BACKGROUND.: The treatment results of buccal squamous cell carcinoma before and after 2002 were compared. METHODS.: Two hundred forty-five patients with buccal cancer who underwent curative treatment were retrospectively reviewed. RESULTS.: The 5-year overall survival rate was 30.0% before 2002 and 53.5% after 2002 (p = .004). On multivariate analysis, T classification, surgical margins, and treatment modality significantly affected overall survival, and N classification and histologic grade had trends to affect it. Invasion depth had a trend to influence locoregional control. For patients with early-stage disease without adverse factors, the locoregional control was similar between surgery alone group and surgery + radiotherapy group. CONCLUSION.: The survival of patients with buccal cancer was improved after 2002, which represented the start of intensity-modulated radiotherapy (IMRT) in our institute. Ipsilateral neck alone irradiation was recommended for T1–2N0–1 and small T3N0 disease, and bilateral neck irradiation could be reserved for advanced disease. © 2012 Wiley Periodicals, Inc. Head Neck, 2013