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Proton Therapy Reduces Side Effects for Pediatric Head, Neck Cancer Patients

By MedImaging International staff writers
Posted on 09 Oct 2013

The precise targeting and careful dosing of radiation using proton therapy is beneficial in continuing efforts to reduce treatment side effects among head and neck cancer patients, according to a new study of pediatric patients.

The study’s findings were presented September 23, 2013, at the 55th annual meeting of the American Society for Radiation Oncology (ASTRO) conference, held in Atlanta, GA, USA. “Children are especially susceptible to the side effects of radiation therapy, and treating them for head and neck cancers poses an additional challenge due to the risk of radiation to developing tissues,” said the study’s lead author, Christine Hill-Kayser, MD, an assistant professor of radiation oncology in Perelman School of Medicine at the University of Pennsylvania’s (Philadelphia, USA) Abramson Cancer Center. “Our findings using proton therapy for these patients, however, show that side effects are milder than those which are typically seen among children undergoing conventional radiation. We hope that this will translate to mean fewer late effects as they survive their cancer.”

Although physicians have hypothesized about reduced toxicity and side effects with proton therapy because the modality spares most normal tissue from damage, clinical data on the new approach have not yet matured, particularly among pediatric cancer patients. The present study sought to shed more light on the issue by tracking a group of 25 patients, ranging in age from 1 to 21 years, all of whom received proton therapy at Penn Medicine’s Roberts Proton Therapy as part of their treatment for a range of head and neck cancers, including Ewing’s sarcoma, rhabdomyosarcoma, and salivary gland tumors. Treatment toxicity was evaluated weekly during proton treatment and every one to three months after that.

After a median of 13 months after treatment, 19 patients (76%) have no evidence of disease, three patients (12%) had developed local recurrence, and five (20%) had tumors that seemed to be stable. One patient died of their cancer. The investigators noted that these outcomes are typically similar to those that would be expected with more conventional X-ray therapy. More importantly, however, were the greatly reduced side effects seen in the study, compared to the prevalence seen among head and neck cancer patients undergoing radiotherapy. “The side-effects profile was really very mild, with basically no high-grade toxicity,” said Dr. Hill-Kayser, who conducted the study along with colleagues from both Penn Medicine and the Children’s Hospital of Philadelphia.

The most common side effects were fatigue and dermatitis. The researchers noted that while skin reactions are frequently observed during radiation treatment, this study seemed to indicate a somewhat greater reaction than expected when proton treatment was followed by specific chemotherapeutic agents, including actinomycin-d and doxorubicin, which can interact with radiation and cause radiation sensitivity. That finding helped the researcher to further customize their approach to minimize that side effect. “If we started those drugs right away after proton therapy, it seemed the dermatitis was worse,” Dr. Hill-Kayser said. “So we learned that after proton therapy, we wanted to hold those drugs and not give them for a month to six weeks, so the patient had time to recover from the skin toxicity before it got worse.”

Another typical side effect of radiation therapy—particularly among head and neck cancer patients—can be weight loss and nutritional problems, but those were also only found to be a slight concern for the patients in the current study. “It’s common to lose some weight during radiation treatment because the mouth and throat get inflamed, but we found that very few patients in our study lost more than 10% of their body weight during the course of treatment. We found that we could minimize that weight loss by using a gastrostomy tube to give tube feedings, but even when we didn't do that, the weight loss was manageable. This was likely the case because proton therapy allowed us to decrease the radiation dose to the mouth and throat compared to equivalent plans using X-ray therapy.”

Over one to three months, all of the study patients fully recovered from any acute side effects from the proton treatment. Dr. Hill-Kayser expects that this research will help to support the growing consensus that “pediatrics is one of the areas where proton therapy is going to provide a lot of benefit.”

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62 (567.91305541992): SELECT fid FROM jos_deeppockets WHERE id=294748574 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748574 AND published='1' LIMIT 1

63 (380.03921508789): 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 (57.93571472168): select jos_twitters.link from jos_twitters where cat=10

65 (38.14697265625): select jos_facebook.link from jos_facebook where cat=10

66 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

67 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

68 (39.100646972656): SELECT fid FROM jos_deeppockets WHERE id=294748574 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748574 AND published='1' LIMIT 1

69 (38.862228393555): 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 (329.01763916016): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (272.98927307129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 10486.125946045): 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 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.226043701172): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (28.133392333984): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.994415283203): 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 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): 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 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

105 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

106 (52.928924560547): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (45.061111450195): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

109 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

110 (47.922134399414): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (427.9613494873): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (560.99891662598): 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 (345.94535827637): 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 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

115 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

116 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

117 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

118 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

120 (245.09429931641): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 18923.044204712): 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

122 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

123 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

124 (445.84274291992): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748574 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748574 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 406894.92225647): ( 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 (106.0962677002): ( 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 (431.06079101562): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (65.803527832031): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (313.99726867676): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (194.07272338867): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (550.0316619873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (395.05958557129): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (266.07513427734): SELECT name FROM jos_deeppockets WHERE id=213

136 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=213

137 (663.99574279785): 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

138 (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

139 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

140 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

141 (!!!!! 9688.8542175293): TRUNCATE TABLE jos_trademed_module

142 (125.16975402832): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (61.03515625): 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=294748574 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (456.09474182129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (81.777572631836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

147 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

148 (!!!!! 1471.996307373): 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

149 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

150 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

151 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748574 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748574 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (44.822692871094): 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)

153 (40.054321289062): 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)

154 (55.074691772461): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

156 (65.803527832031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748574 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748574 AND published='1' LIMIT 1

157 (133.03756713867): select jos_twitters.link from jos_twitters where cat=10

158 (42.915344238281): select jos_facebook.link from jos_facebook where cat=10

159 (38.14697265625): select jos_google_plus.link from jos_google_plus where cat=10

160 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

161 (365.9725189209): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1598.8349914551): insert into jos_banners_delta values (14615,'2025-06-19 20:35:50','216.73.216.120','view'),(14202,'2025-06-19 20:35:50','216.73.216.120','view'),(14203,'2025-06-19 20:35:50','216.73.216.120','view')

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