Hg-32use of Ketogenic Diet as a Complimentary Metabolic Therapy During Chemo-Radiation Therapy in a 7 Year Old Female With Glioblastoma

The ketogenic diet (KD) is a high-fat, low-carbohydrate diet used to control seizures in patients with intractable epilepsy. KD has also been shown to decrease tumor growth and increase overall survival in animals implanted with human glioma cells. In addition, hyperglycemia during glioblastoma (GBM) treatment has been associated with decreased survival. Because of these findings, there is an increased interest in glycemic modulation in patients with high grade glioma. A 7-year-old girl with a large posterior fossa GBM requiring tracheostomy and a gastrostomy tube following tumor biopsy was treated with a ketogenic formula via a gastrostomy tube on an IRB-approved study. KD was initiated at a 1:1 ratio, and advanced stepwise to 3.5:1 ratio using KetoCal 4:1, whey protein and medium chain triglyceride emulsion with electrolyte supplementation during and after chemoradiation therapy. The patient was on dexamethasone following biopsy and throughout radiation therapy to control brain swelling. Mean serum glucose prior to KD was 119 (98-163) mg/dL and 79 (66-95) mg/dL during KD. Mean serum ketone levels on KD was 31 (16-59) mg/dL with moderate to large urine ketones. Electrolytes and serum lipid profile remain within normal limits. No other side effects were noted related to KD except mild decreased serum carnitine. MRI obtained at 10 and 16 weeks post KD initiation and following chemoradiation showed decreased tumor size. This case suggests the ketogenic diet can be a potential complimentary metabolic therapeutic option for patients with GBM that is safe and tolerable and warrants further studies.