The side-effect risk is real and I think it is quite meaningful that at Hopkins they consider existing hearing loss as a contraindication for cisplatin use. It is not as if carbo desn't work, either, that's all my husband had as a chemo drug and he has come through very well from locally advanced cancer, tonsil, BOT and 2 nodes. At least two patients going through same time as he was were switched to carbo from cis- due to severe side effects and now, two years later, they are also doing well. In fact one only got through 24 radiation treatments, as she got so sick, and still is cancer-free.

If there is a hearing loss due to cisplatin, it is usually not reversible so cannot really be "dealt with later" as Amy says. Not everyone has hearing loss but the average percent affected is about 33% (range 2-60%) -- how often the drug is administered and a number of other factors seem to contribute to this wide range.

However, I'll bet many doctors would be hard-pressed to show a really significant difference from one drug to the other within their own practice. I think it is really a matter of "doing what they have been doing."

Also with a tonsil/base of tongue, has Bill been tested for human papilloma virus? It has been shown that even smokers can get HPV cancers, which are biologically different from those caused by smoking and respond more effectively to treatment. A recent paper showed that, surprisingly, the two factors (HPV and smoking) were not synergistic -- that is, smoking did not increase one's risk for the viral cancer. 72% of tonsil/base of tongue patients in this study were found to be HPV+

Gail