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High-Risk Endometrial Cancer Patients Helped with Radiotherapy and Concurrent Chemotherapy After Surgery

By MedImaging International staff writers
Posted on 15 Oct 2014

Radiation therapy administered with concurrent paclitaxel chemotherapy following surgery is an effective treatment for patients with high-risk endometrial cancer.

The findings were published September 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). Endometrial cancer is the most typical gynecologic malignancy. Patients with early-stage disease are typically treated with surgery alone; however, patients with advanced endometrial cancer have higher instances of local or distant recurrence. Concurrent radiation therapy and chemotherapy after surgery is used to reduce the rate of recurrence in patients with advanced disease. This study assessed the effectiveness and toxicity of concurrent chemoradiation with weekly paclitaxel in patients with stage III and IV endometrial cancer.

From January 2006 to March 2008, 57 patients from 20 institutions in Korea were included in the study. Patients eligible to participate in the study were between 20 and 80 years old, with a histologic diagnosis of International Federation of Gynecology and Obstetrics (FIGO) stage III or IV endometrioid adenocarcinoma with no history of prior surgery, radiation therapy, or hemotherapy for the treatment of other cancers.

Patients with diagnoses of other cancers or severe infection requiring parenteral antibiotics, with a history of cardiac arrhythmia, congestive heart failure or myocardial infarction within the previous six months, or with uncontrolled diabetes, infection, hypertension or compromised cardiac, renal, liver or bone marrow functions were not included in the study. Of the 57 patients in this study, 12 patients (21.1%) had FIGO stage IIIA disease, 40 (70.1%) had FIGO stage IIIC disease and five (8.8%) had FIGO stage IV disease. Fourteen patients (24.6%) had grade 1 tumors, 27 (47.3%) had grade 2 tumors, and 16 (28.1%) had grade 3 tumors. The average age of the study patients was 52.2 years old.

All eligible patients had a staging laparotomy, including total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and peritoneal washing cytology. Patients in the study received a total dose of 45.0–50.4 Gy of external pelvic radiation therapy (1.8–2.0 Gy daily, five times a week), and 60 mg/m2 of paclitaxel diluted in 500 m of 5% dextrose in water administered intravenously for three hours, once a week, for six weeks. Radiotherapy and chemotherapy were initiated within six weeks of surgery, and radiation therapy began either two days before or two days after the first chemotherapy treatment.

Chemotherapy was deferred due to adverse toxic effects in two patients. Of those two patients, one experienced septic shock, and one had persistent grade 4 neutropenia for more than two weeks. One patient refused treatment after enrollment, and two patients withdrew from treatment prior to completing all six cycles of chemotherapy. Fifty-two patients were included in the study’s final analysis.

Patients received follow-up for five years after surgery. Chest X-ray and abdominal-pelvic computed tomography (CT) or magnetic resonance imaging (MRI) scanning were done every six months for the first two years post-surgery and then yearly for the next three years. Patients were also assessed by pelvic examinations, monitoring CA125 blood serum levels and Papanicolaou tests every three months for the first two years post-surgery and then every six months for the next three years.

Severe toxicities observed during treatment were primarily hematologic toxicities. Of the 312 treatment cycles (52 patients each received six cycles), 52 episodes (16.7%) of grade 3 or 4 leukopenia (decrease in number of white blood cells) were observed, and 35 episodes (11.2 percent) of grade 3 or 4 neutropenia were observed. Hematologic toxicity caused 98 cycles to be delayed one week, and a paclitaxel dose reduction was required for eight patients (15.3%) who experienced persistent neutropenia for more than one week.

Disease recurrence occurred in 19 (36.5%) of the 52 patients in the final analysis. Eighteen patients (34.6%) experienced extrapelvic recurrence (lung, liver, bone, para-aortic, lymph node, or other sites). One patient (1.9%) had intrapelvic recurrence in the vaginal vault. The median time to the detection of recurrence was 12 months (range 3 to 24 months).

Survival data were available for all 52 patients included in the study. By the end of the five-year follow-up period, nine patients (17.3%) had died of endometrial cancer. For all patients included in the study, the five-year disease-free survival rate was 63.5 % (95% confidence interval [CI]), and the overall survival rate was 82.7% (95% CI).

“There is a lack of clear evidence on the best adjuvant treatment plan for patients with advanced endometrial cancer. There is growing evidence that chemotherapy should be administered to patients with advanced disease in addition to radiation therapy,” said Jae-Hoon Kim, MD, PhD, a coauthor of the study, head of the department of obstetrics and gynecology at Gangnam Severance Hospital (Seoul, South Korea), and a professor in the department of obstetrics and gynecology at Yonsei University College of Medicine (Seoul, South Korea). “This study shows that concomitant radiation therapy and weekly paclitaxel chemotherapy is a reasonable treatment option for patients with advanced endometrial cancer that can reduce toxicity and reduce pelvic recurrence. These favorable findings should be further evaluated in a larger, prospective, randomized, controlled study to validate this treatment approach.”

Related Links:
Gangnam Severance Hospital
Yonsei University College of Medicine

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56 (595.0927734375): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1683.9504241943): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

58 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

59 (129.93812561035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

60 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

61 (108.00361633301): 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 (565.0520324707): SELECT fid FROM jos_deeppockets WHERE id=294755105 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294755105 AND published='1' LIMIT 1

63 (447.03483581543): 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 (72.002410888672): select jos_twitters.link from jos_twitters where cat=10

65 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

66 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

67 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

68 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE id=294755105 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294755105 AND published='1' LIMIT 1

69 (50.067901611328): 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 (442.9817199707): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (350.9521484375): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (72.956085205078): 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 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (63.896179199219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (55.074691772461): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): 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 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (111.81831359863): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (133.99124145508): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (131.13021850586): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (270.84350585938): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (76.770782470703): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1358.0322265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

105 (526.90505981445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

106 (96.797943115234): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (82.015991210938): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1289.8445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

109 (267.02880859375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

110 (815.86837768555): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (853.06167602539): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (873.08883666992): 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 (711.91787719727): 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 (240.08750915527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

115 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

116 (140.19012451172): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

117 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

118 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

119 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

120 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

121 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

122 (392.91381835938): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 28976.917266846): 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 (817.06047058105): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755105 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755105 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9542.9420471191): ( 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 (171.89979553223): ( 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 (321.86508178711): 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 (37.908554077148): 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 (269.88983154297): 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 (55.074691772461): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (226.97448730469): 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 (36.001205444336): 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 (253.91578674316): 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 (47.922134399414): 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 (617.98095703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (588.17863464355): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (311.85150146484): SELECT name FROM jos_deeppockets WHERE id=211

138 (48.87580871582): SELECT name FROM jos_deeppockets WHERE id=211

139 (926.01776123047): 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 (767.94624328613): 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 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

142 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

143 (!!!!! 18248.081207275): TRUNCATE TABLE jos_trademed_module

144 (172.85346984863): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (87.02278137207): 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=294755105 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (949.14436340332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

149 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

150 (!!!!! 1552.8202056885): 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 (111.81831359863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

152 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

153 (71.048736572266): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294755105 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294755105 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (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)

155 (51.021575927734): 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 (57.93571472168): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (186.20491027832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

158 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294755105 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294755105 AND published='1' LIMIT 1

159 (122.7855682373): select jos_twitters.link from jos_twitters where cat=10

160 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

161 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

162 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

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