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Radiation Helps Cure Hodgkin's Lymphoma, Cancer Risk Remains a Problem

By MedImaging International staff writers
Posted on 03 Mar 2011

Modern treatment for early stage Hodgkin's lymphoma is highly effective, leaving most patients with no evidence of cancer. However, experts disagree on the best approach: is chemotherapy adequate or does adding radiation therapy improve the outcome? A systematic review comparing the two approaches found a distinct advantage to combined therapy, at least in the short term.

Those who received both chemotherapy and radiation were less likely to die or to have recurrences of their disease, within the next few years, than those who just had chemotherapy. In view of the apparent superiority of combined treatment, "the available evidence suggests not to avoid additional radiotherapy,” noted review coauthor Andreas Engert, MD, professor of internal medicine, hematology, and oncology at the University Hospital of Cologne (Germany).

Richard Little, MD, a senior oncologist at the US National Cancer Institute (Bethesda, MD, USA; www.cancer.gov), disagreed with that conclusion. "This is an unsettled treatment issue that goes back 40 years and more,” he said. "It comes down to the question of late-term side effects associated with radiation,” a topic that the review did not address.

The reviewers studied analyzed data from five randomized controlled trials involving 1,245 patients with early stage Hodgkin's lymphoma. The studies took place between the 1970s and 2004, and used an array of chemotherapy agents as well as diverse doses and types of radiation therapy. The review appears in the February 2011 issue of the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Analysis of the four studies that reported initial responses to treatment showed that chemotherapy and combined therapy were equally effective in eliminating the malignancy in large part or entirely. However, differences appeared when researchers followed patients for periods that averaged between 2 and 11.4 years. Patients who received radiation therapy in addition to six cycles of chemotherapy were 40% as likely to die as those who had chemotherapy alone. Similarly, among the four studies that included these data, the likelihood that the tumor would recur or progress among patients who had combined therapy was 41% of what it was for those who had chemotherapy alone.

It was not possible to monitor differences in survival or disease recurrence in subgroups defined by age, sex, or the size and location of tumors when treatment began. "This was not a limitation of the meta-analysis, but of the trials themselves, which did not report information on these subgroups,” Dr. Engert wrote in the article.

The studies included in the meta-analysis took place over a 30-year span, and the chemotherapy agents used in the earlier ones were less effective than are those currently used. Although this could weaken review findings, according to Dr. Engert, he added that the comparative effectiveness of chemotherapy and combined therapy was similar in early and later trials. Analysis of all five studies revealed that patients who also received radiation were no more likely to experience adverse effects than those who just had chemotherapy, and these side effects infections, nausea, and vomiting, and hair loss were typically related to chemotherapy. "Probably, the addition of radiotherapy does increases the long-term adverse event rate, but the studies weren't long enough to detect these events or didn't report them,” noted Dr. Engert.

Dr. Little reported that the missing information particularly was crucial because most patients who develop Hodgkin's lymphoma are quite young, in their teens and twenties, and will recover. "Complications due to radiotherapy are more likely to be seen 15, 20, or 30 years later,” he said.

Second malignancies such as breast or lung cancer are a major concern, but cardiovascular disease, thyroid disease, and nonmalignant lung disease develop as well. "Thirty years after radiation therapy, up to 30% of patients have been affected by these serious medical problems,” he said. "What's missing are data on real overall survival that would include patients who have radiation, develop a second cancer and die from it.”

The fact that radiotherapy seems to reduce early recurrences of Hodgkin's lymphoma "clearly tells us that some people benefit from it,” Dr. Little said. However, by the reviewers' own analysis, at least 11 people must be treated to save one. "The real challenge, I think, is to identify those who need radiotherapy, so we can more selectively administer it,” he said.

Ongoing clinical trials might reveal whether positron emission tomography (PET), an imaging modality that aims to differentiate malignant from healthy tissue, can help clinicians meet this challenge. "I'd advise patients to ask their doctors about these trials, or at least have a long, frank discussion about the risks of radiation,” before deciding on treatment, Dr. Little concluded.

Related Links:
University Hospital of Cologne
US National Cancer Institute

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58 (460.14785766602): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1227.1404266357): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

60 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

61 (!!!!! 1332.0446014404): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

62 (375.03242492676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

63 (!!!!! 3614.1872406006): 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

64 (!!!!! 2552.0324707031): SELECT fid FROM jos_deeppockets WHERE id=294733706 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733706 AND published='1' LIMIT 1

65 (65.088272094727): 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`

66 (438.92860412598): select jos_twitters.link from jos_twitters where cat=10

67 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

68 (154.97207641602): select jos_google_plus.link from jos_google_plus where cat=10

69 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

70 (131.84547424316): SELECT fid FROM jos_deeppockets WHERE id=294733706 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733706 AND published='1' LIMIT 1

71 (139.95170593262): 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`

72 (614.16625976562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (422.95455932617): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (39.100646972656): 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`

75 (!!!!! 1979.1126251221): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (258.9225769043): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (216.96090698242): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (426.05400085449): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (730.03768920898): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (591.03965759277): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 2772.0928192139): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (51.975250244141): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (51.975250244141): 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`

92 (716.9246673584): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (116.10984802246): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (267.02880859375): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (151.8726348877): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 1695.1560974121): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (63.896179199219): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (862.12158203125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

107 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

108 (184.05914306641): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 5496.0250854492): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 1435.9951019287): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

111 (401.97372436523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

112 (169.03877258301): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (710.01052856445): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (739.81285095215): 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

115 (523.09036254883): 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

116 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

117 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

118 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

119 (55.789947509766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

120 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

121 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

122 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

123 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

124 (415.08674621582): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 56154.012680054): 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

126 (!!!!! 3175.9738922119): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733706 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733706 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (109.91096496582): ( 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

128 (37.908554077148): ( 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

129 (42.915344238281): 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

130 (30.994415283203): 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

131 (49.114227294922): 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

132 (28.848648071289): 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

133 (27.894973754883): 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

134 (27.894973754883): 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

135 (30.040740966797): 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

136 (27.894973754883): 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

137 (485.89706420898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (396.0132598877): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (66.041946411133): SELECT name FROM jos_deeppockets WHERE id=213

140 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=213

141 (771.99935913086): 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

142 (705.95741271973): 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

143 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

144 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

145 (!!!!! 7659.912109375): TRUNCATE TABLE jos_trademed_module

146 (359.05838012695): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (117.77877807617): 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=294733706 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (!!!!! 1261.9495391846): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (208.13941955566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (!!!!! 3486.8717193604): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

151 (200.03318786621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

152 (!!!!! 2492.9046630859): 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

153 (610.8283996582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

154 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

155 (334.02442932129): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733706 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733706 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (200.98686218262): 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)

157 (45.061111450195): 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)

158 (386.95335388184): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (389.09912109375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

160 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733706 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733706 AND published='1' LIMIT 1

161 (342.13066101074): select jos_twitters.link from jos_twitters where cat=10

162 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

163 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

164 (188.82751464844): select jos_linkedin.link from jos_linkedin where cat=10

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