England, hoping to cancel out Ireland's 49-point advantage, looked to be chasing a big score from the start and led 24-6 at halftime after two tries from Mike Brown, named man of the match for the third time in the tournament, and one for Owen Farrell, who again was faultless with eight out of eight kicks at goal.
Jack Nowell, with his first international try, Mako Vunipola and replacement centre Manu Tuilagi, in his first appearance for England in a year, crossed after the break as England looked on course for the huge win they needed to give them a chance of the title even in the case of an Irish victory in Paris.
However, an interception score by Leonardo Sarto after 68 minutes took the wind out of their sails, before captain Chris Robshaw finished on a high by claiming England's seventh at the death.
Having scraped three narrow wins on their last three visits to Rome, it was another hugely impressive performance by Stuart Lancaster's team, who have eight points from four wins following an opening-game defeat in Paris.
LANCASTER PROUD
"I'm delighted to score seven tries... and really proud overall of the performance of the boys," Lancaster told reporters.
"We didn't nail everything that we wanted to but overall really proud of them.
"I think all seven tries we created. I don't think any of them were down to poor Italian tackling. When we look at them in the analysis I think it'll be the quality of our attack, our intent to play that shows. Italy defended with great passion even towards the end when the game was gone. They deserve credit.
"Last week we played a lot in our own 22 against Wales but when you play you take energy out of the opposition and it tends to tell."
Ireland, with a points difference of +81, and France (+3) each have six points going into their game in Paris (1700GMT).
Any Irish win will give them the title and a fitting farewell for retiring centre Brian O'Driscoll.
France need a 70-point win to top the table, while a third successive draw in the fixture would leave England top for only the second time since 2003.
Italy end the championship with five defeats for the first time since 2009, while Wales play Scotland in Cardiff (14.45) in Saturday's other game.
BRILLIANT OFFLOAD
After a penalty each England scored their first try in the 13th minute after their first extended period of possession.
After sucking in Italy's robust defence the ball was worked left, where a brilliant offload from Luther Burrell allowed Brown to burst past Italy's backs.
Burrell almost let the hosts in for a score when his poor pass was fumbled by Nowell, and it was only a superb last-ditch tackle on Sarto from Farrell that saved England's blushes.
Orquera closed the gap with a second penalty in the 23rd minute but flyhalf Farrell extended the away side's lead to 17-6 just after the half hour with a neat try under the posts.
Brown gave England hope they could overturn the massive points gap to Ireland a minute before the break, scoring his second after a lovely passing move.
The start of the second half was as scrappy as the first, and it took England 12 minutes to get more points on the board when Nowell nipped in after good work at a scrum deep in Italy's 22.
Two tries in six minutes from Vunipola and Tuilagi made it 45-6 but a try gifted to Sarto extinguished England's chances of overtaking Ireland 12 minutes before the end, a minute after Tuilagi's touchdown.
Robshaw ended the match on a positive note in added time when he took George Ford's pass to score.
