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Single-Fraction Radiotherapy for Palliation of Bone Metastases Improves Quality of Life

By MedImaging International staff writers
Posted on 25 Aug 2014

Standardizing prescribing protocols for single-fraction radiation therapy (SFRT) for palliation of bone metastases could lead to cost savings and improvement in bone cancer patients’ quality of life, according to recent research.

Bone metastases are a common manifestation of distant spread of disease, occurring most frequently in patients with prostate, breast, and lung cancers. More...

Of these, two-thirds develop bone metastases to the spine, pelvis, or extremities. Radiation therapy is an effective form of palliative treatment for bone metastases. There are more than 25 randomized, controlled trials demonstrating that SFRT provides the same amount of pain control as multiple-fraction radiation therapy (MFRT); however, there is low use internationally of SFRT for bone metastases.

This project is one of the largest, current studies on the use of SFRT. The study was designed to determine the use of SFRT in British Columbia, a publicly funded health care system where there is no financial incentive for extended fractionation and all radiation therapy is provided by the BC Cancer Agency with no direct cost to patients.

Patients who received palliative radiation therapy for bone metastases, regardless of the primary cancer site at diagnosis, from 2007 to 2011 were identified using the BC Cancer Agency’s Cancer Agency Information System (CAIS). During the study period, 8,601 patients received 16,898 courses of radiation therapy. Patients who received re-irradiation for bone metastases were included, and patients who received more than one course of radiation therapy were considered independently for each course (patients could be counted more than once). Radiation therapy fractionation was sorted into two categories: SFRT or MFRT. The most common primary disease site was breast (23.4%), and the most frequently treated bony metastatic site was the spine (42.2%).

SFRT was employed to treat bone metastases in 49.2% (7,097) of the radiation therapy regimens. SFRT was most typically used to treat bone metastases that originated from hematologic (56.6%) and prostate (56.1%) cancers; the most typical bony metastatic sites treated with SFRT were the ribs (83%) and extremities (66.4%).

There was a substantial variation in the use of SFRT by each of the five cancer centers run by the BC Cancer Agency during the time of the study, with a range of 25.5%–73.4% (p < 0.001). The findings demonstrated that the overall utilization rate of SFRT in British Columbia is 49.2%, a rate consistent with other Canadian and European data that reveal SFRT use ranges from 32%–64%t. SFRT use is much higher, however, than in the United States, where SFRT use ranges from only 3%–13%. The study findings were published August 1, 2014, in the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of the American Society for Radiation Oncology (ASTRO).

“Previous research has shown that single-fraction radiation therapy is equally as effective as longer multiple-fraction courses. Single-fraction radiation therapy offers greater convenience for patients, is associated with fewer side effects, and incurs a lower cost. Even a modest change in the frequency of single-fraction radiation therapy use, in Canada and America, could lead to meaningful cost-savings, improved patient convenience and reduced patient side effects, thereby increasing patients’ quality of life,” said Robert A. Olson, MD, MSc, lead author of the study, and the research and clinical trials lead and a radiation oncologist at the BC Cancer Agency Center for the North (Prince George, BC, Canada). “As a result of discussing our study outcomes among radiation oncologists in British Columbia, we have already seen an increase in the use of single-fraction radiation therapy for bone metastases. We are hopeful that these results will motivate practice change worldwide.”

Related Links:
BC Cancer Agency Center for the North

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59 (!!!!! 1669.16847229): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

60 (106.0962677002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

61 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

62 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

63 (124.93133544922): 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

64 (502.10952758789): SELECT fid FROM jos_deeppockets WHERE id=294754120 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754120 AND published='1' LIMIT 1

65 (371.93298339844): 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`

66 (87.976455688477): select jos_twitters.link from jos_twitters where cat=10

67 (45.7763671875): select jos_facebook.link from jos_facebook where cat=10

68 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

69 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

70 (52.928924560547): SELECT fid FROM jos_deeppockets WHERE id=294754120 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754120 AND published='1' LIMIT 1

71 (44.107437133789): 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`

72 (236.98806762695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (489.95018005371): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (81.062316894531): 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`

75 (63.180923461914): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (102.99682617188): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (!!!!! 2737.0452880859): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (114.91775512695): 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`

92 (!!!!! 4315.1378631592): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (118.97087097168): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

107 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

108 (90.837478637695): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (64.13459777832): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (183.10546875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

111 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

112 (87.976455688477): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (689.02969360352): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 4617.2142028809): 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

115 (!!!!! 1933.8130950928): 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 (618.93463134766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

117 (!!!!! 1666.0690307617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

118 (491.85752868652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

119 (155.92575073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

120 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

121 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

122 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

123 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

124 (!!!!! 1473.9036560059): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 96561.908721924): 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

126 (804.18586730957): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754120 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754120 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 11630.058288574): ( 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

128 (152.1110534668): ( 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 (82.969665527344): 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

130 (47.922134399414): 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 (86.784362792969): 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

132 (50.067901611328): 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 (530.00450134277): 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

134 (82.015991210938): 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 (69.141387939453): 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

136 (42.915344238281): 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 (617.98095703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (493.04962158203): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (425.81558227539): SELECT name FROM jos_deeppockets WHERE id=211

140 (58.889389038086): SELECT name FROM jos_deeppockets WHERE id=211

141 (857.83004760742): 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

142 (841.14074707031): 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 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

144 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

145 (!!!!! 11925.935745239): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 1922.1305847168): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (180.95970153809): 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=294754120 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (!!!!! 2446.8898773193): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

151 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

152 (!!!!! 2093.0767059326): 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

153 (121.11663818359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

154 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

155 (136.8522644043): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754120 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754120 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (54.836273193359): 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)

157 (46.968460083008): 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 (63.896179199219): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (!!!!! 1219.0341949463): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

160 (154.97207641602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754120 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754120 AND published='1' LIMIT 1

161 (96.08268737793): select jos_twitters.link from jos_twitters where cat=10

162 (51.975250244141): select jos_facebook.link from jos_facebook where cat=10

163 (!!!!! 1648.9028930664): select jos_google_plus.link from jos_google_plus where cat=10

164 (88.214874267578): select jos_linkedin.link from jos_linkedin where cat=10

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