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Lung Tumor Growth Rates Revealed by CT Screening

By MedImaging International staff writers
Posted on 11 Apr 2012

Growth rates of lung cancers identified by yearly rounds of computed tomography (CT) screening are vital for determining the usefulness and frequency of screening, as well as for determining the treatment. According to a recent report, lung cancers diagnosed in annual repeat rounds of CT screening are comparable--both in volume doubling time and cell-type distribution--to those found in clinical practice.

The International Early Lung Cancer Action Program (I-ELCAP; Temple, AZ, USA) report was published online March 29, 2012, in the journal Radiology. “There was concern that cancers diagnosed in the screening context were somehow different than cancers found in routine practice, that they were not aggressive,” said I-ELCAP principal investigator Claudia I. Henschke, MD, PhD, and professor of radiology at Mount Sinai School of Medicine (New York, NY, USA). “We demonstrate here that they are quite similar.”

The researchers reported that growth rates found in cancers detected in repeat rounds of annual CT screening are not significantly different from growth rates reported for cancers detected in clinical practice in the absence of screening. In addition, the frequencies of small-cell carcinoma and adenocarcinoma among all lung cancers have been reported to be approximately 20% and 50%, respectively, in the absence of screening. In repeat rounds of CT screening, these frequencies were nearly identical (19% and 50%).

Lung cancer is the leading cause of cancer death among men and women. The American Cancer Society estimates that in 2012, about 226,160 new cases of lung cancer will be diagnosed in the United States alone and 160,340 people will die from the disease.

CT screening has been found effective in detecting lung cancer at its earliest, most curable stage. “This study shows that the cell types of cancer diagnosed in annual rounds of screening, as well as their growth rates, are quite similar to those that are found in clinical practice where it is well understood that lung cancer is highly lethal,” Dr. Henschke said. The first, or baseline, round of screening for any cancer identifies a higher degree of slower-growing tumors than those detected in clinical practice, she noted. The subsequent, repeat rounds of screening, however, mirror what is found in clinical practice.

The study’s findings showed that there is a difference in the growth rates of tumors in solid and sub-solid lesions and that the sub-solid ones tend to be less aggressive than solid ones. “This suggests that a less aggressive approach is indicated for both diagnosis and treatment of sub-solid lesions,” Dr. Henschke said.

The researchers reviewed results from the I-ELCAP database for 1993 to 2009, consisting of men and women at risk for lung cancer who underwent annual repeat rounds of CT screening. The research team identified 111 instances of first primary lung cancer diagnosed either through screening or between rounds after a negative result of the earlier screening seven to 18 months earlier. Of the 111 tumors identified, 88 were clinical stage I. The investigators then assessed volume doubling time and cell-type distribution.

The findings revealed that the median volume doubling time was 98 days. Most of the tumors, 99 of the 111, manifested as solid nodules, whereas only 12 of the tumors manifested as subsolid nodules. Solid nodule cancers had considerably faster volume doubling times than subsolid nodule cancers. According to Dr. Henschke, identifying the volume doubling times for specific lesion types may lead to more tailored treatment for the patient.

Volume doubling times for lung tumors detected in clinical practice in the absence of screening have been reported to range from 20 to 360 days. A recent study, based on a systematic medical literature review, reported a mean volume doubling time of 135 days for non-small-cell lung cancers diagnosed in the absence of screening.

Dr. Henschke recommended that individuals at high risk for lung cancer talk with their physician to discuss the benefits and risks of screening so as to make an informed decision about enrolling in a screening program.

Related Links:
International Early Lung Cancer Action Program
Mount Sinai School of Medicine

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59 (!!!!! 13129.949569702): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

60 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

61 (!!!!! 1464.84375): 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 (!!!!! 1177.0725250244): SELECT fid FROM jos_deeppockets WHERE id=294740157 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740157 AND published='1' LIMIT 1

63 (229.83551025391): 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 (993.01338195801): select jos_twitters.link from jos_twitters where cat=10

65 (190.97328186035): select jos_facebook.link from jos_facebook where cat=10

66 (133.03756713867): select jos_google_plus.link from jos_google_plus where cat=10

67 (545.97854614258): select jos_linkedin.link from jos_linkedin where cat=10

68 (203.84788513184): SELECT fid FROM jos_deeppockets WHERE id=294740157 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740157 AND published='1' LIMIT 1

69 (169.03877258301): 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 (!!!!! 5386.1141204834): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (464.91622924805): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (55.074691772461): 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 (817.06047058105): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (509.97734069824): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (198.8410949707): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (193.11904907227): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (157.83309936523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (143.05114746094): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (247.00164794922): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (329.97131347656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (170.94612121582): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1724.0047454834): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (51.021575927734): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (205.03997802734): 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 (756.02531433105): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (252.00843811035): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (201.94053649902): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 1054.048538208): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (268.93615722656): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (359.05838012695): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (759.84001159668): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (91.075897216797): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (665.90309143066): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (458.95576477051): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (998.97384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

105 (!!!!! 1307.0106506348): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

106 (!!!!! 1404.0470123291): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1078.1288146973): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 8166.0747528076): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

109 (!!!!! 6824.9702453613): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

110 (!!!!! 8314.1326904297): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 7519.9604034424): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (828.98139953613): 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 (938.89236450195): 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 (646.82960510254): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

115 (163.07830810547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

116 (619.88830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

117 (483.03604125977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

118 (996.82807922363): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

119 (214.0998840332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

120 (553.13110351562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

121 (344.99168395996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

122 (!!!!! 1602.8881072998): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 43411.016464233): 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 (!!!!! 1100.0633239746): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740157 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740157 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (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

126 (39.100646972656): ( 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 (200.98686218262): 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 (219.10667419434): 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 (327.11029052734): 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 (145.91217041016): 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 (156.87942504883): 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 (139.95170593262): 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 (278.94973754883): 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 (35.04753112793): 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 (!!!!! 1556.8733215332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1228.0941009521): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (61.03515625): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 1024.9614715576): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1124.1436004639): 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 (688.79127502441): 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 (!!!!! 1116.0373687744): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

142 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

143 (!!!!! 21514.892578125): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6793.0221557617): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1042.1276092529): 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=294740157 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 9372.9496002197): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (508.06999206543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

149 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

150 (!!!!! 1791.0003662109): 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 (504.0168762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

152 (!!!!! 1372.8141784668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

153 (505.20896911621): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740157 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740157 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (358.10470581055): 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 (36.954879760742): 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 (646.11434936523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 7590.0554656982): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

158 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740157 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740157 AND published='1' LIMIT 1

159 (!!!!! 1353.9791107178): select jos_twitters.link from jos_twitters where cat=10

160 (154.01840209961): select jos_facebook.link from jos_facebook where cat=10

161 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

162 (945.09124755859): select jos_linkedin.link from jos_linkedin where cat=10

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