nach oben

Strahlentherapie und Onkologie

Erschienen in:

02.05.2022 | Original Article

Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Patients with head and neck cancer (HNC) are at risk of malnutrition, especially during radiochemotherapy. We aimed to study the impact of a ketogenic diet (KD) versus an unspecified standard diet (SD) on body composition and survival in HNC patients undergoing radio(chemo)therapy.

Methods

As part of a controlled clinical trial, non-metastasized HNC patients were enrolled into either a KD (N = 11) or an SD (N = 21) group between May 2015 and May 2021. Body composition was measured weekly by bioimpedance analysis and analyzed using linear mixed effects models. Overall and progression-free survival was assessed during regular follow-up.

Results

A total of 7 KD and 21 SD patients completed the study and were eligible for comparative analysis. Chemotherapy was significantly associated with declines in all body composition parameters, while the KD had opposing, yet nonsignificant effects. In patients receiving chemotherapy, average weekly reductions of body mass (BM) and skeletal muscle mass (SMM) were 0.9 kg and 0.31 kg in the KD group versus 1.2 kg and 0.57 kg in the SD group, respectively. Patients in the KD group receiving no chemotherapy achieved an average increase of 0.04 kg BM and 0.12 kg SMM per week. After a median follow-up of 42 months (range 6.7–78 months) there were no significant differences in progression-free or overall survival between the groups.

Conclusion

The KD may partially counteract the detrimental effects of radiochemotherapy on body composition in HNC patients. This should encourage further research into KDs in frail cancer patient populations and motivate their implementation as complementary therapy for selected patients.

Initially, the maximum volume of the ketogenic drink was 250 ml (one container) [27], but was reduced to 225 ml after a re-sizing of the containers took place by the manufacturing company.

Donaldson SS, Lenon RA (1979) Alterations of nutritional status: impact of chemotherapy and radiation therapy. Cancer 43:2036–2052CrossRef

Bassett MR, Dobie RA (1983) Patterns of nutritional deficiency in head and neck cancer. Otolaryngol Head Neck Surg 91:119–125CrossRef

Selberg O, Selberg D (2002) Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 86:509–516. https://doi.org/10.1007/s00421-001-0570-4CrossRefPubMed

Arab A, Karimi E, Vingrys K, Shirani F (2021) Is phase angle a valuable prognostic tool in cancer patients’ survival? A systematic review and meta-analysis of available literature. Clin Nutr 40:3182–3190. https://doi.org/10.1016/j.clnu.2021.01.027CrossRefPubMed

De Luis DA, Aller R, Izaola O, Terroba M, Cabezas G, Cuellar L (2006) Tissue electric properties in head and neck cancer patients. Ann Nutr Metab 50:7–10. https://doi.org/10.1159/000089484CrossRefPubMed

McCall JL, Tuckey JA, Parry BR (1992) Serum tumour necrosis factor alpha and insulin resistance in gastrointestinal cancer. Br J Surg 79:1361–1363CrossRef

Noguchi Y, Yoshikawa T, Marat D, Doi C, Makino T, Fukuzawa K et al (1998) Insulin resistance in cancer patients is associated with enhanced tumor necrosis factor‑α expression in skeletal muscle. Biochem Biophys Res Commun 253:887–892CrossRef

Yoshikawa T, Noguchi Y, Doi C, Makino T, Nomura K (2001) Insulin resistance in patients with cancer: relationships with tumor site, tumor stage, body-weight loss, acute-phase response, and energy expenditure. Nutrition 17:590–593CrossRef

Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ (2013) Nutritional considerations for head and neck cancer patients: a review of the literature. J Oral Maxillofac Surg 71:1853–1860. https://doi.org/10.1016/j.joms.2013.04.028CrossRefPubMed

10.

Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F et al (2017) ESPEN guidelines on nutrition in cancer patients. Clin Nutr 36:11–48. https://doi.org/10.1016/j.clnu.2016.07.015CrossRefPubMed

11.

Cereda E, Cappello S, Colombo S, Klersy C, Imarisio I, Turri A et al (2017) Nutritional counseling with or without systematic use of oral nutritional supplements in head and neck cancer patients undergoing radiotherapy. Radiother Oncol 126:81–88. https://doi.org/10.1016/j.radonc.2017.10.015CrossRefPubMed

12.

