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Single Radiotherapy Session for Breast Cancer an Option to Daily Postop Treatments

By MedImaging International staff writers
Posted on 20 Nov 2013

Two new studies revealed that targeted radiotherapy delivered to women undergoing surgery for early breast cancer could offer an effective alternative to current procedures.

Most women who undergo partial mastectomy (lumpectomy) surgery for breast cancer also complete a course of radiotherapy delivered to the whole of the affected breast. EBRT has been shown to cut the risk of cancer recurring in the breast, but can cause disagreeable side effects, and requires women to attend radiotherapy centers for 20–30 days after surgery, which can cause problems for women who live far away from radiotherapy centers, especially those in very rural or remote areas. In some cases, women who are qualified for lumpectomy may end up undergoing full mastectomy, simply because they cannot meet the demands of ensuing radiotherapy treatment required by partial tissue removal.

Women who undergo lumpectomy are at risk of the cancer recurring, typically either at, or near, the site of the original tumor if they do not choose to have radiotherapy treatment. This has led several groups of researchers to assess whether a single dose of radiation, specifically targeted to the tumor area, and delivered during or right after surgery, might offer a practical alternative treatment to reduce the risk of recurrence. Two articles published November 11, 2013, in the Lancet and the Lancet Oncology revealed new findings from two trials evaluating two different methods of delivering targeted radiation in this way.

In the Lancet article, an international team of researchers led by Prof. Michael Baum and Prof. Jayant Vaidya, from the University College London (UK), explored the performance of TARGIT (where radiation is delivered to the tumor site using a miniature X-ray emitting device) compared with a standard EBRT course of daily doses for three to six weeks. Over 12 years, 1,721 women received the study treatment (TARGIT), compared to a control group of 1,730 women who received standard EBRT treatment. The TARGIT technique was originally developed by Prof. Michael Baum, Prof. Jayant Vaidya, and Prof. Jeffrey Tobias, and has been assessed in 33 different centers since 1998.

The 3,451 patients who participated in the final analysis were comprised from two separate strata, equivalent to two trials run in parallel. The first included 2,298 patients, 1,140 of whom received TARGIT at the same time of the initial surgery. These participants were compared with 1,158 patients receiving conventional EBRT. However, after receiving requests from some clinicians, they extended the trial to include 1,143 women, 562 of whom were allocated EBRT, and 581 of whom were assigned to receive TARGIT as a second procedure a median of 37 days after surgery (postpathology stratum).

The trial was intended to portray real-life practice as far as possible, so women who had received TARGIT at the time of surgery but were subsequently shown to carry high-risk features for recurrence also received EBRT. Overall, about 80% patients in the TARGIT group completed their surgery and radiotherapy under a single anesthetic agent, without needing any additional EBRT.

The researchers specified at the outset that if the difference in five-year local recurrence between the two treatments was less than 2.5% then TARGIT should be considered “non-inferior” (as good as) standard radiotherapy. Across all trial participants, the difference in five-year risk for cancer coming back in the breast (local recurrence) was within the originally set limit of 2.5%, meaning that a single TARGIT treatment was “non-inferior” to EBRT in controlling cancer. Furthermore, the overall mortality was 3.9% with TARGIT and 5.3% with EBRT, due to significantly fewer deaths from cardiovascular causes and other cancers. When TARGIT was given at the same time as lumpectomy, as the researchers originally planned, the local recurrence and breast cancer deaths were similar in the TARGIT and EBRT groups, and deaths from other causes were significantly reduced with TARGIT (1.3% for TARGIT vs. 4.4% for EBRT).

Researchers who authored the Lancet Oncology article led by Prof. Umberto Veronesi of the European Institute of Oncology (Milan, Italy; www.ieo.it), reported findings from a trial of a slightly different way of delivering targeted radiation using a device that generates electron radiation to the tumor site (electron intraoperative radiotherapy [ELIOT]). Six hundred and fifty-one women attending the European Institute of Oncology in Milan, Italy for early breast cancer treatment received ELIOT during lumpectomy surgery, and a control group of 654 women received standard EBRT after lumpectomy.

