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27 Jul 2025 - 30 Jul 2025

AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

First Adaptive Radiotherapy Trial Initiated for Head and Neck Cancer Patients

By MedImaging International staff writers
Posted on 28 Feb 2012

Researchers have released initial findings from a first-of-its-kind clinical trial in adaptive radiotherapy (ART) for head and neck cancer. The trial, sponsored by the US National Cancer Institute (Bethesda, MD, USA), provides indications that ART may benefit patients with less technical problems than previously believed.

The findings of this trial were released online February 2012 in advance of publication in the International Journal of Radiation Oncology Biology Physics. Physicians commonly use radiotherapy to treat squamous cell carcinoma of the oropharynx. Current standard-of-care treatment is called intensity-modulated radiotherapy (IMRT). IMRT allows clinicians to “sculpt” radiation to fit the anatomy of individual patients. Although attractive, this technique has a major problem--it is based entirely on a computed (CT) or magnetic resonance imaging (MRI) scan taken before actual treatment begins. Because a typical course of radiation treatment for oropharynx cancer lasts six to seven weeks, standard IMRT cannot compensate for typical changes that take place in a patient’s body during this time, such as weight loss, shrinkage of tumor, or gradual movement of normal tissues. Recent work suggests that the inability of standard IMRT to keep up with these changes might lead to unanticipated toxicity, or potentially worse, missing of tumor.

For this new trial, which was conducted at the University of Texas M.D. Anderson Cancer Center (Houston, TX, USA), investigators began patients on standard IMRT. They then took CT scans while patients were lying in the radiation treatment room each day so they could track changes in tumor and normal tissues during the entire course of treatment. Through computerized techniques, the investigators adapted treatment if they noticed significant tumor or body changes that could affect quality of treatment. Most interestingly, the researchers found that most patients required only one or at most two adaptions of IMRT to maintain treatment quality.

“This is the first prospective clinical trial of its kind to gauge how ‘refitting’ of IMRT to a patient’s body actually impacts care for a patient who has head and neck cancer,” noted David Schwartz, MD, vice-chair of radiation medicine at the North Shore- Long Island Jewish (LIJ) Health System, associate professor at the Hofstra-North Shore Long Island Jewish LIJ School of Medicine (Hempstead, NY, USA), and a senior investigator at The Feinstein Institute for Medical Research (Manhasset, NY, USA).
“What most encouraged us was that ART appears effective with only one or two additional replans. This means that ART does not have to be overly burdensome or expensive to make a difference. This is something that is feasible, and could eventually make a real-world difference in many clinics. ART keeps radiation treatment tightly fitted to a patient’s body, almost as if it were being shrink-wrapped. It is as individualized as our current treatment can realistically be.”

Twenty-four patients enrolled onto this institutional review board approved trial; data for 22 of these patients were analyzed with at least 12 months follow-up. Treatment was initiated with a baseline IMRT plan, and computed tomography (CT) imaging was performed in the treatment room each day to map tumors and normal anatomy to assess need for ART replanning.

Primary site was base of tongue in 15 patients, tonsil in six patients, and glossopharyngeal sulcus in one patient. Twenty patients (9%) had American Joint Committee on Cancer (AJCC) stage IV disease. T stage distribution was two T1, 12 T2, three T3, and five T4. N stage distribution was one N0, two N1, five N2a, 12 N2b, and two N2c. Of the patients, 21 (95%) received systemic therapy.

All patients required at least one ART replan because of tumor and normal tissue changes; eight patients (36%) required a second ART replan. For the patients who required one adaptive replan, parotid salivary glands had shrunk by an average of 16% and tumors had shrunk by 5% by the time of the replan. For the patients who required a second adaptive replan, parotid glands and tumors had shrunk by 24% and 14%, respectively. Most ART replans were completed within one day.

With a 31-month median follow-up, there has been no primary site failure and one nodal relapse, yielding 100% local and 95% regional disease control at two years. Chronic toxicity and functional outcomes beyond one year remain favorable relative to published results for standard IMRT.

Related Links:
University of Texas M.D. Anderson Cancer Center
Hofstra-North Shore Long Island Jewish School of Medicine
Feinstein Institute for Medical Research

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58 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

59 (141.85905456543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

60 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

61 (128.98445129395): 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 (709.77210998535): SELECT fid FROM jos_deeppockets WHERE id=294739494 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739494 AND published='1' LIMIT 1

63 (425.10032653809): 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 (70.095062255859): select jos_twitters.link from jos_twitters where cat=10

65 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

66 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

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

68 (51.021575927734): SELECT fid FROM jos_deeppockets WHERE id=294739494 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739494 AND published='1' LIMIT 1

69 (46.968460083008): 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 (369.07196044922): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (303.03001403809): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (50.783157348633): 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 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (64.13459777832): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (53.882598876953): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (47.206878662109): 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 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

105 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

106 (82.969665527344): 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (72.956085205078): 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (93.221664428711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

109 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

110 (72.002410888672): 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (645.16067504883): 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (766.03889465332): 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 (568.86672973633): 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 (176.19132995605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

115 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

116 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

117 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

118 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

119 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

120 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

121 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

122 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 28364.896774292): 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 (694.03648376465): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739494 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739494 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 10181.903839111): ( 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 (123.02398681641): ( 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 (419.85511779785): 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 (64.849853515625): 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 (290.87066650391): 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 (91.075897216797): 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 (298.02322387695): 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 (53.167343139648): 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 (285.14862060547): 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 (54.836273193359): 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 (567.91305541992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (442.0280456543): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (285.14862060547): SELECT name FROM jos_deeppockets WHERE id=211

138 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=211

139 (751.01852416992): 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 (702.85797119141): 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 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

142 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

143 (!!!!! 10364.055633545): TRUNCATE TABLE jos_trademed_module

144 (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 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (77.009201049805): 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=294739494 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (586.03286743164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

149 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

150 (!!!!! 1311.0637664795): 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 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

152 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

153 (54.836273193359): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739494 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739494 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (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=211 or channel_id is null)

155 (32.186508178711): 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 (34.809112548828): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (250.81634521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

158 (93.221664428711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739494 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739494 AND published='1' LIMIT 1

159 (85.830688476562): select jos_twitters.link from jos_twitters where cat=10

160 (147.10426330566): select jos_facebook.link from jos_facebook where cat=10

161 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

162 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

163 (336.88545227051): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1208.0669403076): insert into jos_banners_delta values (14615,'2025-06-21 03:47:01','216.73.216.120','view'),(14202,'2025-06-21 03:47:01','216.73.216.120','view'),(14203,'2025-06-21 03:47:01','216.73.216.120','view')

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