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Top Line: Could a ketogenic diet or intermittent fasting improve outcomes for patients with brain tumors? 
The Study: This is not an uncommon question in the clinic. In ERGO2, 50 patients receiving re-irradiation for recurrent gliomas (mostly GBM) were randomized to a dietary intervention of ketogenic diet (KD) and intermittent fasting (IF). The KD-IF intervention lasted 9 days and consisted of 3 days of KD followed by 3 days of fasting and then 3 more days of KD. On the KD days, patients could have 21-23 kcal/kg and up to 50g of carbs. Re-irradiation (5 Gy x 4 in >80%) was given on days 4-8 of KD-IF. The trial sought to determine if there was an improvement in 6-month progression-free survival, which there wasn’t. But realistically, the trial was fairly small and had a brief dietary intervention for such an ambitious goal. It does show us, though, the feasibility of a short, 9 day course of ketogenic diet and fasting during glioma re-irradiation. In the KD-IF arm, 13% withdrew during the diet compared to 4% in the control arm. This trial also shows the challenge of exploring different methods and timing of caloric restriction in patients with brain tumors. 
TBL: Brief caloric restriction during re-irradiation for recurrent glioma doesn’t dramatically impact treatment outcomes. | Voss, Int J Radiat Oncol Biol Phys 2020

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