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Proton Therapy for Early Stage Breast Cancer Less Expensive Than Various Alternative Radiotherapy Techniques

By MedImaging International staff writers
Posted on 10 Nov 2014

Patients with early stage breast cancer may benefit from accelerated partial breast irradiation (APBI) using proton therapy versus whole breast irradiation (WBI), in terms of duration of treatment and cost.

In a cost analysis study based on typical patient characteristics, researchers used Medicare reimbursement codes to analyze allowable charges for eight different types of partial and whole breast irradiation therapies and treatment schedules available to early stage breast cancer patients. Combined, these represent approximately 98% of the treatment alternatives available to these patients. The cost of proton therapy when used for APBI, introduced to decrease overall treatment time and toxicity, was estimated at USD 13,833. Comparatively, WBI using intensity-modulated radiation therapy (IMRT) resulted in the highest US Medicare charges at USD 19,599. The average charges across the eight treatment regimens were USD 12,784; thus, proton costs were similar to that of other types of radiation.

The findings were presented at the inaugural North America meeting of the Particle Therapy Cooperative Group (PTCOG) recently held at MD Anderson Proton Therapy Center (Houston, TX, USA). “It is often suggested that trials of proton APBI are irrelevant due to the modality's presumed high cost, but our data shows that this perception is false. Correcting this perpetual assumption is an important step in helping patients obtain the necessary health coverage to participate in clinical research,” said Valentina Ovalle, MD, postdoctoral research fellow and lead investigator. “Further, we anticipate that because charges vary proportionately across payers, the estimated Medicare reimbursement costs likely reflect relative charges to other third-party payers.”

Early breast cancer stage I or II is the most common invasive breast cancer in the US. With treatment, these patients generally have a good prognosis. Standard treatment approaches typically include breast-conserving surgery (BCS) followed by radiotherapy for the entire breast—five days per week, for up to six weeks, including one week of “boost” radiation to the area where the initial tumor was removed.

The role of APBI for early stage breast cancer is still being evaluated, but its intent is to deliver a highly effective dose of radiation while greatly reducing treatment time—10 treatments twice per day over one week. Furthermore, on average it spares at least two-thirds of breast tissue from a full dose of radiation. “The biggest drawback to WBI is that it is inconvenient, interrupting lives,” said Eric A. Strom, MD, FACR, study coauthor and professor in radiation oncology. Dr. Strom is lead investigator of a clinical trial sponsored by the US National Cancer Institute on proton APBI.

APBI is delivered via two approaches: brachytherapy and external beam. Proton therapy is offered as a type of external beam APBI, and according to Dr. Strom, is distinctive in its ability to provide the full dose of radiation precisely to the tumor site and nowhere else, eliminating radiation to the remaining breast, lung, and heart. To date, research on proton APBI has shown effective tumor control, limited side effects, and good cosmetic outcomes.

“This cost analysis must be interpreted in light of clinical evidence for proton APBI, which while still in nascent stages, is promising,” said Dr. Ovalle. “The findings counter the presumption that proton APBI is so expensive that even excellent clinical results would be immaterial. If the payment barrier for proton therapy is removed so that current and future research can proceed, the outcomes may ultimately benefit patients, physicians and insurers: better treatments at lower costs.”

Related Links:
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64 (643.96858215332): select jos_twitters.link from jos_twitters where cat=10

65 (212.9077911377): select jos_facebook.link from jos_facebook where cat=10

66 (558.13789367676): select jos_google_plus.link from jos_google_plus where cat=10

67 (241.99485778809): select jos_linkedin.link from jos_linkedin where cat=10

68 (262.02201843262): SELECT fid FROM jos_deeppockets WHERE id=294755614 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294755614 AND published='1' LIMIT 1

69 (301.12266540527): 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 (453.94897460938): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (550.98533630371): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (441.7896270752): 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 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (63.896179199219): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (24.080276489258): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (44.822692871094): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755614 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=294755614 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 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (23.841857910156): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (62.227249145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

105 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

106 (100.13580322266): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.014785766602): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (285.14862060547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

109 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

110 (93.936920166016): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (409.84153747559): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (617.98095703125): 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 (375.98609924316): 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 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

115 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

116 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

117 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

118 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

119 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

120 (328.06396484375): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 39879.083633423): 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 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

123 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

124 (468.96934509277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755614 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755614 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 526044.84558105): ( 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 (209.09309387207): ( 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 (232.93495178223): 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 (172.13821411133): 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 (224.11346435547): 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 (203.13262939453): 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 (205.99365234375): 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 (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

133 (458.95576477051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (683.78448486328): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (220.06034851074): SELECT name FROM jos_deeppockets WHERE id=213

136 (44.822692871094): SELECT name FROM jos_deeppockets WHERE id=213

137 (561.95259094238): 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 (588.89389038086): 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 (878.81088256836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

140 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

141 (!!!!! 22825.956344604): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 3545.0458526611): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (136.13700866699): 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=294755614 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (578.88031005859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

147 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

148 (!!!!! 1530.1704406738): 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 (!!!!! 2431.8695068359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

150 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

151 (72.956085205078): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755614 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755614 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (51.975250244141): 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 (42.200088500977): 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 (43.869018554688): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (180.00602722168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

156 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755614 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755614 AND published='1' LIMIT 1

157 (54.121017456055): select jos_twitters.link from jos_twitters where cat=10

158 (38.14697265625): select jos_facebook.link from jos_facebook where cat=10

159 (36.001205444336): 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 (414.13307189941): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 3031.0153961182): insert into jos_banners_delta values (14615,'2025-05-02 11:27:21','18.119.192.101','view'),(14202,'2025-05-02 11:27:21','18.119.192.101','view'),(14203,'2025-05-02 11:27:21','18.119.192.101','view')

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