How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?

This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.

The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...

Remember that ECOG 3311 was a Phase II trial and the study was not powered to show non-inferiority between Arms B & C, but rather, in the words of the Ferris et al. publication, "to generate normative data regarding TOS (transoral surgery) and the feasibility of reduced postoperative radiation dose"...

They still don't change much.

a) The <15% recurrence rate in 27 N1 patients in Arm A, to me, does not justify radiating these patients. Historically 15% was a magic number to justify a risk where radiation was warranted (and I believe referenced in the first edition of Million and Cassisi's classic t...