Champ CE, Mishra MV, Showalter TN, Ohri N, Dicker AP, Simone NL (2013) Dietary recommendations during and after cancer treatment: consistently inconsistent? Nutr Cancer 65:430–439. https://doi.org/10.1080/01635581.2013.757629CrossRefPubMed

13.

Zhu X‑P, Zhu L‑L, Zhou Q (2013) Prescribing practice and evaluation of appropriateness of enteral nutrition in a university teaching hospital. Ther Clin Risk Manag 9:37–43CrossRef

14.

Fietkau R, Lewitzki V, Kuhnt T, Hölscher T, Hess C‑F, Berger B et al (2013) A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial. Cancer 119:3343–3353. https://doi.org/10.1002/cncr.28197CrossRefPubMed

15.

Bozzetti F, Stanga Z (2020) Does nutrition for cancer patients feed the tumour? A clinical perspective. Crit Rev Oncol Hematol 153:103061. https://doi.org/10.1016/j.critrevonc.2020.103061CrossRefPubMed

16.

Richtsmeier WJ, Dauchy R, Sauer LA (1987) In vivo nutrient uptake by head and neck cancers. Cancer Res 47:5230–5233PubMed

17.

Sandulache VC, Ow TJ, Pickering CR, Frederick MJ, Zhou G, Fokt I et al (2011) Glucose, not glutamine, is the dominant energy source required for proliferation and survival of head and neck squamous carcinoma cells. Cancer 117:2926–2938. https://doi.org/10.1002/cncr.25868CrossRefPubMed

18.

Sattler UGA, Meyer SS, Quennet V, Hoerner C, Knoerzer H, Fabian C et al (2010) Glycolytic metabolism and tumour response to fractionated irradiation. Radiother Oncol 94:102–109. https://doi.org/10.1016/j.radonc.2009.11.007CrossRefPubMed

19.

Seyfried TN, Shelton LM (2010) Cancer as a metabolic disease. Nutr Metab (Lond) 7:7. https://doi.org/10.1186/1743-7075-7-7CrossRef

20.

Holm E, Kämmerer U (2011) Lipids and carbohydrates in nutritional concepts for tumor patients. Aktuel Ernahrungsmed 36:286–298CrossRef

21.

Klement RJ, Kämmerer U (2011) Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutr Metab (Lond) 8:75. https://doi.org/10.1186/1743-7075-8-75CrossRef

22.

Klement RJ (2019) The influence of ketogenic therapy on the 5 R’s of radiobiology. Int J Radiat Biol 95:394–407. https://doi.org/10.1080/09553002.2017.1380330CrossRefPubMed

23.

Tisdale MJ, Brennan RA, Fearon KC (1987) Reduction of weight loss and tumour size in a cachexia model by a high fat diet. Br J Cancer 56:39–43. https://doi.org/10.1038/bjc.1987.149CrossRefPubMedPubMedCentral

24.

Shukla SK, Gebregiworgis T, Purohit V, Chaika NV, Gunda V, Radhakrishnan P et al (2014) Metabolic reprogramming induced by ketone bodies diminishes pancreatic cancer cachexia. Cancer Metab 2:18. https://doi.org/10.1186/2049-3002-2-18CrossRefPubMedPubMedCentral

25.

Ma DC, Anderson CM, Rodman SN, Buranasudja V, McCormick ML, Davis A et al (2021) Ketogenic diet with concurrent chemoradiation in head and neck squamous cell carcinoma: preclinical and phase 1 trial results. Radiat Res. https://doi.org/10.1667/RADE-20-00150.1CrossRefPubMedPubMedCentral

26.

Klement RJ, Sweeney RA (2016) Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes 9:143. https://doi.org/10.1016/j.clnesp.2015.11.001CrossRefPubMedPubMedCentral

27.

Klement RJ, Sweeney RA (2016) Impact of a ketogenic diet intervention during radiotherapy on body composition: II. Protocol of a randomised phase I study (KETOCOMP). Clin Nutr ESPEN 12:e1–6. https://doi.org/10.1016/j.clnesp.2015.11.001CrossRefPubMed

28.

Klement RJ, Schäfer G, Sweeney RA (2020) A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: an interim analysis of the KETOCOMP study. J Tradit Complement Med 10:180–187. https://doi.org/10.1016/j.jtcme.2019.03.007CrossRefPubMed

29.

