ECOG-ACRIN E3311: transoral surgery followed by reduced-dose radiotherapy for HPV-positive oropharyngeal cancer
In HPV-positive oropharyngeal cancer removed by transoral robotic surgery, patients with intermediate-risk pathology did just as well with a reduced 50 Gy dose of radiotherapy as with the standard 60 Gy, supporting surgery-based de-escalation.
Overview
Phase 2 trial of 495 patients with resectable HPV-positive oropharyngeal cancer treated with transoral surgery and neck dissection, then allocated by pathology: observation for low risk, randomisation to 50 or 60 Gy radiotherapy for intermediate risk, and chemoradiotherapy for high risk.
Two-year progression-free survival was 96.9 percent with observation, 94.9 percent with 50 Gy and 96.0 percent with 60 Gy, and 90.7 percent with chemoradiation, with better swallowing outcomes at lower doses.
- Two-year progression-free survival 94.9 percent with 50 Gy vs 96.0 percent with 60 Gy in intermediate-risk patients.
- Low-risk patients observed after surgery had 96.9 percent two-year progression-free survival.
Transoral surgery with pathology-guided reduced-dose radiotherapy is a validated de-escalation pathway for HPV-positive oropharyngeal cancer in experienced centres.
- Phase 2 with no non-surgical comparator.
- Requires surgical expertise with low positive-margin rates.