text:
Radiation Oncology/Breast/DCIS

Ductal Carcinoma in Situ

Clinical Presentation

 * Ductal carcinoma in situ - by default not metastatic; up to 5% axillary LN+ probably due to undiagnosed invasive focus
 * Risk factors same as invasive BCA: FH, reproductive events, EtOH consumption

Imaging

 * Presenting abnormalities (Tabar, 1999):
 * microcalcifications 76%
 * asymmetric densities 10%
 * Size underestimated by 1-2cm compared to pathology

MRI
 * IRCIS Trial, France; 2019 (2010 - 2014) -- PMID 30811290 -- "Preoperative Breast Magnetic Resonance Imaging in Women With Local Ductal Carcinoma in Situ to Optimize Surgical Outcomes: Results From the Randomized Phase III Trial IRCIS." (Balleyguier C, J Clin Oncol. 2019 Apr 10;37(11):885-892. doi: 10.1200/JCO.18.00595. Epub 2019 Feb 27.)
 * Randomized. 360 patients, 10 hospitals. Biopsy-proven, microcalcifications or mass <30 mm. Arm 1) no MRI vs Arm 2) MRI
 * Outcome: Re-operation rate for close/positive margins MRI 20% vs control 27% (NS). Mastectomy rate 18% vs 17% (NS).
 * Conclusion: No sufficient surgical improvement to be clinically relevant

Pathology

 * 16-24 duct-lobular systems, culminating in collecting duct at the nipple; multiple lateral ductal anastomoses
 * Histologically very diverse, no easy way to grade, but typically 3 groups

Upstaging to Invasive Disease

 * Harvard; 2008 PMID 17891441 -- "Sentinel node biopsy is important in mastectomy for ductal carcinoma in situ." (Dominguez FJ, Ann Surg Oncol. 2008 Jan;15(1):268-73. Epub 2007 Sep 22.)
 * Retrospective. 179 patients, mastectomy with SLB for DCIS on initial biopsy.
 * Outcome: Size of DCIS were not recorded uniformly. Unsuspected invasive cancer in 11%; of these, 20% had SLN+. However, overall SLN+ in 11% (micromets 1%, ITCs 10%), suggesting 10% SLN+ (94% ITCs) in patients with DCIS only. Completion ALND in 3 patients, SLNB was the only positive node in all of them
 * Conclusion: 11% of DCIS patients had invasive disease; use of SLND allowed them to avoid axillary dissection

Natural history

 * Considered rare until 1980's, prior to advent of population-wide mammographic screening
 * Autopsy series show rates <1% - 13%
 * Cumulative lifetime risk: ~0.5%
 * Prevalence on screening mammograms: ~20%

Progression of DCIS into invasive cancer:
 * Cumulative progression rate after biopsy in 7 studies: 36%. Most occur within 10 years, but some >15 years
 * Development of invasive CA (10-year rates): after BCS only ~15%, after BCS+RT ~8%
 * Nurses' Health Study, 2005 - PMID 15770688 — "Outcome of patients with ductal carcinoma in situ untreated after diagnostic biopsy: results from the Nurses' Health Study." Collins LC et al. Cancer. 2005 May 1;103(9):1778-84.
 * 13 pts with DCIS later identified in breast biopsy originally thought benign. 6 pts developed invasive cancer (OR 13.5) and 10 pts developed either an invasive or in-situ lesion (OR was 20.1).

Mastectomy

 * Locoregional failure rate 4% or less, cancer specific mortality <4%
 * No randomized study comparing mastectomy with BCT

Surgical Margin

 * MDACC; 2013 (1996-2009) PMID 23975313 -- "Incidence and consequence of close margins in patients with ductal carcinoma-in situ treated with mastectomy: is further therapy warranted?" (Fitzsullivan E, Ann Surg Oncol. 2013 Dec;20(13):4103-12.)
 * Retrospective. 810 pts.
 * 94 pts with close margins (<3 mm), including 5 with positive margins, 54 with margins <= 1 mm, and 35 with margins > 1 mm.
 * 10-year LRR rate: 5.0% for margin <= 1mm, 3.6% for >1 and <3 mm, and 0.7% for >= 3 mm (SS).
 * Conclusion: "Close margins occur in a minority of patients undergoing mastectomy for DCIS and is the only independent risk factor for LRR. As the LRR rate in patients with close margins is low and less than the rate of contralateral breast cancer, PMRT is not warranted except for patients with multiple close/positive margins that cannot be surgically excised."

 * Harvard; 2012 (1998-2005) PMID 22975615 -- "Impact of Margin Status on Local Recurrence After Mastectomy for Ductal Carcinoma In Situ." (Childs SK, Int J Radiat Oncol Biol Phys. 2012 Sep 10.)
 * Retrospective. 142 pts underwent mastectomy without RT for pure DCIS (without microinvasion).
 * positive margin: 21 (15%). close margin (<= 2 mm): 23 (16%). Deep margin (close 14, positive 6). Superficial margin (close 13, positive 19).
 * Median f/u 7.6 yr.
 * Chest wall recurrence 2/142 (1.4%) -- 1/21 (4.8%) for positive margins, 1/23 (4.3%) for close margins, 0/98 for negative margins.
 * Conclusion: "Mastectomy for pure DCIS resulted in a low rate of local or distant recurrences. Even with positive or close mastectomy margins, the rates of chest wall recurrences were so low that PMRT is likely not warranted."