Klement RJ, Champ CE, Kämmerer U, Koebrunner PS, Krage K, Schäfer G et al (2020) Impact of a ketogenic diet intervention during radiotherapy on body composition: III—final results of the KETOCOMP study for breast cancer patients. Breast Cancer Res 22:94. https://doi.org/10.1186/s13058-020-01331-5CrossRefPubMedPubMedCentral

30.

Klement RJ, Weigel MM, Sweeney RA (2021) A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clin Nutr 40:4267–4274. https://doi.org/10.1016/j.clnu.2021.01.023CrossRefPubMed

31.

Klement RJ, Koebrunner PS, Meyer D, Kanzler S, Sweeney RA (2021) Impact of a ketogenic diet intervention during radiotherapy on body composition: IV. Final results of the KETOCOMP study for rectal cancer patients. Clin Nutr 40:4674–4684. https://doi.org/10.1016/j.clnu.2021.05.015CrossRefPubMed

32.

Klement RJ, Meyer D, Kanzler S, Sweeney RA (2021) Ketogenic diets consumed during radio-chemotherapy have beneficial effects on quality of life and metabolic health in patients with rectal cancer. Eur J Nutr 40:4674–4684. https://doi.org/10.1007/s00394-021-02615-yCrossRef

33.

Lucà-Moretti M (1998) Discovery of the master amino acid pattern. Ann R Natl Acad Med Spain CXV:397–416

34.

Perneger TV (1998) What’s wrong with Bonferroni adjustments. BMJ 316:1236–1238CrossRef

35.

Benjamin DJ, Berger JO, Johannesson M, Nosek BA, Wagenmakers EJ, Berk R et al (2018) Redefine statistical significance. Nat Hum Behav 2:6–10. https://doi.org/10.1038/s41562-017-0189-zCrossRefPubMed

36.

Anderson DR (2008) Model based inferences in the life sciences: a primer on evidence, 1st edn. Springer Science+Business Media, LLC, New YorkCrossRef

37.

Kuznetsova A, Brockhoff PB, Christensen RHB (2017) lmertest package: tests in linear mixed effects models. J Stat Softw 82:1–26. https://doi.org/10.18637/jss.v082.i13CrossRef

38.

Klement RJ (2014) Restricting carbohydrates to fight head and neck cancer—is this realistic? Cancer Biol Med 11:145–161. https://doi.org/10.7497/j.issn.2095-3941.2014.03.001CrossRefPubMedPubMedCentral

39.

Hopanci Bicakli D, Ozkaya Akagunduz O, Meseri Dalak R, Esassolak M, Uslu R, Uyar M (2017) The effects of compliance with nutritional counselling on body composition parameters in head and neck cancer patients under radiotherapy. J Nutr Metab 2017:8631945. https://doi.org/10.1155/2017/8631945CrossRefPubMedPubMedCentral

40.

Allen BG, Bhatia SK, Anderson CM, Eichenberger-Gilmore JM, Sibenaller ZA, Mapuskar KA et al (2014) Ketogenic diets as an adjuvant cancer therapy: history and potential mechanism. Redox Biol 2:963–970. https://doi.org/10.1016/j.redox.2014.08.002CrossRefPubMedPubMedCentral

41.

Quennet V, Yaromina A, Zips D, Rosner A, Walenta S, Baumann M et al (2006) Tumor lactate content predicts for response to fractionated irradiation of human squamous cell carcinomas in nude mice. Radiother Oncol 81:130–135. https://doi.org/10.1016/j.radonc.2006.08.012CrossRefPubMed

42.

Sattler UGA, Mueller-Klieser W (2009) The anti-oxidant capacity of tumour glycolysis. Int J Radiat Biol 85:963–971. https://doi.org/10.3109/09553000903258889CrossRefPubMed

43.

Voelxen NF, Blatt S, Knopf P, Henkel M, Appelhans C, Righesso LAR et al (2018) Comparative metabolic analysis in head and neck cancer and the normal gingiva. Clin Oral Investig 22:1033–1043. https://doi.org/10.1007/s00784-017-2185-0CrossRefPubMed

44.

Schroeder U, Himpe B, Pries R, Vonthein R, Nitsch S, Wollenberg B (2013) Decline of lactate in tumor tissue after ketogenic diet: in vivo microdialysis study in patients with head and neck cancer. Nutr Cancer 65:843–849. https://doi.org/10.1080/01635581.2013.804579CrossRefPubMed

45.

