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Higher-Dose Radiotherapy for Stage III Lung Cancer Patients Results in Inferior Survival

By MedImaging International staff writers
Posted on 14 Jun 2013

In a recent US randomized phase III clinical trial, high-dose (HD) radiotherapy compared with standard-dose (SD) radiotherapy (RT) with concurrent chemotherapy (CT) did not improve overall survival of patients with stage III non-small-cell lung cancer (NSCLC).

Of all the patients in the United States with lung cancer, the country’s leading cause of cancer death, 75%–80% of them have NSCLC, with 30%–40% of those being considered locally advanced (stage IIIA or IIIB). Although RT plus CT has been the standard of care for locally advanced NSCLC, more research has centered on the integration of appropriate CT drugs than on revisiting the 60-Gy RT dose established over 30 years ago.

Worries over local tumor progression rates near 85% following treatment for stage III NSCLC with CT in addition to traditional RT doses and research findings revealing increased median survival time tied to a 74-Gy RT dose led to the development of RTOG 0617 [Radiation Therapy Oncology Group clinical trial study number 0617], which sought to identify the optimal RT dose for the treatment of patients with locally advanced NSCLC. The trial also assessed the hypothesis that the addition of cetuximab, an agent that targets the epidermal growth factor receptor (EGFR) pathway and has radiation-sensitizing properties, to chemoradiation would lead to improved survival.

The trial randomized 464 patients with pathologically diagnosed unresectable stage IIIA or IIIB NSCLC to SD (60 Gy) or HD (74 Gy) arms. All patients received concurrent CT of weekly paclitaxel and carboplatin, as well as additional cycles of consolidation CT following combined CT and RT.

The Radiation Therapy Oncology Group (RTOG; Philadelphia, PA, USA) trial’s final findings on radiation dose were presented June 4, 2013, at the American Society of Clinical Oncology 2013 annual meeting, held in Chicago (IL, USA), by lead investigator Jeffrey D. Bradley, MD, a professor in radiation oncology, and chief of thoracic service at Washington University School of Medicine (St. Louis, MO, USA; http://wustl.edu). Median follow-up time of the trial’s 419 evaluable patients was 17.2 months, with a median survival time of 28.7 vs. 19.5 months and 18-month overall survival rates of 66.9% vs. 53.9% for the SD and HD arms, respectively. Local failure rates at 18 months similarly favored the SD over the HD arms. “In the setting of concurrent chemotherapy with daily radiation therapy for stage III lung cancer, these results definitively confirm that 60 Gray is superior to 74 Gray, with a clear detriment associated with the higher radiation dose,” concluded Dr. Bradley.

Although participants were stratified according to the RT technique used (three-dimensional [3D] vs. intensity- modulated RT [IMRT]), analysis of survival, patterns of failure, and physician-reported toxicity did not identify one technique to be better or worse than the other, according to Dr. Bradley. He pointed to two emerging research directions that benefit from the knowledge gained by the RTOG 0617 trial. “With the identification of a number of genetic driver mutations, targeted therapy is clearly the next phase of treatment for NSCLC,” clarified Dr. Bradley. RTOG 1306 is an example of a phase II study evaluating newly developed agents that block EGFR or anaplastic lymphoma kinase (ALK) mutations. “Patients will receive either a targeted agent for a few months followed by chemoradiation or chemoradiation alone, which represents the standard arm in RTOG 0617.”

A second research direction addresses how to improve RT in the setting of concurrent CT with the efficacy of the lower RT dose now confirmed. According to Bradley, efforts will focus on evaluating the use of adaptive RT, which involves changing the radiation treatment plan delivered to a patient during a course of RT. In RTOG 1106 protocol, for example, a patient on the experimental arm undergoes a PET scan after 20 RT treatments, and the RT plan is then refocused on the remaining tumor volume, with a higher dose per fraction given for the remaining 10 treatments.”

