Background: Head and neck cancers constitute a significant health burden in developing countries, particularly in India, where a large proportion of patients present with locally advanced, recurrent, or metastatic disease unsuitable for curative treatment. Metronomic palliative chemotherapy has emerged as an economical and well-tolerated therapeutic approach that may improve disease control and survival outcomes with minimal toxicity.

Aim: To evaluate the survival outcomes, clinical response, and toxicity profile of metronomic palliative chemotherapy in patients with locally advanced and recurrent head and neck cancer.

Materials and Methods: This retrospective observational study was conducted in a tertiary care teaching hospital using medical records of patients treated between January 2022 and December 2024. A total of 48 patients with histopathologically confirmed locally advanced unresectable, recurrent, or metastatic head and neck squamous cell carcinoma receiving metronomic palliative chemotherapy were included. Patients received oral methotrexate and celecoxib-based metronomic therapy. Demographic details, clinical characteristics, treatment response, toxicity profile, and survival outcomes were collected from hospital records. Tumor response was assessed using RECIST version 1.1 criteria, while treatment-related toxicities were graded according to CTCAE version 5.0. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan–Meier survival analysis.

Results: The majority of patients were males with a mean age of 56.4 ± 10.8 years, and oral cavity carcinoma was the most common primary tumor site. Clinical benefit comprising complete response, partial response, and stable disease was observed in the majority of patients. Median overall survival and progression-free survival demonstrated favorable palliative outcomes. Most treatment-related adverse effects were mild to moderate, while severe Grade III/IV toxicities were infrequent, indicating good tolerability of the regimen.

Conclusion: Metronomic palliative chemotherapy demonstrated satisfactory clinical benefit, acceptable survival outcomes, and manageable toxicity in patients with advanced and recurrent head and neck cancers. Owing to its affordability, oral administration, and favorable safety profile, it represents an effective palliative treatment strategy in resource-limited settings.

Keywords: Head and Neck Cancer, Metronomic Chemotherapy, Palliative Chemotherapy, Overall Survival, Progression-free Survival, Recurrent Head and Neck Carcinoma.