Conference: The Staffan Lindeberg Memorial Conference, Lisbon 2017
Introduction: Prognosis for patients with high-grade brain tumor is poor and survival did neither substantially change with advances in chemotherapy, radiotherapy and molecular profiling. Ketogenic diets have been suggested as a promising alternative therapy. However, group studies in cancer patients with the classical ketogenic diet so far provided little or no evidence that the classical ketogenic diet is indeed beneficial in terms of prolonging survival. Results: Here we present three cases: one patient with grade 3 brain tumor, (pat #1: anaplastic oligodendroglioma) and two patients with grade 4 brain tumor (pat #2: recurrent glioblastoma; pat #3: new-onset glioblastoma). The three patients were started on the strickest form of the paleolithic ketogenic diet (PKD): the full meat-fat diet. At the time of diet onset all three patients refused chemotherapy and radiotherapy and did neither use any dietary supplements nor standard medications. They all strictly adhered to the diet and were in constant ketosis. Pat #1, who was overweight at diet onset, lost 25 kg on the diet during the first nine months of the diet. During this time tumor size was relatively stable. Later on tumor size gradually increased which was preceded by a gradual increase in food intake without affecting ketosis. Along with this inflammatory parameters increased as well. The patient was advised to decrease food intake and subsequently inflammatory parameters decreased again. In pat #2, in addition to recurrent glioblastoma, past history also included bladder cancer. Despite surgery and radiochemotherapy his brain tumor recurred. Upon recurrence, the patient stopped radiochemotherapy and started the PKD as a stand-alone therapy. Currently, the patient is on the diet for 14 months and is progression-free. Pat #3 had a stable tumor size for the first two months of the diet when he used the diet as a stand-alone therapy. Then, despite being progression-free and having no sympoms at all, the patient decided to have radiotherapy. Although we advised against, he also started taking multiple supplements and began hyperbaric oxigen therapy. From this time on his disease progressed and the patient died at 11 months. Conclusions: The two patients using the PKD as a stand-alone therapy are still alive at 25 and 14 months while the third patient after starting additional therapies experienced progression and died.