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Purpose <p>Ketogenic diets (KDs) have been proposed to target glycolytic cancer metabolism and synergize with radio- and chemotherapy. We herein report survival outcomes of rectal and head and neck cancer (HNC) patients who followed a&#xa0;KD during radio(chemo)therapy.</p> Methods <p>Thirty-five patients on a&#xa0;KD during radiotherapy and 46&#xa0;patients on a&#xa0;standard diet were prospectively followed. Overall (OS), progression-free (PFS), and locoregional recurrence-free survival (RFS) were analyzed with the Kaplan–Meier method and by computing restricted mean survival times. Acute radiotherapy-induced side effects were compared using Fisher’s exact test. In an exploratory analysis, patients in the KD group were matched to control patients with propensity score matching, and survival analysis was performed.</p> Results <p>Median follow-up was 77.4 (range 12.1–107.9; HNC) and 71.3 (1.5–127.1) months (rectal cancer), respectively. There were no significant differences in any survival outcome between the KD and control groups in either cohort. A&#xa0;numerically longer restricted mean RFS time for HNC patients did not reach the statistical significance threshold (KD: 100.5&#xa0;months, 0&#xa0;events; control group: 87.3 ± 7.0&#xa0;months, 3&#xa0;events; <i>p</i> = 0.059). In the propensity score-matched HNC sample, patients on a&#xa0;KD exhibited numerically longer OS (log-rank test: <i>p</i> = 0.084) and RFS (<i>p</i> = 0.064); however, these differences were not statistically significant. Acute skin toxicity was less severe in HNC patients on a&#xa0;KD (<i>p</i> = 0.063), which became significant in intention-to-treat analysis (<i>p</i> = 0.0495); all other acute toxicities were without significant differences between the groups.</p> Conclusion <p>Our analysis failed to detect a&#xa0;significant survival benefit of a&#xa0;KD during radio(chemo)therapy in HNC and rectal cancer patients, but provides further evidence for the safety of this approach.</p>

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Survival outcomes of rectal and head and neck cancer patients receiving radio(chemo)therapy with a ketogenic diet. A post-hoc analysis from the KETOCOMP trial

  • 期刊论文

  • 发表日期：

    2025年12月17日

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  • Rainer J. Klement,
  • Reinhart A. Sweeney

摘要

Purpose

Ketogenic diets (KDs) have been proposed to target glycolytic cancer metabolism and synergize with radio- and chemotherapy. We herein report survival outcomes of rectal and head and neck cancer (HNC) patients who followed a KD during radio(chemo)therapy.

Methods

Thirty-five patients on a KD during radiotherapy and 46 patients on a standard diet were prospectively followed. Overall (OS), progression-free (PFS), and locoregional recurrence-free survival (RFS) were analyzed with the Kaplan–Meier method and by computing restricted mean survival times. Acute radiotherapy-induced side effects were compared using Fisher’s exact test. In an exploratory analysis, patients in the KD group were matched to control patients with propensity score matching, and survival analysis was performed.

Results

Median follow-up was 77.4 (range 12.1–107.9; HNC) and 71.3 (1.5–127.1) months (rectal cancer), respectively. There were no significant differences in any survival outcome between the KD and control groups in either cohort. A numerically longer restricted mean RFS time for HNC patients did not reach the statistical significance threshold (KD: 100.5 months, 0 events; control group: 87.3 ± 7.0 months, 3 events; p = 0.059). In the propensity score-matched HNC sample, patients on a KD exhibited numerically longer OS (log-rank test: p = 0.084) and RFS (p = 0.064); however, these differences were not statistically significant. Acute skin toxicity was less severe in HNC patients on a KD (p = 0.063), which became significant in intention-to-treat analysis (p = 0.0495); all other acute toxicities were without significant differences between the groups.

Conclusion

Our analysis failed to detect a significant survival benefit of a KD during radio(chemo)therapy in HNC and rectal cancer patients, but provides further evidence for the safety of this approach.