“These results stand as an excellent example of the importance of rigorously testing new radiotherapy strategies and of RTOG’s essential role in conducting clinical trials to provide the evidence to guide clinical care,” said Walter J. Curran, Jr. MD, RTOG group chair and executive director of the Winship Cancer Institute of Emory University (Atlanta, GA, USA).

Related Links:

Radiation Therapy Oncology Group
Washington University School of Medicine

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58 (!!!!! 5905.1513671875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

59 (!!!!! 14221.906661987): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

60 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

61 (!!!!! 4796.028137207): 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 (!!!!! 1276.969909668): SELECT fid FROM jos_deeppockets WHERE id=294746776 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746776 AND published='1' LIMIT 1

63 (686.8839263916): 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 (!!!!! 6819.0097808838): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 2695.0836181641): select jos_facebook.link from jos_facebook where cat=10

66 (108.95729064941): select jos_google_plus.link from jos_google_plus where cat=10

67 (45.061111450195): select jos_linkedin.link from jos_linkedin where cat=10

68 (92.983245849609): SELECT fid FROM jos_deeppockets WHERE id=294746776 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746776 AND published='1' LIMIT 1

69 (531.19659423828): 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 (846.86279296875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2855.0624847412): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (172.85346984863): 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 (!!!!! 4705.1906585693): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 3783.9412689209): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 6659.984588623): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 5252.8381347656): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (746.9654083252): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (617.02728271484): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (153.0647277832): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1608.8485717773): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (!!!!! 1332.9982757568): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (455.85632324219): 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 (!!!!! 1342.0581817627): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (80.108642578125): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 1467.9431915283): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (286.10229492188): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (90.122222900391): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (973.93989562988): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1814.1269683838): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (679.96978759766): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 1879.9304962158): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (70.810317993164): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (329.01763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4398.1075286865): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

105 (!!!!! 9279.9663543701): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

106 (!!!!! 5584.0015411377): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1837.0151519775): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2189.8746490479): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

109 (836.13395690918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

110 (!!!!! 1713.0374908447): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (830.88874816895): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (818.01414489746): 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 (!!!!! 1363.0390167236): 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 (!!!!! 5711.0786437988): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

115 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

116 (!!!!! 1739.0251159668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

117 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

118 (!!!!! 2896.0704803467): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

119 (!!!!! 1065.0157928467): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

120 (!!!!! 1988.8877868652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

121 (230.07392883301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

122 (!!!!! 3014.087677002): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 100004.91142273): 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 (!!!!! 1320.1236724854): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746776 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746776 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 31072.854995728): ( 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 (83.92333984375): ( 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 (284.19494628906): 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 (53.882598876953): 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 (!!!!! 1697.0634460449): 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 (66.041946411133): 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 (478.98292541504): 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 (62.942504882812): 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 (65.803527832031): 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 (52.928924560547): 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 (!!!!! 2346.0388183594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (931.0245513916): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (482.08236694336): SELECT name FROM jos_deeppockets WHERE id=211

138 (326.15661621094): SELECT name FROM jos_deeppockets WHERE id=211

139 (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

140 (!!!!! 1235.9619140625): 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 (!!!!! 2383.9473724365): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

142 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

143 (!!!!! 27732.133865356): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 5083.0841064453): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1196.1460113525): 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=294746776 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1059.0553283691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (355.00526428223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 5356.0733795166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

149 (!!!!! 3937.0059967041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

150 (!!!!! 2744.197845459): 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 (719.07043457031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

152 (125.88500976562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

153 (!!!!! 1180.1719665527): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746776 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746776 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (72.956085205078): 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 (53.167343139648): 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 (!!!!! 1767.8737640381): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3239.1548156738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

158 (344.99168395996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746776 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746776 AND published='1' LIMIT 1

159 (!!!!! 4416.9425964355): select jos_twitters.link from jos_twitters where cat=10

160 (255.82313537598): select jos_facebook.link from jos_facebook where cat=10

161 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

162 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

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