Actually even OCF had the wrong data at the beginning (2000) when we used to say 75% tobacco/alcohol and 25% we don't know. That data came from a Blott paper published in 1988 (old) and was referenced again in a more read Mashberg paper in the early 90's. They were good guesstimates at the time, but they were wrong even then and more so now. The current thinking from Gillison at Hopkins and other opinion leaders is that is is about 50% tobacco alcohol, and 30-40% HPV. A small percentage (likely about 5%) are genetically related, though the data on this is thin. And 5% we have no clue at all what causes them. Tobacco use has declined in the US every year for at least 15 years, (with the current usage of all types at about 21% of the population as tobacco users) while the incidence rate of OC has stayed the same during this period, and in 2007 actually increased by 11%. So HPV as a replacement etiology was discussed in the 80's but definitively proven as a subset etiology in 2000 in a breakthrough Gillison paper. But it is obvious that you can't have a decline in the stated prevalent cause (tobacco) and and increase in the rate of incidence without a replacement etiology.

Bottom line is that even with these statistical changes we are finding that the demographics of the populations getting oral cancers are very different. The historical tobacco/alcohol etiology is still older, more male, more black vs white, and the HPV population is younger, more white, and evenly men and women. They will eventually be called two different diseases and likely somewhere down the road, have different treatment protocols though that is not the case today.

So the deal with people who get (and luckily catch early) SCC and have surgical only solutions is not unknown or uncommon. Historically they have been treated as described, particularly in patients with no known risk factors - using surgical only solutions. In the past (6-7 years ago) I was very against this approach. My thinking now from listening to many, many speakers at research and cancer conferences that I speak at, is that my previous feeling that all patients should have the biggest hammer thrown at them from the get go, may have been premature or overkill in certain situations. We all know that even with clean surgical margins there are often micro mets that cannot been seen on scans, that given a couple of years, they can prosper into another recurrence. Radiation deals with these, but it is a one time only deal, though as stated by others, in limited cases SOME re radiation is OK in IMRT patients in particular. So Docs tend to think of this as something to use when surgical solutions do not control in the long term. Long term survival is the goal, this is sometimes accomplished via repeated management, not absolute cure. A small surgery in a closely monitored patient they feel, even if it has to be done every few years is preferable in their minds to QOL altering radiation for what appears to be very localized early stage disease states.

Now without knowledge of HPV influence, and the lack of field cancerization in the process (no known etiology), and the acceptance that some patients develop these from genetic aberrations which cannot be controlled, the thinking has changed a bit. HPV patients have fewer recurrences when their primary is found early. The do not have second primaries in remote areas like tobacco people because the HPV virus does not effect those tissue types (anecdotally believed but not proven conclusively) and field cancerization is missing from the equation. So perhaps radiation is overkill in patients that can be managed with lots of minor surgical procedures. The key here is constant monitoring and early discovery of the recurrence. Late discovery is a "go to surgery plus radiation and possibly chemo or monoclonal antibodies" immediately. Late stage disease spreads quickly via the lymph and circulatory systems regardless of tobacco, HPV positive or negative origin, and regardless of genetic predisposition or origin. Once that wild fire starts, it runs fast and hot regardless of how you come to it. With patients with field cancerization, (tobacco etiology) radiation of surrounding tissues, and the known pathways of dissemination of the disease is prudent and likely the best course early in the game.

The thinking is that with a genetic origin, radiation is not going to stop the many recurrences. It is not going to stop the body's predisposition to continue to spin off malignancies. Right now there is no good genetic profiling for this etiology determination. So it is a judgment call by the doctors, and to some extent a best guess in treatment planning. They hold the radiation for the day that it is not caught early and then the fight begins in earnest, because the caca is hitting the fan quickly. There is a wide variance in patient compliance in monitoring and follow up, financial ability to do so many repeated surgeries, doctors abilities to catch the smallest beginnings of the next event, etc. This is a dangerous situation to say the least. The adage that it is "eternal vigilance or eternal rest" (engraved on a plaque in my dad's B-17 bomber that he flew over Germany in WWII) could not be truer in these situations where causality is unknown or unprovable and surgical only solutions are used.

I hope that these comments and observations answer some of your questions. They come from many years of listening to the finest minds in the realms of research and treatment who are out on the lecture circuit with me. I am only a common man of modest accomplishments and knowledge, you are reading the ideas of much smarter people - not mine- which I am restating here.