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Stereotactic Body Radiotherapy Provides Sustained Local Control for Inoperable, Early Stage Lung Cancer Patients

By MedImaging International staff writers
Posted on 16 Nov 2014

A 10-year span of research has revealed excellent, sustained local tumor control findings with minimal side effects for medically inoperable, early stage lung cancer patients who received high-dose rate stereotactic body radiotherapy (SBRT).

The findings were derived from an analysis of data from an institutional patient registry on SBRT, and indicated excellent long-term, local control, 79% of tumors, for medically inoperable, early stage lung cancer patients treated with SBRT from 2003 to 2012, according to research presented at the 2014 Chicago (IL, USA) Multidisciplinary Symposium in Thoracic Oncology, held October 30-November 1, 2014. The symposium was sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), the International Association for the Study of Lung Cancer (IASLC), and The University of Chicago Medicine.

The 300 patients in the study had 340 lesions and were treated from October 1, 2003 through December 31, 2012, at the Cleveland Clinic, one of the early adopters of SBRT technology for lung cancer patients in the United States. Patients in the study had a median age of 74 years (range = 37–97 years), a median Karnofsky performance status (KPS) of 80 (range = 40–100), and were not suitable for surgery because of associated medical disorders, of which chronic obstructive pulmonary disease (COPD) was the most common (62%). Median follow-up was 17.4 months (range = 0.3–112.2 months), with 46.7% (140) patients alive at the time of follow-up. Median tumor diameter was 2.4 cm (range 0.1–10 cm), and 36.3% of tumors (123) had either no biopsy or a non-diagnostic biopsy. Fifteen percent of patients (45) received two or more SBRT treatments.

SBRT for lung cancer requires accurate and tailored mapping of each individual patient’s anatomy and a method of accounting for breathing motion to optimally target tumors while sparing as much of the neighboring healthy tissue as possible. All patients in the study were equally treated using a vacuum-bag immobilization system and abdominal compression to limit breathing effects. Then, CT images were acquired to record tumor motion when at rest, full inhalation and full exhalation. These three images merged together generated the internal target volume (ITV) of the tumors, essentially representing a virtual map of tumor motion. Radiation doses were calculated to deliver ≥ 95% of the planning target volume (PTV), defined as the ITV + 5 mm “safety” margin. All patients received 50 Gy in five fractions delivered during one week by seven to nine highly targeted radiation beams.

Early and late toxicity, as defined by the common terminology criteria for adverse events (CTCAE) version 3.0 was measured for all patients. The overall rate of any toxicity was 13.0% (45), with most patients having minimal toxicities (grade 2 or less) and no grade 4 or 5 toxicity events were recorded. The most typical incidents were chest wall toxicity, 7.7%, and pneumonitis (inflammation of the lung tissue), 4.1%. The toxicity rate for the 115 lesions classified as “central” tumors, according to the RTOG 0813 definition of “within or touching the zone of the proximal bronchial tree or adjacent to mediastinal or pericardial pleura,” vs. non-central tumors (225 lesions) was 15.5% (18 lesions) vs. 11.7% (27 lesions).

At five years post-treatment, local control was 79.0% vs. 75.4% for patients with central tumors vs non-central tumors, respectively. The distant metastases-free and disease failure-free rates were 49.5% vs. 56.7%, and 37.3% vs 34.3%, respectively. Overall survival was 18.3% vs. 20.3%, respectively. The failure rates of the central vs. non-central tumors utilizing all parameters had no statistically significant differences. Rates of local, lobar (within a whole lobe of the lung) and regional node failure for lesions were 11.2%, 4.1%, and 13.5%, respectively.

“We have been privileged in demonstrating that lung SBRT can now be considered the standard of care for medically inoperable patients with early stage lung cancer,” said Gregory M.M. Videtic, MD, lead study author, and a radiation oncologist at the Cleveland Clinic Foundation and associate professor of radiation oncology at the Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (Cleveland, OH, USA). “Since our results indicate no unusual long term side effects, we are hoping to extend the potential uses of this therapy to more-fit, operable lung cancer patients whose cancer has not spread outside of the lung and to collaborate with other institutions on conducting such a clinical trial. SBRT could provide a more minimally invasive procedure than surgery, with fewer side effects and improved patient outcomes.”

Related Links:
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University

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58 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

59 (136.8522644043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

60 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

61 (94.890594482422): 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 (511.88468933105): SELECT fid FROM jos_deeppockets WHERE id=294755718 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294755718 AND published='1' LIMIT 1

63 (318.76564025879): 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 (45.061111450195): select jos_twitters.link from jos_twitters where cat=10

65 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (48.160552978516): SELECT fid FROM jos_deeppockets WHERE id=294755718 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294755718 AND published='1' LIMIT 1

69 (32.901763916016): 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 (236.03439331055): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (201.94053649902): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (86.069107055664): 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 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (75.101852416992): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (240.80276489258): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (183.8207244873): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 3098.9646911621): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (59.843063354492): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.007995605469): 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 (!!!!! 1394.9871063232): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (147.10426330566): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3297.0905303955): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 3095.1499938965): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

105 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

106 (66.995620727539): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (64.849853515625): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

109 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

110 (54.121017456055): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (568.15147399902): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (581.97975158691): 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 (846.14753723145): 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 (380.9928894043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

115 (!!!!! 1322.9846954346): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

116 (460.14785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

117 (602.96058654785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

118 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

119 (200.03318786621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

120 (248.90899658203): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 83822.965621948): 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 (259.8762512207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

123 (504.97055053711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

124 (!!!!! 1264.8105621338): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755718 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755718 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 671519.99473572): ( 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 (!!!!! 542753.93486023): ( 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 (100.13580322266): 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 (45.061111450195): 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 (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

130 (42.200088500977): 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 (41.961669921875): 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 (36.954879760742): 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 (609.8747253418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (499.96376037598): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (300.16899108887): SELECT name FROM jos_deeppockets WHERE id=213

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

137 (628.94821166992): 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 (514.03045654297): 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 (!!!!! 1418.8289642334): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

140 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

141 (!!!!! 10387.897491455): TRUNCATE TABLE jos_trademed_module

142 (128.03077697754): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (791.07284545898): 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=294755718 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (477.07557678223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

147 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

148 (!!!!! 1459.1217041016): 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 (154.97207641602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

150 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

151 (492.09594726562): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755718 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755718 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (52.928924560547): 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 (43.869018554688): 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 (49.114227294922): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

156 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755718 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755718 AND published='1' LIMIT 1

157 (51.975250244141): select jos_twitters.link from jos_twitters where cat=10

158 (39.100646972656): 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 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

161 (324.01084899902): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1292.9439544678): insert into jos_banners_delta values (14615,'2025-05-02 10:55:38','3.22.66.60','view'),(14202,'2025-05-02 10:55:38','3.22.66.60','view'),(14203,'2025-05-02 10:55:38','3.22.66.60','view')

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