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Tumor Separation Surgery Plus High-Dose Stereotactic Radiosurgery Shown to Control Spine Metastases

By MedImaging International staff writers
Posted on 04 Feb 2013

Tumor “separation surgery” followed by high-dose hypofractionated stereotactic radiosurgery (SRS) or high-dose single-fraction SRS, has been found to be safe and effective in controlling spinal metastases regardless of the radiosensitivity of the specific tumor type that has invaded the spine. More...

This new research’s findings were published online January 22, 2013, ahead of print by Ilya Laufer, MD, and colleagues, published online in the Journal of Neurosurgery: Spine. The authors, from Memorial Sloan-Kettering Cancer Center (New York, NY, USA), reviewed and analyzed data in the charts of 186 patients who presented with epidural spinal cord compression caused by spinal metastases. All of these patients underwent tumor separation surgery to decompress the spinal cord and stabilize the spine sometime between 2002 and 2011.

During this procedure, the tumor was dissected away from the spinal cord—or separated—providing a space between the spinal dura and any remaining tumor. Dissimilar to conventional spinal tumor surgery, extensive tumor resection was not pursued to reduce surgical morbidity. The spine was also stabilized with screws and rods.

Within two to four weeks after surgery, stereotactic radiosurgery (SRS) was performed to deliver radiation to the remaining metastatic tumor without injuring the spinal cord. In 40 patients (21.5%), radiation was delivered in a single 24-Gray (Gy) dose to the tumor (high-dose single-fraction SRS). In 37 patients (19.9%) a median total dose of 27 Gy (range 24 to 30 Gy) was delivered in three fractions (high-dose hypofractionated SRS), and in 109 patients (58.6%) a median total dose of 30 Gy (range 18 to 36 Gy) was delivered in five or six fractions (low-dose hypofractionated SRS).

In their review and analysis, the authors identified the following: (1) Better local tumor control in patients who underwent high-dose hypofractionated SRS than in those who underwent low-dose hypofractionated SRS. (2) The one-year cumulative local progression rates were 4.1% in the high-dose group and 22.6% in the latter group. (3) The difference in tumor progression-free survival between these two groups was statistically significant. (4) In the group of patients who underwent single-fraction SRS, the one-year cumulative local progression rates were 9.0%.

There was no statistically significant difference in tumor progression-free survival between this group and the high-dose hypofractionated SRS group.

Other variables were assessed to determine their effect on local tumor control, particularly individual patient characteristics, radiosensitivity of the metastatic tumor to conventional radiation, response to preoperative radiotherapy, grade of spinal cord compression, and extent of spinal cord decompression. None of these variables considerably correlated with progression-free survival. This lack of correlation validated that the “tumor response to high-dose radiation is independent of these characteristics.”

Unlike conventional external beam radiation therapy, SRS delivers a far more focused beam of radiation to the tumor. This allows physicians to deliver large doses of radiation to diseased areas of the body and still protect surrounding healthy tissue from radiation’s effects. The authors noted that radiosensitive tumors can be treated successfully with lower radiation doses delivered by traditional external beam radiation therapy; radioresistant tumors, however, require large doses of radiation, which are best delivered by SRS. By first performing “separation surgery,” creating a space between the spine and the remaining tumor, the surgeons protect the spinal cord from the high levels of radiation required to treat radioresistant tumors.

The authors noted their reasoning behind treatment of metastatic spine tumors. Care “is palliative with the goal of improving or maintaining neurological function, achieving spine stability, relieving pain, and providing durable tumor control.” The goal, according to the investigators, is to make the patient as comfortable and neurologically functional as long as possible despite the presence of systemic disease. In this situation sometimes, less surgery is better.

According to coauthor Dr. Mark Bilsky, “The strategy of separation surgery followed by high-dose hypofractionated or single-fraction radiation has revolutionized our ability to provide meaningful palliation for this very complicated patient population with metastatic spine tumors. This limited surgery consisting of spinal cord decompression and posterior segmental fixation is well tolerated and can be performed with limited morbidity. Instead of attempting gross total resection followed by conventional external beam radiation, separation surgery followed by SRS provides excellent durable tumor control of residual vertebral body tumors and even large paraspinal tumors, while minimizing the extent of surgical intervention. The integration and wide availability of SRS as a postoperative adjuvant following separation surgery will help move treatment strategies for metastatic spine tumors to ultimately provide better palliation for these patients.”

