This retrospective analysis was undertaken to assist with the development of a national protocol for children with MEGCTs in South Africa to standardise management and toxicity assessments. In the new national protocol the choice of platinum will be influenced by several factors: firstly, previous local reports of the cost effectiveness of JEb as an outpatient strategy (16) and the significant relationship between SES and outcome reported here; secondly, the rates of platin-related ototoxicity reported here and that under-testing has potentially resulted in a failure to detect significant numbers of hearing impaired children, and; lastly, the availability of audiology services and nuclear medicine facilities which are not ubiquitously available and tend to be clustered near larger POUs in wealthier urban areas.