**Background:** Laryngeal cancer is a significant oncological entity with rising incidence over the last three decades, particularly in Central and Eastern Europe. Smoking and heavy alcohol consumption are the main risk factors, with additional contributions from aging, HPV infection, and occupational exposures. Despite advances in diagnostic methods, many patients present with advanced disease requiring total laryngectomy, which has profound psychophysical and social impacts on quality of life. The debate between organ preservation strategies and total laryngectomy for advanced disease continues, with eligibility criteria for larynx preservation including tolerance to radiotherapy and chemotherapy.
**Methods:** This retrospective two-year study (January 2021 to December 2022) included 152 patients diagnosed with stage III or IV laryngeal cancer at Colțea Clinical Hospital, Bucharest, Romania. Workup included complete head and neck examination, fiberoptic examination, neck CT with contrast, MRI with contrast in nine selected cases, and chest CT. Biopsy was performed via direct laryngoscopy under general anesthesia. All cases were evaluated by a multidisciplinary tumor board. Patients with distant metastases at diagnosis were excluded. Both primary tumors and recurrences were enrolled. Staging followed UICC/AJCC classification.
**Key Results:** The average age was 62 years (range 44-83), with 87% male patients and a male-to-female ratio of 6.6:1. Most patients were from non-urban areas (82 rural vs. 50 urban). The 60+ age group represented 61% of cases. All female patients were diagnosed with stage IV, with an average age of 52.8 years (range 44-63). Regarding risk factors, 83% were current smokers, 15% former smokers, and only 2% never smokers. Among 126 current smokers, 106 were severe smokers (>20 cigarettes/day). Alcohol consumption was reported by 78.2% of patients, and 81.1% had combined alcohol and tobacco use. Poor oral health was present in 89% of patients, and GERD symptoms in 21%. The most frequent symptom was dysphonia with or without dyspnea in 142 cases (93.42%), followed by dyspnea alone in nine patients (5.92%) and dysphagia in one case (0.66%). The mean lag time between symptom onset and first consultation was 12 months (range 3 months to 2 years). Tumor localization was glottic in 63%, supraglottic in 30%, and subglottic in 7%. Most tumors were stage IV (92 cases), and 96.2% were squamous cell carcinomas. The main treatment was total laryngectomy (63%, n=96), all with bilateral neck dissection. Partial laryngectomy was performed in 20 patients, and total circular pharyngo-laryngectomy in four patients. Eight patients had recurrence after initial organ preservation treatment, with an average recurrence time of approximately 2.5 years. A phonatory fistula was created in 63 cases with primary puncture and 12 with secondary puncture, but 34% of patients with vocal prostheses did not use them. Four patients refused total laryngectomy and underwent concurrent systemic therapy and radiotherapy. Two patients died before starting treatment, and two had high-risk factors for anesthesia and received radiotherapy alone.
**Clinical Implications:** This study confirms that total laryngectomy remains the predominant treatment for advanced laryngeal cancer in Eastern Europe, contrasting with Western trends toward organ preservation. The high proportion of advanced-stage presentations (particularly stage IV) and the significant delay between symptom onset and consultation (average 12 months) underscore critical gaps in early detection. The low use of vocal prostheses (34% non-use) highlights rehabilitation challenges. The authors emphasize the need for prevention protocols including patient education on dental caries prevention, diet counseling, and oral hygiene, as well as improved screening programs and increased awareness among general practitioners and non-specialist physicians. The findings are particularly relevant for Eastern European countries where laryngeal cancer incidence is among the highest in Europe and where resource limitations affect treatment options.