates of serious bleeding.

The trial, alongside the phase 2 PATHOS study in Britain, made surgery followed by pathology-guided reduced adjuvant treatment a standard route to de-escalation for HPV-positive disease, in contrast to the definitive chemoradiation setting where reduced doses failed in NRG-HN005.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-17
- Registry id: NCT01898494
- Phase: 2
- Setting: Resectable HPV-positive oropharyngeal cancer: transoral surgery and neck dissection, then adjuvant treatment by pathological risk, with intermediate-risk patients randomised to 50 or 60 Gy of radiotherapy
- Sponsor: ECOG-ACRIN Cancer Research Group
- Enrolled: 519
- Result: Two-year progression-free survival 96.9% (observation), 94.9% (50 Gy), 96.0% (60 Gy) and 90.7% (high-risk chemoradiation).
- Outcomes: Progression-free survival at 2 years: Low risk, observation 96.9% vs Intermediate risk, 50 Gy 94.9% vs Intermediate risk, 60 Gy 96% vs High risk, 66 Gy + cisplatin 90.7%
- Replication: PATHOS (phase 2/3, United Kingdom) is testing the same design with swallowing and survival endpoints; the Mayo Clinic MC1273 series reported similar control with even lower postoperative doses.

## Sources

- ClinicalTrials.gov NCT01898494: https://clinicaltrials.gov/study/NCT01898494

## Connected records

- cancers: [HPV-positive oropharyngeal cancer](https://onco.cc/cancers/hpv-positive-oropharyngeal-cancer/), [Oropharyngeal cancer (tonsil and base of tongue)](https://onco.cc/cancers/oropharyngeal-cancer/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Transoral robotic surgery (TORS)](https://onco.cc/technologies/tors/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/)
- institutions: [ECOG-ACRIN Cancer Research Group](https://onco.cc/institutions/ecog-acrin/)
- terms: [HPV-positive (p16) head and neck cancer](https://onco.cc/terms/hpv-p16/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/)
- trials: [PATHOS](https://onco.cc/trials/pathos/)

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