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Oropharyngeal Cancer Patients with HPV Have Better Response to Radiotherapy

By MedImaging International staff writers
Posted on 03 Oct 2012

Cancer researchers have found considerable differences in radiation-therapy response among patients with oropharyngeal cancer depending on whether they carry the human papillomavirus (HPV), a common sexually transmitted virus. These new findings could lead to more personalized radiation treatment regimens, which for many patients with HPV could be lessened and potentially less toxic.

HPV-related cancers of the oropharynx have steadily increased in recent years, according to the US National Cancer Institute (Bethesda, MD, USA), particularly among men. At the same time, the frequency of oropharyngeal cancers related to other causes, such as smoking or alcohol consumption, is declining. HPV is the most common sexually transmitted infection in the United States; it can spread through direct skin-to-skin contact during vaginal, anal, and oral sex.

The study, conducted by Dr. Allen Chen, associate professor at the University of California (UC), Davis (Sacramento, CA, USA) department of radiation oncology, examined patterns of tumor reduction during radiation treatment in two otherwise similar groups of patients with oropharyngeal cancer: those who tested positive for HPV and those who tested negative for the virus. None of the HPV patients in the study was a smoker, a leading risk factor for the disease. The study’s findings were published online September 25, 2012, in the Laryngoscope Journal.

Dr. Chen utilized computed tomography (CT) scans acquired during image-guided radiation therapy (IGRT) and endoscopy to capture three-dimensional (3D) images of the patients’ tumors and monitor their treatment progress. He discovered that within the first two weeks after beginning radiation, the gross tumor volume decreased by 33% in HPV-positive patients, whereas the volume decreased by only 10% in HPV-negative patients.

Dr. Chen noted that the findings reveal that HPV-positive patients have a more rapid and robust response to radiation treatments, confirming what clinicians have suspected for years. “These HPV-related tumors literally melt before your eyes,” he said. “It is very gratifying to tell patients early on during treatment that their tumors are responding so quickly. Most of them are pleasantly relieved to hear such news.”

The rapid rate of tumor regression did not continue, however, after the second week of radiation treatment, and by the end of the seven-week regimen, the total tumor shrinkage in both groups of patients was nearly the same. However, “the dramatic early response observed in the HPV-positive patients strongly implies that these tumors behave distinctly from a biological standpoint and could be approached as a separate disease process,” Dr. Chen said.

For instance, the findings suggest that treatment for HPV-positive cancer may not need to be as intensive for it to be effective, according to Dr. Chen, adding that a shorter, condensed treatment regimen would potentially lessen the side effects from radiation, which include sore throat, dry mouth, taste loss, and swallowing difficulties. “It is likely that treatment in the future will be individualized based on biomarkers present in the tumor, and HPV has the potential to do just that,” said Dr. Chen.

Dr. Chen reported that there is increasing evidence that HPV-positive patients who receive radiation treatments live longer and have higher cure rates. According to the NCI, 88% of the HPV-positive patients are still alive two years after their treatments, compared with 66% of the HPV-negative patients. “Given the impressive outcomes for patients with HPV-positive cancer using currently aggressive treatments, how to deintensify therapy while maintaining cure rates is definitely a hot topic right now,” said Dr. Chen.

Dr. Chen, in collaboration with colleagues, has recently launched a clinical trial of HPV-positive oropharyngeal cancer patients to evaluate outcomes when their radiation doses are reduced from seven weeks to either five or six, depending on their response to initial chemotherapy. This institutional trial, recently opened enrollment.

The current clinical trial also involves collection of oropharyngeal patient blood and tumor samples during treatment, so that researchers can precisely correlate HPV in these specimens with a patient’s rate of response to radiation therapy. The drastic increase in oropharyngeal cancers in recent years has been described as an “epidemic,” Dr. Chen said, caused in large part to the increasing prevalence of HPV. In the United States, more than half of cancers currently diagnosed in the oropharynx are linked to HPV-16, according to the National Cancer Institute. “Our trial was designed to help determine what the optimal treatment approach for these patients might be in the future,” he said.

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60 (!!!!! 1326.7993927002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

61 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

62 (164.98565673828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

63 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

64 (102.99682617188): 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

65 (528.09715270996): SELECT fid FROM jos_deeppockets WHERE id=294742778 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742778 AND published='1' LIMIT 1

66 (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`

67 (43.153762817383): select jos_twitters.link from jos_twitters where cat=10

68 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

69 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

70 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

71 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294742778 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742778 AND published='1' LIMIT 1

72 (34.093856811523): 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`

73 (412.94097900391): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (344.99168395996): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (66.995620727539): 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`

76 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (67.949295043945): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (35.04753112793): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (36.001205444336): 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`

93 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

108 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

109 (57.93571472168): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (48.87580871582): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

112 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

113 (70.095062255859): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (782.01293945312): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (780.10559082031): 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

116 (412.94097900391): 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

117 (156.87942504883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

118 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

119 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

120 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

121 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

122 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

123 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

124 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

125 (434.87548828125): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 26387.929916382): 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

127 (768.18466186523): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742778 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742778 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (!!!!! 10674.953460693): ( 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

129 (142.09747314453): ( 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

130 (107.0499420166): 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

131 (54.836273193359): 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

132 (95.129013061523): 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

133 (55.074691772461): 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

134 (464.91622924805): 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

135 (87.976455688477): 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

136 (74.863433837891): 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

137 (50.067901611328): 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

138 (636.10076904297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (517.12989807129): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (86.069107055664): SELECT name FROM jos_deeppockets WHERE id=211

141 (52.928924560547): SELECT name FROM jos_deeppockets WHERE id=211

142 (888.10920715332): 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

143 (849.00856018066): 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

144 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

145 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

146 (!!!!! 12073.993682861): TRUNCATE TABLE jos_trademed_module

147 (169.03877258301): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (118.97087097168): 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=294742778 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (673.05564880371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (!!!!! 1038.7897491455): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

152 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

153 (!!!!! 3057.9566955566): 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

154 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

155 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

156 (!!!!! 2804.9945831299): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742778 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742778 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (107.0499420166): 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)

158 (55.074691772461): 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)

159 (66.041946411133): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

161 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742778 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742778 AND published='1' LIMIT 1

162 (82.969665527344): select jos_twitters.link from jos_twitters where cat=10

163 (173.09188842773): select jos_facebook.link from jos_facebook where cat=10

164 (60.081481933594): select jos_google_plus.link from jos_google_plus where cat=10

165 (123.02398681641): select jos_linkedin.link from jos_linkedin where cat=10

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