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New Tool for Presurgical Detection of Kidney Cancers Helps to Avoid Unnecessary Surgeries

By MedImaging International staff writers
Posted on 06 Jul 2010

The results of a prospective multicenter phase III study demonstrate that the use of an antibody called 124I-girentuximab with positron emission tomography/computed tomography (PET/CT) imaging can help to distinguish clear cell renal-cell carcinoma (RCC), the predominant variant of kidney cancer, from other types of benign or malignant kidney masses.

If approved by the U.S. Food and Drug Administration (FDA), this will be one of the first diagnostic scans which can differentiate not only identify a tumor's origin and location, but also provide data on the type (histology) of that tumor. Armed with this information, physicians and patients will be able to make more informed treatment choices.

Kidney cancer is a radiographic diagnosis, which means treatment decisions are often made based on the findings of a solid mass on CT or magnetic resonance imaging (MRI). Unfortunately, these tests cannot distinguish the different types of kidney cancers that have variable risks. As more individuals continue to be scanned as part of their evaluation for various ailments and symptoms, the number of kidney tumors found serendipitously has increased such that now up to 70% of kidney tumors are discovered incidentally.

Kidney cancer is a surgical disease, which means that many patients with incidentally detected masses will be offered surgery. Frequently, however, the tumors are shown postsurgically to have been benign or indolent, and many would not have required immediate surgical intervention. In the absence of a definitive presurgical diagnosis, surgeons generally must opt for surgery.

Robert G. Uzzo, M.D., F.A.C.S., chairman of Fox Chase Cancer Center's (Philadelphia, PA, USA) department of surgery, presented the results of this phase III study entitled multicenter phase III REDECT trial with 124 I-girentuximab-PET/CT for the presurgical Detection of Clear Cell Renal Carcinoma (cc(RCC) study at the 2010 annual meeting of the American Urological Association, in San Francisco, CA, USA, on June 1, 2010.

124I-girentuximab is a monoclonal antibody that binds to a unique protein expressed highly on the most common and lethal type of kidney cancer (clear cell renal-cell carcinoma). When injected intravenously as part of a PET/CT scan, it gives histologic data providing useful noninvasive clinical insights to renal masses' biologic properties. The PET imaging with 124I-girentuximab (REDECTANE) is a cutting-edge type of molecular imaging tool. Researchers at Fox Chase Cancer Center have led accrual nationally to this important phase III trial.

"The ability to distinguish preoperatively between aggressive and less aggressive kidney masses is a critical clinical challenge,” said Dr. Uzzo, who is also codirector of Fox Chase's Keystone Program in Personalized Kidney Cancer Therapy. "Such information makes a direct impact on patient management, giving physicians the ability to match tumor biology to appropriate treatment strategies.”

The 124I-girentuximab PET/CT is performed similarly to any PET or CT--the antibody is injected intravenously and the patient is then imaged. In the case of kidney cancer, REDECTANE provides oncologists with superior imaging, allowing them to distinguish the aggressive RCC phenotype from other renal cell subtypes and benign tumor much better than current tests. Furthermore, the technology may aid in more precise diagnosis of tumor stage, detecting early and otherwise undetectable metastatic deposits.

Researchers identified and enrolled 226 patients in the multi-center study and found that the antibody 124I-girentuximab (cG250) binds to an aggressive phenotype, which is expressed in more than 95% of clear cell RCC--the most common form of kidney cancer, accounting for up to 90% of all kidney cancer deaths.

In this study, Dr. Uzzo and his team used PET/CT scans with 124I-girentuximab to differentiate effectively the aggressive RCC phenotype from less aggressive subtypes prior to surgery. The sensitivity and specificity of the test were 86% and 87%, respectively, with a positive predictive value of 95% for clear cell renal cancer. Such strategies potentially can help reduce the number of unnecessary surgeries and guide individualized patient management. The multicenter phase III REDECT trial was conducted at 14 centers across the United States and sponsored by Wilex AG (Munich, Germany).

The Keystone Program in Personalized Kidney Cancer Therapy, codirected by Robert G. Uzzo, M.D., FACS, Gary Hudes, M.D., and Joseph R. Testa, Ph.D., investigates the biologic processes that lead to kidney cancer metastasis and aims to uncover the molecular signals that predict how an individual patient's kidney tumor will respond to therapies.

Related Links:
Fox Chase Cancer Center

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58 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

59 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

60 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

61 (131.84547424316): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (504.97055053711): SELECT fid FROM jos_deeppockets WHERE id=294730128 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294730128 AND published='1' LIMIT 1

63 (42.915344238281): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

64 (40.054321289062): select jos_twitters.link from jos_twitters where cat=10

65 (34.809112548828): select jos_facebook.link from jos_facebook where cat=10

66 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

68 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294730128 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294730128 AND published='1' LIMIT 1

69 (49.114227294922): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

70 (352.85949707031): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (268.93615722656): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (51.021575927734): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (34.093856811523): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (128.03077697754): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 3907.9189300537): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (79.870223999023): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

105 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

106 (53.882598876953): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (562.90626525879): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

109 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

110 (58.174133300781): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (577.92663574219): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (653.98216247559): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (561.95259094238): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (149.96528625488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

115 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

116 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

117 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

118 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

119 (52.213668823242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

120 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

121 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

122 (399.82795715332): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 41691.064834595): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (627.99453735352): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294730128 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294730128 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 16376.01852417): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (71.048736572266): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (64.13459777832): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (32.901763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (465.15464782715): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (!!!!! 3870.964050293): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (43.153762817383): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (498.05641174316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (357.86628723145): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=213

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=213

139 (571.96617126465): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (495.91064453125): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

142 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

143 (!!!!! 15680.074691772): TRUNCATE TABLE jos_trademed_module

144 (90.837478637695): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (55.789947509766): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294730128 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (905.99060058594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (513.07678222656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

149 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

150 (!!!!! 1589.0598297119): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (577.92663574219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

152 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

153 (318.05038452148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294730128 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294730128 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (362.15782165527): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

155 (39.100646972656): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

156 (66.995620727539): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (654.93583679199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

158 (170.94612121582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294730128 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294730128 AND published='1' LIMIT 1

159 (115.15617370605): select jos_twitters.link from jos_twitters where cat=10

160 (291.82434082031): select jos_facebook.link from jos_facebook where cat=10

161 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

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