Because of the betel-nut, cigarette, and alcohol use, the incidence of head and neck cancer (HNC) among male individuals in Taiwan continued to increase. In contrast to the HPV-related HNC in western countries, most patients with HNC in Taiwan were HPV- and incurred high recurrence rate and poor prognosis. The treatment strategy of head and neck cancer could be categorized as surgery-based or radiation-based treatment. Different sequelae of treatment modalities had been reported. Recently, precision medicine or tailor-made treatment strategy had been proposed for HNC with incorporation of systemic treatment, and genomic testing. We will present treatment strategies for HNC. The main issues discussed were as the followings: (1) Personalized surgical planning for oral cavity cancers: Up to half of HNC in Taiwan were oral cancer. Oncological outcomes vs QoL, resection margins, Induction chemotherapy followed by surgery vs upfront surgery, types of madibulectomy, and flap selections will be discussed.(2) Optimal swallowing function in oropharyngeal cancer (OPC) patients treated with neoadjuvant chemotherapy (NAC) followed by transoral surgery (TOS) : Up to 70% OPC patients in Taiwan were p16-. De-escalation strategy developed for HPV+ OPC might not be completely applied. Using NAC response as a guide, patients with favorable response to IC followed by TOS had excellent survival outcomes and optimal swallowing function evaluated with MDADI. In contrast to de-escalation strategy in HPV+ OPC, our protocol could be used in both HPV- and HPV+ OPC patients. (3) Personalized medicine in the treatment of advanced head and neck cancer: Finding suitable cases is the most important step in precision medicine era. Application of whole exome sequencing, oncogene panel sequencing, cell-free DNA (cfDNA), circulating tumor cells (CTC) and CTC clusters, and markers for ICI for clinical HNSCC management will be the focus for future development of personalized medicine for HNSCC.Our program summarizes the tailor-made treatment strategy in head and neck cancer in area where betel nut is common.