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Studies Show Benefits of Radiotherapy for Patients with Early Stage Lung Cancer

By MedImaging International staff writers
Posted on 18 Oct 2011

New research findings demonstrated that patients with different types of early stage non-small-cell lung cancer (NSCLC) can benefit from treatment with stereotactic body radiosurgery (SBRT).

In a presentation on October 4, 2011, at the American Society of Radiation Oncology (ASTRO) 53rd annual meeting held in Miami, FL, USA, Frank Lagerwaard, MD, radiation oncologist at VU University Medical Center (Amsterdam, The Netherlands; www.vumc.com) reported that potentially operable patients with stage I NSCLC who were treated with stereotactic ablative radiotherapy (SABR), which is another term for SBRT, achieved comparable tumor control rates to those treated with the current surgical standard of care. Thirty-three percent of the patients in the study were treated with Varian Medical System’s (Palo Alto, CA, USA) RapidArc delivered on a Novalis TX linear accelerator from Varian and Brainlab, AG (Feldkirchen, Germany).

NSCLC is considered stage I when the tumor is small and has not spread to nearby lymph nodes or distant sites within the body. The standard of care is typically surgery that involves removal of a section of the affected lung. Complications of this kind of surgery can include chest wall pain, atrial fibrillation, wound infections, and pneumonia. “Based on the results of our analysis, SABR appears to be an important option to be considered by all patients presenting with early-stage lung cancer,” said Dr. Lagerwaard, lead study author. “These data also support ongoing randomized clinical trials comparing surgery and SABR in potentially operable stage I NSCLC.”

SABR involves treating the tumor with a targeted high-energy radiation beam. The radiation is intended to damage tumor cell DNA and kill the cancer cell. Complications of SABR in treating NSCLC may include radiation-induced pneumonitis, chest wall complications (pain, rib fractures, chest wall swelling), fatigue, cough, and difficulty breathing.

Dr. Lagerwaard and colleagues retrospectively reviewed records of lung cancer patients treated between 2003 and 2010 to find those who could have been surgical candidates, based on their tumor characteristics and overall health, but who instead received SABR. A total of 177 patients (101 males and 76 females) were evaluated in the study. Medical records demonstrated that at three years’ posttreatment, 93% of SABR-treated patients included in the study did not show local tumor regrowth. This is comparable to previously reported outcomes for patients who received surgery for treatment of NSCLC.

Median overall survival (OS) for the operable patients who received SABR was 61.5 months with one-, three- and five-year survival rates of 94.7%, 84.7 %, and 51.3%, respectively. Thirty-day mortality in patients who received SABR was 0%. This compared favorably to an earlier report by other researchers predicting that, for patients undergoing a lobectomy (removal of the affected lobe of the lung), 2.6% would have been predicted to die within 30 days (based on the Thorascore model, Falcoz PE, 2007).

Forty-two percent of patients in the study reported no early side effects with the SABR treatments. Those that did experience early side-effects experienced fatigue (25%), cough (14%), local chest wall pain (11%), and dyspnea (10%), with some patients reporting more than one side effect. Late side effects of SABR consisted of radiation pneumonitis for which medication was needed in 2% of patients and rib fractures in 3% of patients.

In another presentation, Jeffrey Bradley, MD, associate professor of radiation oncology at Washington University in St. Louis (MO, USA) summarized early results from a prospective phase I/II study to determine the optimal dose of stereotactic body radiotherapy (SBRT) for early-stage non-small-cell lung cancer (NSCLC) located in the central part of the lung, close to the bronchial tree (main airway). The study enrolled 24 patients with stage 1 NSCLC.

According to Dr. Bradley, an earlier study of SBRT for lung cancer did not differentiate between peripheral and central tumors. Patients with both types were enrolled in a prospective dose-escalation study that started by delivering three treatments of 8 Gy each and increased up to 24 Gy at each of three treatments. “From that experience, the investigators described excessive toxicity for tumors located within 2 cm of the proximal bronchial tree and warned of potential toxicity,” Dr. Bradley said. “Based on that report, we launched this prospective phase I/II study in an effort to help determine a viable treatment protocol for centrally located early-stage lung cancers. The Radiation Therapy Oncology Group [RTOG] followed along and also has a prospective dose escalation study ongoing for this population.” The RTOG is a US clinical cooperative group funded by the National Cancer Institute (Bethesda, MD, USA) to conduct cancer treatment research.

Each patient enrolled in Dr. Bradley’s study received five SBRT treatments. Five patients received a dose of 9 Gy units per treatment; six received 10 Gy each time; six received 11 Gy each time; and five received 12 Gy each time. The overall primary tumor control rate was 95.5%.

