Head and neck cancer

Cancer Biol Med 2014;11:145-161. doi: 10.7497/j.issn.2095-3941.2014.03.001

Introduction

Head and neck cancer (HNC) is a collective term for cancers

originating from the lip, oral and nasal cavity, paranasal sinuses,

pharynx, larynx and trachea. Approximately 90% of HNCs are

head and neck squamous cell carcinoma (HNSCC) originating

from the mucosal lining (epithelium) of these regions.

Frequent comorbidities of HNCs include various feeding

difficulties and malnutrition that are often aggravated by tobacco

and alcohol abuse and a general unhealthy lifestyle1. At time of

diagnosis up to 60% of all HNC patients present with improper

nutritional status2,3, so that nutritional support becomes an

important aspect in the treatment of these patients. A general

recommendation is that even HNC patients who appear healthy

should be counseled and advised to eat a high-calorie and

high-protein diet4. In practice, however, the variety of available

supplementary nutrition formulas and general inconsistent

dietary advices for cancer patients5 pose a difficulty for deciding

on the optimal diet for preventing muscle loss, improving the

quality of life, reducing inflammation and withstanding therapyinduced

side-effects. Many physicians seem unaware of the fact

that besides the amount of caloric intake, the composition of the

diet may have profound influences on these dietary goals. This

is exemplified by a recent investigation of enteral and parenteral

feeding practices in a Chinese university teaching hospital6 where

only 2.1% of cancer patients received Supportan, a diseasespecific

high-fat nutrition formula that has been shown to

improve nutritional and functional parameters in HNC patients

compared to a standard formula7.

Like most aggressive tumors, HNCs exhibit a high rate of and

dependence on glycolysis to meet their metabolic demands8,9. It

has therefore been reasoned that diets restricted in carbohydrates

(CHOs) could target the altered metabolism of such glycolytic

tumors10,11. Indeed, there is some evidence that a ketogenic

diet (KD), a high-fat low-CHO diet that leads to the elevation

of circulating ketone bodies into the mM range, may not only

Restricting carbohydrates to fight head and neck cancer—is

this realistic?

Rainer J. Klement

Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital, Schweinfurt 97421, Germany

REVIEW

Correspondence to: Rainer J. Klement

E-mail: rainer_klement@gmx.de

Received May 29, 2014; accepted July 13, 2014.

Available at www.cancerbiomed.org

Copyright © 2014 by Cancer Biology & Medicine

ABSTRACT

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