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49 (159.02519226074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

50 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

51 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

52 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

53 (138.99803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

54 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

55 (488.0428314209): SELECT name FROM jos_deeppockets WHERE id=294744596 LIMIT 1

56 (411.9873046875): SELECT name FROM jos_deeppockets_archive WHERE id=294744596 LIMIT 1

57 (95.129013061523): 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'

58 (108.00361633301): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1054.048538208): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

60 (!!!!! 1892.08984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

61 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

62 (!!!!! 2170.8011627197): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

63 (119.92454528809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

64 (132.08389282227): 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 (483.03604125977): SELECT fid FROM jos_deeppockets WHERE id=294744596 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744596 AND published='1' LIMIT 1

66 (83.92333984375): 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 (80.82389831543): select jos_twitters.link from jos_twitters where cat=10

68 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

69 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

70 (33.855438232422): select jos_linkedin.link from jos_linkedin where cat=10

71 (59.127807617188): SELECT fid FROM jos_deeppockets WHERE id=294744596 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744596 AND published='1' LIMIT 1

72 (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`

73 (405.78842163086): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (221.96769714355): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (105.85784912109): 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 (138.99803161621): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (77.962875366211): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (62.942504882812): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (39.100646972656): 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 (83.92333984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 1147.985458374): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (142.09747314453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

108 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

109 (108.00361633301): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (184.77439880371): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (152.1110534668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

112 (668.04885864258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

113 (729.79927062988): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (501.87110900879): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (149.01161193848): 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=294744595 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (591.03965759277): 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=294744595 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

117 (812.05368041992): 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

118 (468.01567077637): 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

119 (!!!!! 1729.9652099609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

120 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

121 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

122 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

123 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

124 (250.10108947754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

125 (337.83912658691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

126 (172.13821411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

127 (442.9817199707): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

128 (!!!!! 61446.905136108): 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

129 (821.11358642578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744596 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744596 AND type='deeppockets_item' AND published='1' LIMIT 1

130 (!!!!! 22711.992263794): ( 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

131 (92.029571533203): ( 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

132 (104.18891906738): 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

133 (51.975250244141): 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

134 (80.82389831543): 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

135 (44.107437133789): 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

136 (625.1335144043): 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

137 (52.213668823242): 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

138 (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

139 (36.954879760742): 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

140 (!!!!! 2964.0197753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

141 (782.96661376953): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

142 (86.069107055664): SELECT name FROM jos_deeppockets WHERE id=211

143 (45.061111450195): SELECT name FROM jos_deeppockets WHERE id=211

144 (!!!!! 1018.0473327637): 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

145 (!!!!! 1450.0617980957): 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

146 (!!!!! 3996.1338043213): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

147 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

148 (!!!!! 20876.884460449): TRUNCATE TABLE jos_trademed_module

149 (!!!!! 4604.1011810303): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

150 (755.07164001465): 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=294744596 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

151 (468.01567077637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

152 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

153 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

154 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

155 (!!!!! 1727.1041870117): 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

156 (149.01161193848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

157 (!!!!! 2461.1949920654): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

158 (94.890594482422): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744596 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744596 AND type='deeppockets_item' AND published='1' LIMIT 1

159 (57.93571472168): 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=0 or channel_id is null)

160 (49.114227294922): 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=0 or channel_id is null)

161 (84.161758422852): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

162 (221.96769714355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

163 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744596 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744596 AND published='1' LIMIT 1

164 (69.856643676758): select jos_twitters.link from jos_twitters where cat=10

165 (44.107437133789): select jos_facebook.link from jos_facebook where cat=10

166 (48.87580871582): select jos_google_plus.link from jos_google_plus where cat=10

167 (49.114227294922): select jos_linkedin.link from jos_linkedin where cat=10

168 (!!!!! 1627.2068023682): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

169 (!!!!! 20776.987075806): insert into jos_banners_delta values (14615,'2025-08-19 12:14:05','216.73.216.0','view'),(14202,'2025-08-19 12:14:05','216.73.216.0','view'),(14203,'2025-08-19 12:14:05','216.73.216.0','view')

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