The researchers differentiated between true local recurrence of breast cancer, and recurrence of cancer in the same breast that had been operated on (ipsilateral recurrence). In both instances, after five years, recurrence was significantly higher in the ELIOT group than the control group: 21 women (2.5%) in the ELIOT group experienced local recurrence, rising to 35 women (4.4%) when any ipsilateral recurrence was included, compared to just four women (0.4%) in the control group who experienced any recurrence.

Overall survival at five years, in spite of the different rates of breast cancer recurrence, did not differ significantly between the ELIOT and control groups (34 deaths in ELIOT vs. 31 deaths in the control group); there were no substantial disparities between the number of deaths caused by breast cancer, or due to any other cause.

For the patients in the ELIOT group, the researchers examined the characteristics of tumors where relapse occurred, allowing them to identify several features tied to recurrence, including large tumor (> 2 cm), and estrogen-receptor negative (ER-negative).

Prof. David Azria and Dr. Claire Lemanski of the Institut du Cancer Montpellier (France), writing in an editorial comment on both studies, suggested that although it is clear that additional study will be needed to identify the patients least apt to experience recurrence of cancer after undergoing surgery and intraoperative radiotherapy, “The new data from TARGIT-A and ELIOT reinforce our conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at very low risk of local recurrence.”

Related Links:
University College London
European Institute of Oncology

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56 (438.92860412598): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1586.9140625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

58 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

59 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

60 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

61 (122.0703125): 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 (644.92225646973): SELECT fid FROM jos_deeppockets WHERE id=294749259 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294749259 AND published='1' LIMIT 1

63 (360.96572875977): 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 (53.882598876953): select jos_twitters.link from jos_twitters where cat=10

65 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

66 (38.862228393555): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE id=294749259 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294749259 AND published='1' LIMIT 1

69 (39.100646972656): 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 (359.05838012695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (282.04917907715): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (49.114227294922): 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 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (53.167343139648): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (37.908554077148): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.961669921875): 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 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

105 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

106 (70.095062255859): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (65.088272094727): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

109 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

110 (94.890594482422): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (596.04644775391): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (717.8783416748): 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 (441.07437133789): 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 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

115 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

116 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

117 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

118 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

119 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

120 (325.91819763184): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 27014.017105103): 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=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

123 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

124 (553.13110351562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749259 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749259 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 436397.07565308): ( 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 (72.956085205078): ( 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 = 294800513 LIMIT 1

128 (30.994415283203): 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 (46.014785766602): 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 (56.982040405273): 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 (47.922134399414): 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 (528.81240844727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (394.82116699219): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (281.09550476074): SELECT name FROM jos_deeppockets WHERE id=213

136 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=213

137 (466.10832214355): 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 (398.87428283691): 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 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

140 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

141 (!!!!! 16592.025756836): TRUNCATE TABLE jos_trademed_module

142 (644.92225646973): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (85.115432739258): 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=294749259 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (441.07437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (126.12342834473): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (585.79444885254): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

147 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

148 (!!!!! 1448.8697052002): 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 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

150 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

151 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749259 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749259 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (47.922134399414): 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 (40.769577026367): 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 (44.107437133789): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (155.92575073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

156 (567.91305541992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749259 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749259 AND published='1' LIMIT 1

157 (47.922134399414): select jos_twitters.link from jos_twitters where cat=10

158 (34.809112548828): select jos_facebook.link from jos_facebook where cat=10

159 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

160 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

161 (378.84712219238): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1482.9635620117): insert into jos_banners_delta values (14615,'2025-06-19 21:16:22','216.73.216.120','view'),(14202,'2025-06-19 21:16:22','216.73.216.120','view'),(14203,'2025-06-19 21:16:22','216.73.216.120','view')

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