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In Patients with Early Breast Cancer, Intensity-Modulated Radiotherapy Reduces Side Effects

By MedImaging International staff writers
Posted on 16 May 2013

Intensity-modulated radiotherapy (IMRT) provides better results than
conventional radiotherapy in patients with early breast cancer, according to new findings.

The randomized trial findings were presented April 22, 2013, at the 2nd
Forum of the European Society for Radiotherapy and Oncology (ESTRO), held in Geneva (Switzerland). IMRT is an advanced, high-precision form of
radiotherapy that can deliver an even dose of radiation, thus reducing the cosmetic problems that can often occur after breast radiotherapy.

“We believe that this study, the largest prospective trial in the world to
test breast IMRT against standard two-dimensional radiotherapy, will be
practice-changing at an international level,” said Dr. Charlottes Coles, from Addenbrooke’s Hospital Oncology Center (Cambridge, UK) “Analyzing the results five years after treatment, we saw significant benefits in patients who had received IMRT.”

Researchers analyzed the radiotherapy treatment plans of 1,145 patients
with early breast cancer who had previously had breast-conserving surgery. The plans were screened to see if they would produce an uneven radiation dose with standard two-dimensional radiotherapy (2DRT). Seventy-one percent of the plans fell into this classification, and those patients were randomized between conventional 2DRT and IMRT. The 29% of patients whose plans would not produce an uneven dose were treated with standard 2DRT, but still followed up within the trial.

One of the objectives of external radiotherapy is to treat the target—in
this instance the whole breast—with an even dose distribution, i.e.,
within 95%–107% of the prescribed dose. Too low a dose can risk tumor recurrence, and too high a dose can cause undesirable side effects such as skin changes. The researchers tried to determine whether the effect of
using IMRT in those patients who would have received a dose greater than 107% to areas of their breast with 2DRT would translate into clinical benefit. IMRT planning uses results from scans to determine the dose intensity that will best treat the tumor, and therefore is more complex and time-consuming than 2DRT planning, so there was an important need to see a clear advantage to patients from the use of the procedure.

The only prior research looking at this was much smaller, and instead of
selecting all patients with doses greater than 107% and randomizing them, it only included women with larger breasts who are already known to be more likely to have regions of dose above the upper limit. “Our trial was more inclusive as all women were able to take part and we could quantify those who would receive an uneven dose,” said Dr. Coles. “We saw that fewer patients in the IMRT group developed skin telangiectasia, and the overall cosmetic effect in the breast was better,” she said. Although there was no significant difference between the two groups in breast edema, breast shrinkage, breast induration, and pigmentation alterations, the advantages of using IMRT in these patients were obvious. The researchers’ goal is to follow-up their research by studying the patients’ questionnaires to see whether IMRT has an influence on quality of life.

The trial has also contributed 1,000 blood samples to the UK translational
research RAPPER (Radiogenomics: Assessment of Polymorphisms for Predicting the Effects of Radiotherapy) study, which intends to eventually develop individualized radiotherapy plans based on the analysis of individual patients’ genetic composition.

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62 (302.07633972168): SELECT fid FROM jos_deeppockets WHERE id=294746265 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746265 AND published='1' LIMIT 1

63 (!!!!! 13983.011245728): 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 (!!!!! 7559.061050415): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 7830.1429748535): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 8039.9513244629): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7584.0950012207): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 7611.0363006592): SELECT fid FROM jos_deeppockets WHERE id=294746265 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746265 AND published='1' LIMIT 1

69 (!!!!! 4046.2017059326): 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 (!!!!! 1019.9546813965): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 5080.9383392334): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1312.0174407959): 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 (100.13580322266): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (573.15826416016): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (69.856643676758): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1593.8282012939): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (82.015991210938): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (59.843063354492): 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 (!!!!! 2084.9704742432): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (692.12913513184): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (166.89300537109): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (107.0499420166): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (!!!!! 3840.9233093262): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (216.00723266602): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (114.91775512695): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (165.93933105469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

105 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

106 (99.897384643555): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (80.82389831543): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (211.00044250488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

109 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

110 (68.902969360352): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (982.04612731934): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (590.08598327637): 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 (401.97372436523): 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 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

115 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

116 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

117 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

118 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

119 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

120 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

121 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

122 (386.95335388184): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 126280.0693512): 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 (!!!!! 7750.0343322754): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746265 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746265 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7972.9557037354): ( 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 (!!!!! 4585.0276947021): ( 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 (!!!!! 2321.9585418701): 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 (!!!!! 3664.0167236328): 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 (!!!!! 3998.0411529541): 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 (!!!!! 8067.1310424805): 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 (!!!!! 4705.1906585693): 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 (!!!!! 7951.021194458): 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 (!!!!! 1745.9392547607): 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 (!!!!! 4228.8303375244): 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 (!!!!! 3607.0346832275): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (941.99180603027): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (648.97537231445): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 1363.99269104): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 1785.9935760498): 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 (!!!!! 5733.0131530762): 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 (!!!!! 4745.0065612793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

142 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

143 (!!!!! 26696.20513916): TRUNCATE TABLE jos_trademed_module

144 (195.02639770508): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (79.154968261719): 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=294746265 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (437.02125549316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

149 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

150 (!!!!! 1314.1632080078): 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 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

152 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

153 (37.193298339844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746265 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746265 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (29.802322387695): 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 (26.941299438477): 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 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2840.9957885742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

158 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746265 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746265 AND published='1' LIMIT 1

159 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

160 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

161 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

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