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Particle Beam Radiation Therapy Has Potential But Unproven for Treating Cancer

By MedImaging International staff writers
Posted on 21 Oct 2009

Particle beam radiation therapy, a technology used to treat several types of cancer, is considered by some clinicians to be superior to conventional radiation, but there is limited evidence about its safety compared with other types of radiation therapy, according to a new comparative effectiveness report.

The report was funded by the U.S. Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ; Rockville, MD, USA). "As technologies develop and new clinical interventions arise, it is important to balance access to potentially beneficial new technologies with ongoing research and evaluation to determine whether the technologies deliver what they promise,” said AHRQ director Carolyn M. Clancy, M.D. "Increased funding for comparative effectiveness research is an exciting opportunity to continue important research on medical therapies and interventions.”

Particle beam radiation therapy, also known as charged particle radiation therapy or proton beam-radiation therapy, utilizes beams of protons or other charged particles for cancer radiation treatment. Particle beam radiation therapy is an alternative to other types of cancer radiation therapy such as external radiotherapy with ionizing photon (X- or gamma-ray) beams or brachytherapy with implanted radioactive sources.

All types of radiation therapy can harm both cancerous and healthy tissues; therefore, clinicians strive to target the radiation to the cancer while avoiding adjacent healthy tissues. This is particularly important for tumors adjacent to vital body parts such as those in the eye, brain, head, and neck. Particle beam radiation therapy can target the radiation with a high level of precision, but its potential advantages over other radiotherapy alternatives have not been verified in long-term outcome studies, according to the new AHRQ technical brief.

Particle beam radiation therapy was introduced as an experimental treatment in the 1950s but was not cleared for widespread use by the U.S. Food and Drug Administration (FDA) until 2001. The technology is very expensive--an estimated US$175 million for each device--and is typically only available in large academic medical centers. Only seven centers in the United States currently provide the therapy, with an additional center currently under construction and expected to be operational by 2010. Although details have not been disclosed, several other hospitals are considering developing smaller treatment facilities based on upcoming technologies that have not yet been cleared by the FDA.

The technical brief did not indicate that particle beam radiation therapy is riskier than conventional radiation therapy. However, most studies about the therapy were conducted on small numbers of patients and did not compare the safety of particle beam radiation therapy against other therapies. For many cancers other than head and neck cancers, there are not enough comparative studies in the literature to base an evaluation of the clinical or cost effectiveness of particle beam radiation therapy compared with other treatments. AHRQ is currently reviewing scientific studies on radiation therapies for head and neck cancers that will evaluate the clinical effectiveness of particle beam radiation therapy for those cancers.

The report is the Agency's first in a series of technical briefs--rapid-turnaround reports that summarize key issues regarding emerging treatments. Technical briefs highlight where more research is needed and where research may be sufficient to warrant a full systematic review. Technical briefs are produced by AHRQ's Effective Health Care program. Future technical briefs will describe the evidence on fetal surgery, stereotactic surgery for non-brain-cancers, and percutaneous heart valves.

AHRQ's new report, Technical Brief: Particle Beam Radiation Therapies for Cancer, is the newest research review from the Agency's Effective Health Care program. That program represents an important federal effort to compare alternative treatments for health conditions and make the findings public. The program is intended to help patients, physicians, nurses, pharmacists, and others choose the most effective treatments.

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U.S. Agency for Healthcare Research and Quality

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62 (422.95455932617): SELECT fid FROM jos_deeppockets WHERE id=294726083 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726083 AND published='1' LIMIT 1

63 (65.088272094727): 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=211 ORDER BY `ordering`

64 (!!!!! 3149.9862670898): select jos_twitters.link from jos_twitters where cat=10

65 (96.08268737793): select jos_facebook.link from jos_facebook where cat=10

66 (65.803527832031): select jos_google_plus.link from jos_google_plus where cat=10

67 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

68 (76.055526733398): SELECT fid FROM jos_deeppockets WHERE id=294726083 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726083 AND published='1' LIMIT 1

69 (56.028366088867): 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=211 ORDER BY `ordering`

70 (377.89344787598): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (348.09112548828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (51.021575927734): 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 (79.154968261719): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (40.769577026367): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 4188.060760498): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (110.86463928223): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (66.041946411133): 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 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (!!!!! 4121.0651397705): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (112.77198791504): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (147.10426330566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

105 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

106 (89.883804321289): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (76.055526733398): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 4065.0367736816): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

109 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

110 (56.028366088867): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (602.00691223145): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (698.08959960938): 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 (674.00932312012): 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 (379.08554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

115 (329.01763916016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

116 (195.98007202148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

117 (150.91896057129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

118 (192.16537475586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

119 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

120 (174.99923706055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

121 (141.14379882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

122 (325.91819763184): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 73050.022125244): 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

124 (883.10241699219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726083 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726083 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (91.075897216797): ( 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 (51.975250244141): ( 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 (55.074691772461): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (48.160552978516): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (66.995620727539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (33.140182495117): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (560.04524230957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (356.91261291504): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=211

138 (30.994415283203): SELECT name FROM jos_deeppockets WHERE id=211

139 (676.87034606934): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (560.04524230957): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

142 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

143 (!!!!! 10207.891464233): TRUNCATE TABLE jos_trademed_module

144 (152.1110534668): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (67.949295043945): 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=294726083 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (600.81481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

149 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

150 (!!!!! 1419.0673828125): 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

151 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

152 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

153 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726083 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726083 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (36.001205444336): 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=211 or channel_id is null)

155 (34.809112548828): 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=211 or channel_id is null)

156 (53.167343139648): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

158 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726083 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726083 AND published='1' LIMIT 1

159 (39.815902709961): select jos_twitters.link from jos_twitters where cat=10

160 (34.809112548828): select jos_facebook.link from jos_facebook where cat=10

161 (74.148178100586): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

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