Sixteen of the 24 patients remain alive with a projected three-year overall survival rate of 45.7%, a projection that is based on the published data on this medically inoperable group. Treatment-related toxicities remained tolerable at doses up to 12 Gy, with only one patient developing a grade 3 pneumonitis. The trial will proceed to phase II to measure efficacy at a dose level of 5 x 11 Gy.

“To date, local tumor control has been excellent for the patients in this trial,” said Dr. Bradley. “This study, along with others, will help determine a viable SBRT treatment protocol for centrally-located early-stage lung cancer, which could provide a treatment option for patients with this inoperable disease.”

“The findings from these two studies show the importance of continuing to evaluate new treatments for lung cancer. Advancements in radiotherapy have the potential to help treat early-stage lung cancer without some of the complications of surgery, and they appear to offer inoperable patients a viable treatment option,” said Dow Wilson, Varian’s chief operating officer.

Varian’s high-energy linear accelerators, and the company’s RapidArc radiotherapy technology, are indicated to provide stereotactic radiosurgery and precision radiotherapy for lesions, tumors, and conditions anywhere in the body when radiation treatment is indicated. While clinical studies such as those highlighted here may support the effectiveness of Varian’s technology when used for radiotherapy or radiosurgery, individual results may vary.

Related Links:
VU University Medical Center
Varian Medical System
Washington University in St. Louis

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54 (100.85105895996): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

55 (369.07196044922): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (!!!!! 1303.9112091064): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 4555.9406280518): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

58 (!!!!! 1160.1448059082): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

59 (!!!!! 6448.9841461182): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

60 (!!!!! 2290.9641265869): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

61 (836.13395690918): 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 (!!!!! 2016.7827606201): SELECT fid FROM jos_deeppockets WHERE id=294737636 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737636 AND published='1' LIMIT 1

63 (563.8599395752): 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 (604.86793518066): select jos_twitters.link from jos_twitters where cat=10

65 (48.87580871582): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 1827.0015716553): select jos_google_plus.link from jos_google_plus where cat=10

67 (482.08236694336): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 2295.970916748): SELECT fid FROM jos_deeppockets WHERE id=294737636 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737636 AND published='1' LIMIT 1

69 (277.99606323242): 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 (!!!!! 4824.8767852783): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2974.0333557129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (62.942504882812): 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 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3435.8501434326): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (179.05235290527): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (69.141387939453): 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 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 3174.7817993164): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (98.228454589844): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3122.091293335): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

105 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

106 (102.04315185547): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (597.95379638672): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

109 (859.02214050293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

110 (!!!!! 7949.8291015625): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (893.83125305176): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1795.0534820557): 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 (677.82402038574): 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 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

115 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

116 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

117 (479.93659973145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

118 (823.02093505859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

119 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

120 (689.98336791992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

121 (!!!!! 1113.1763458252): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

122 (!!!!! 2053.97605896): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 52120.923995972): 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 (494.00329589844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737636 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737636 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (262.02201843262): ( 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 (46.014785766602): ( 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 (461.10153198242): 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 (50.067901611328): 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 (106.8115234375): 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 (275.85029602051): 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 (35.04753112793): 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 (30.994415283203): 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 (44.822692871094): 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 (43.153762817383): 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 (956.05850219727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 2944.9462890625): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (840.90232849121): SELECT name FROM jos_deeppockets WHERE id=211

138 (984.19189453125): SELECT name FROM jos_deeppockets WHERE id=211

139 (933.17031860352): 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 (986.09924316406): 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 (!!!!! 3895.9980010986): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

142 (!!!!! 8255.9585571289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

143 (!!!!! 15846.014022827): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3660.2020263672): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1701.831817627): 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=294737636 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3039.8368835449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (663.99574279785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

149 (553.13110351562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

150 (!!!!! 6032.9437255859): 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 (!!!!! 1162.052154541): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

152 (672.1019744873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

153 (!!!!! 3630.1612854004): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737636 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737636 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (56.028366088867): 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 (37.908554077148): 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 (!!!!! 3486.8717193604): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (470.87669372559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

158 (642.06123352051): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737636 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737636 AND published='1' LIMIT 1

159 (!!!!! 1595.9739685059): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 1548.0518341064): select jos_facebook.link from jos_facebook where cat=10

161 (543.11752319336): select jos_google_plus.link from jos_google_plus where cat=10

162 (49.114227294922): select jos_linkedin.link from jos_linkedin where cat=10

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