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Intraoperative Radiotherapy May Offer Faster, More Precise Treatment for Breast Cancer

By MedImaging International staff writers
Posted on 26 Apr 2011

Clinicians are currently utilizing a new treatment option for breast cancer that allows women to receive a full dose of radiation therapy during breast-conserving surgery.

Conventionally, women who opt to have a lumpectomy must first have surgery then undergo about six weeks of radiation. This schedule can be challenging for women who have busy schedules or do not have access to a center offering radiation therapy. In some instances, the demanding schedule causes women not to comply with the recommended course of treatment, increasing their risk for cancer recurrence. Intraoperative radiation therapy combines lumpectomy and the full course of radiation during a two and half hour operation.

"With this technique, the radiation oncologist will be in the operating room administering radiation to the tumor bed immediately following the surgeon's removal of the tumor," said William Small, Jr., MD, vice chairman radiation oncology at Northwestern Memorial Hospital and professor of radiation oncology at Northwestern University Feinberg School of Medicine (Chicago, IL, USA). "Instead of waiting a month to start the radiation therapy, it will take place immediately. A patient will wake up from surgery and have received the full amount of radiation therapy that is typically administered over six weeks."

Currently, a breast cancer patient first sees a surgeon to remove the tumor and then she is referred to a radiation oncologist for follow up radiotherapy. Intraoperative radiation therapy allows physicians to deliver radiotherapy at the time of surgery directly to the area where the cancer was removed. Using a system called IntraBeam, manufactured by Carl Zeiss (Oberkochen, Germany), the radiation oncologist is now able to be in the operating room with the surgical oncologist, delivering the entire dose of radiation during surgery. A large international randomized trial confirmed that delivering radiation at the time of lumpectomy was as effective in preventing breast cancer recurrence as whole breast radiation therapy in selected patients (WBRT).

Not all patients who choose lumpectomy comply with the recommended follow up treatment because of factors including time, costs, distance, and access to a treatment facility. Disregarding follow-up radiation after lumpectomy can increase the risk of cancer recurrence. Intraoperative radiation considerably decreases treatment time and allows women to complete radiation and surgery at the same time.

"By eliminating the geographic and time constraints of traditional radiotherapy, intraoperative radiation can make breast conservation surgery a realistic option for more women," said Kevin Bethke, MD, surgical oncologist at Northwestern Memorial and assistant professor of clinical surgery at the Feinberg School. "Active women with busy jobs can choose lumpectomy and comply with the recommended radiation therapy, but limit the impact the treatment has on their lives."

Combined with offering an expedited treatment schedule, intraoperative radiation therapy also has the potential for better cosmetic outcomes, including less scarring, and fewer side effects compared to those associated with WBRT. Skin reactions, including redness, rashes, and irritation, as well as more severe complications including fatigue, swelling, tissue stiffness, and scarring are sometimes associated with traditional radiation therapy.

While early findings indicate single-dose radiation is as effective as WBRT in limiting recurrence of breast cancer in selected patients, it is not an option for every breast cancer diagnosis. Currently, only women with early stage breast cancer are considered as candidates for intraoperative radiation therapy.

"This isn't a replacement for traditional breast cancer treatment, but for the right candidate it may be an attractive alternative," said Dr. Small. "This has potential to expand access to radiation therapy allowing more women to comply with the recommended course of treatment. Hopefully, with a more concise and convenient treatment available, a broader group of women will have the option to choose breast-conserving treatment options."

The physicians hope that by offering intraoperative radiation therapy, they can help their patients effectively treat their cancer, but also do so in a manner that minimizes its impact on their daily lives. "A cancer diagnosis can be extremely stressful for a patient, so it's important that treatment is not," noted Dr. Bethke. "With this new option, we're giving women a way to treat their disease while continuing to live a normal, active life."

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60 (!!!!! 6804.9430847168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

61 (!!!!! 3844.0227508545): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

62 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

63 (!!!!! 7572.8893280029): 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 (995.87440490723): SELECT fid FROM jos_deeppockets WHERE id=294734680 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734680 AND published='1' LIMIT 1

65 (822.06726074219): 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 (501.87110900879): select jos_twitters.link from jos_twitters where cat=10

67 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

68 (28.848648071289): select jos_google_plus.link from jos_google_plus where cat=10

69 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

70 (259.8762512207): SELECT fid FROM jos_deeppockets WHERE id=294734680 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734680 AND published='1' LIMIT 1

71 (39.815902709961): 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 (!!!!! 2996.9215393066): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (271.79718017578): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (46.014785766602): 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 (571.96617126465): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (219.10667419434): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (134.94491577148): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (199.79476928711): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (475.16822814941): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (609.8747253418): 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 (549.0779876709): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (174.04556274414): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (592.94700622559): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (525.95138549805): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1425.02784729): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 1940.9656524658): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

107 (!!!!! 1324.8920440674): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

108 (162.83988952637): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (817.06047058105): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 3633.975982666): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

111 (!!!!! 7938.8618469238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

112 (!!!!! 7910.9668731689): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 4856.1096191406): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 1179.9335479736): 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 (607.96737670898): 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 (388.14544677734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

117 (896.21543884277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

118 (876.90353393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

119 (172.13821411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

120 (!!!!! 1693.9640045166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

121 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

122 (340.93856811523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

123 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

124 (!!!!! 6775.1407623291): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 99973.917007446): 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 (957.01217651367): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734680 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734680 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (393.86749267578): ( 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 (64.13459777832): ( 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 (180.00602722168): 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 (329.97131347656): 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 (458.0020904541): 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 (46.968460083008): 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 (41.961669921875): 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 (524.04403686523): 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 (57.220458984375): 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 (42.915344238281): 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 (!!!!! 4792.9286956787): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (!!!!! 1632.9288482666): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (67.949295043945): SELECT name FROM jos_deeppockets WHERE id=213

140 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=213

141 (965.11840820312): 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 (!!!!! 1314.1632080078): 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 (!!!!! 2990.0074005127): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

144 (!!!!! 5290.0314331055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

145 (!!!!! 23688.077926636): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 6826.8775939941): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (144.95849609375): 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=294734680 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (933.17031860352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (946.044921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (243.18695068359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

151 (478.02925109863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

152 (!!!!! 2315.0444030762): 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 (653.98216247559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

154 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

155 (91.075897216797): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734680 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734680 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (159.02519226074): 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 (43.153762817383): 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 (250.10108947754): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (941.03813171387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

160 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734680 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734680 AND published='1' LIMIT 1

161 (460.14785766602): select jos_twitters.link from jos_twitters where cat=10

162 (52.928924560547): select jos_facebook.link from jos_facebook where cat=10

163 (269.88983154297): select jos_google_plus.link from jos_google_plus where cat=10

164 (48.160552978516): select jos_linkedin.link from jos_linkedin where cat=10

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