Arthur AE, Goss AM, Demark-Wahnefried W, Mondul AM, Fontaine KR, Chen YT et al (2018) Higher carbohydrate intake is associated with increased risk of all-cause and disease-specific mortality in head and neck cancer patients: results from a prospective cohort study. Int J Cancer 143:1105–1113. https://doi.org/10.1002/ijc.31413CrossRefPubMedPubMedCentral

46.

Rabinovitch R, Grant B, Berkey BA, Raben D, Ang KK, Fu KK et al (2006) Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03. Head Neck 28:287–296. https://doi.org/10.1002/hedCrossRefPubMed

47.

Fearon KC, Borland W, Preston T, Tisdale MJ, Shenkin A, Calman KC (1988) Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism. Am J Clin Nutr 47:42–48CrossRef

48.

Ok JH, Lee H, Chung H‑Y, Lee SH, Choi EJ, Kang CM et al (2018) The potential use of a ketogenic diet in pancreatobiliary cancer patients after pancreatectomy. Anticancer Res 38:6519–6527. https://doi.org/10.21873/anticanres.13017CrossRefPubMed

49.

Löser A, Ramke K, Grohmann M, Krause L, Roser P, Greinert F et al (2021) The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial. Strahlenther Onkol. https://doi.org/10.1007/s00066-021-01865-3CrossRefPubMedPubMedCentral

50.

Ho YW, Yeh KY, Hsueh SW, Hung CY, Lu CH, Tsang NM et al (2021) Impact of early nutrition counseling in head and neck cancer patients with normal nutritional status. Support Care Cancer 29:2777–2785. https://doi.org/10.1007/s00520-020-05804-3CrossRefPubMed

51.

Sherwin RS, Hendler RG, Felig P (1975) Effect of ketone infusions on amino acid and nitrogen metabolism in man. J Clin Invest 55:1382–1390. https://doi.org/10.1172/JCI108057CrossRefPubMedPubMedCentral

52.

Buse MG, Biggers JF, Friderici KH, Buse JF (1972) Oxidation of branched chain amino acids by isolated hearts and diaphragms of the rat. The effect of fatty acids, glucose, and pyruvate respiration. J Biol Chem 247:8085–8096CrossRef

53.

Palaiologos G, Felig P (1976) Effects of ketone bodies on amino acid metabolism in isolated rat diaphragm. Biochem J 154:709–716CrossRef

54.

Tome D (2012) Criteria and markers for protein quality assessment—a review. Br J Nutr 108:S222–9. https://doi.org/10.1017/S0007114512002565CrossRefPubMed

55.

Ræder H, Kværner AS, Henriksen C, Florholmen G, Henriksen HB, Bøhn SK et al (2018) Validity of bioelectrical impedance analysis in estimation of fat-free mass in colorectal cancer patients. Clin Nutr 37:292–300. https://doi.org/10.1016/j.clnu.2016.12.028CrossRefPubMed

Titel: Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients
Publikationsdatum: 02.05.2022
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 11/2022
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01941-2

Neu im Fachgebiet Onkologie

25.04.2024 | Nierenkarzinom | Nachrichten

Springer Medizin

Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 11/2022

Ist die elektive Bestrahlung der Lymphknotenlevel IV und Vb bei Nasopharynxkarzinomen erforderlich?

Intensity-modulated radiotherapy does not induce volumetric changes of the Bichat fat pad in nasopharyngeal cancer

Nebenwirkungsprofil einer frühen Immuntherapie nach Radiotherapie: eine gepoolte Analyse von Studien in der Datenbank der US Food and Drug Administration

Evaluation of novel 3D-printed and conventional thermoplastic stereotactic high-precision patient fixation masks for radiotherapy

DEGRO practical guideline for central nervous system radiation necrosis part 2: treatment

ORATOR2-Studie – randomisierter Vergleich einer primären Operation oder primären Strahlentherapie bei HPV-positivem Oropharynxkarzinom im Kontext einer Therapiedeeskalation

Neu im Fachgebiet Onkologie

Adjuvante Immuntherapie verlängert Leben bei RCC

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

Bei Senioren mit Prostatakarzinom auf Anämie achten!

ICI-Therapie in der Schwangerschaft wird gut toleriert

Update Onkologie