There are many, many factors to be considered - HPV, smoking or not, not, the health of the patient, the size of the tumor, lymph node involvement (bundled or not), EFGR level, exact subsite (tonsil vs. BOT), to name a few. You should be able to find study results on both protocols - evaluate them based on HPV/non smoker analysis. In this case, one of the factors you mention is:

[quote]They are recommending starting with chemo first because the tumors in the lymph are so large. They want to get them reduced as much as possible. My understanding is if they are smaller it is less likely for other areas in the mouth/neck/ears etc to be damaged in the process.
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Although the chemo is rough, radiation is the gift that keeps on giving - reducing the target volume with the induction sounds pretty compelling to me.

In discussing this with the doctor, you might ask if his recommendation for himself would be different than for his brother - if they each had the exact same cancer as your husband. If the answers are different, you will know that the doctor thinks the protocol he picks for himself has a good enough risk/reward level and less side effects, but that the one he picks for his brother has a lower risk of failure (I'm basing this on a couple of studies I've seem - can try to find them other the weekend). If he answers the same for him and his brother, pick that one.

To add to the complexity, it's looking like a slightly accelerated radiation therapy may be of benefit. Not all centers can accomodate this, but it wouldn't hurt to ask.

Maria