TABLE 3.
Noncontrolled studies reporting results of RT associated with a KD in cancer patients1
| Authors, year (ref) | Cancer types | Therapeutic protocol | KD, % of lipids/carbohydrates/proteins | Radiotherapy | Effects |
|---|---|---|---|---|---|
| Nebeling et al., 1995 (78) | Astrocytoma, advanced stage | RT + CT + KD | 70/20/10 | 36 Gy on neuroaxis, 54 Gy on posterior fossa | Tumor response with possible increasing OS |
| Zuccoli et al., 2010 (79) | Glioblastoma | CR (660 kcal/d) + RT + TMZ + KD | 75/15/10 | 60 Gy in 30 fractions of 2 Gy | TR, recurrence after diet suspension5 TP |
| Champ et al., 2014 (80) | Glioblastoma multiforme (n = 6) | RT + TMZ + KD | 77/15/8 | 60 Gy in 30 fractions of 2 Gy | 1 complete response |
| Klement et al., 2016 (81) | Breast, prostate, SCLC, and 2 rectal adenocarcinomas (n = 6) | RT + CT + KD | 73/12/5 | ST | 1 TP (SCLC) and 5 TR |
| Kato et al., 2016 (82) | Invasive rectal cancers | RT + KD | 40% kcal fat and CHO <100 g/d | ST | Reduced risk of cancer specific death? |
| Zahra et al., 2017 (77) | NSCLC (n = 7), pancreas (n = 2) | RT + CT + KD | 90/2/8 | ST | No difference in OS and PFS |
| Elsakka et al., 2018 (83) | Glioblastoma multiforme | RT + TMZ + CR (900 kcal/d) + KD + HOBT + MIX | 70/15/15 | 30 times 2 Gy | TR |
| van der Louw et al., 2019 (84) | Intrinsic Pontine glioma (n = 3) | RT + CT (TMZ or GCB) + KD 4:1 (for 3 mo) | Ketone levels >3 mmol/L KD with MCT emulsions | Fractionated RT up to 60 Gy | 3 patients died |
| Klement et al., 2019 (70) | Colorectal, breast, head, and neck cancers (n = 81): 20 KD vs. 61 control diet | SF + KD + RT ± CT | KD during RT: MCT + 10 g EAAs or full KD + 10 g EAAs | RT, RT + CT | Differential effects on weight fat and lean mass |
1CHO, carbohydrate; CR, caloric restriction; CT, chemotherapy; EAA, essential amino acid; GCB, gemcitabine; HOBT, hyperbaric oxygen therapy; KD, ketogenic diet; MCT, medium-chain triglyceride; MIX, metformin, methylfolate, chloroquine, epigallocatechin gallate, and levetiracetam; NSCLC, non–small cell lung cancer; OS, overall survival; PFS, progression-free survival; ref, reference; RT, radiotherapy; SCLC, small cell lung cancer; SF, short fasting; ST, standard treatment; TMZ, temozolomide; TP, tumor progression; TR, tumor response.