 * UC San Francisco; 2010 (1985-2005) PMID 20646871 -- "Is Radiation Indicated in Patients With Ductal Carcinoma In Situ and Close or Positive Mastectomy Margins?" (Chan LW, Int J Radiat Oncol Biol Phys. 2010 Jun 18. [Epub ahead of print])
 * Retrospective. 193 patients underwent mastectomy. DCIS median size 4.5 cm. Surgical margin: 55 close SM, 4 SM+. Median F/U 8 years
 * Outcome: Chest wall recurrence 1/59 close/positive SM (patient had 4 cm, G3 DCIS, SM 5 mm, skin-sparing mastectomy).
 * Conclusion: Risk of chest wall recurrence low for patients with margin <5 mm; not enough cases with positive margin

 * Southern California Permanente; 2008 (1994-2002) PMID 18954711 -- "Close or positive margins after mastectomy for DCIS: pattern of relapse and potential indications for radiotherapy." (Rashtian A, Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1016-20.)
 * Retrospective. 80 patients, DCIS treated with mastectomy without RT, with margins <10 mm. SM ≤2 in 39%, SM 2.1-10 61%. Median F/U 5 years
 * Outcome: Local recurrence 7%; if SM ≤ 2 mm 16% vs SM >2 mm 2% (SS). Of the 6 patients with LR, 5 had G3 DCIS and/or comedonecrosis. All were <60 years
 * Conclusion: Greater than expected local recurrence in patients with <2 mm margin, particularly if they have high grade disease or comedonecrosis

 * Swedish Cancer Institute, Seattle; 2007 (1990-2006) ASTRO Abstract -- "The Role of Adjuvant Radiotherapy After Mastectomy in Ductal Carcinoma In Situ, Breast" (Eulau SM, Abstract 2043, 2007)
 * Retrospective. 16 patients, mastectomy for DCIS, adjuvant RT. Average DCIS size 6.8 cm, positive or ≤ 1mm SM 7 patients, 1 mm SM 7 patients, ≥ 2 mm 2 patients (lesion size 10 and 15 cm). RT dose average 55.8 Gy (45 - 66.4). Median F/U 4.7 years
 * Outcome: LC 100%, DFS 100%, OS 100%
 * Toxicity: No lymphedema, decreased shoulder ROM 12%, chronic mild pain 12%. In 2 immediate reconstructions, both failed. In 2 delayed reconstruction, neither failed.
 * Conclusion: Excellent local control with RT despite close/positive margins and large lesions

 * Emory; 2007 PMID 17481544 -- "Local recurrence of ductal carcinoma in situ after skin-sparing mastectomy." (Carlson GW, J Am Coll Surg. 2007 May;204(5):1074-8; discussion 1078-80.)
 * Retrospective. 223 patients, DCIS treated with skin-sparing mastectomy and immediate reconstruction. No adjuvant RT. Mean F/U 6.9 years
 * Outcome: local recurrence 3.3%, regional recurrence 0.9%, distant recurrence 0.9%. If SM <1mm, local recurrence 10%. High grade also influenced LR
 * Conclusion: LR after skin-sparing mastectomy similar to total mastectomy. Re-excision of close SM should be performed and adjuvant RT should be considered

Wide excision alone

 * ECOG E-5194, 2009 (1997-2002)
 * 2009 PMID 19826126 "Local Excision Alone Without Irradiation for Ductal Carcinoma In Situ of the Breast: A Trial of the Eastern Cooperative Oncology Group." (Hughes LL, J Clin Oncol. published online ahead of print Oct 13 2009.)
 * Prospective, non-randomized. 670 pts. Low or intermediate grade DCIS 2.5 cm or less, or high grade DCIS 1 cm or less; surgical margins 3 mm or greater; no residual calcifications on postoperative mammography. Presence of comedo necrosis was categorized in the high grade group. Tamoxifen was allowed in those pts enrolled after 2000 (about 30% of pts received tamoxifen). Pathologic assessment was rigorous (sequential sectioning and complete embedding).
 * Median f/u 6.2 yrs(low-int;n=565) and 6.7 yrs(high grade;n=105). Median age 60; median tumor sizes 6mm (low/int grade) and 5mm (high grade). 5-yr ipsilateral breast events 6.1% (low/int) and 15.3% (high); 7-yr rate 10.5% (low/int) and 18.0% (high).
 * Conclusion: "Rigorously evaluated and selected patients with low- to intermediate-grade DCIS with margins 3 mm or wider had an acceptably low rate of ipsilateral breast events at 5 years after excision without irradiation. Patients with high-grade lesions had a much higher rate, suggesting that excision alone is inadequate treatment."
 * Comment: pathologic assessment included "complete sequential tissue processing". Their results may not be extrapolated to other centers using less rigorous pathologic assessment.
 * 10 year update ECOG 5194 (Solin SABCS 2012): 10 yr IBTR is is ~ 15% in both groups. http://cancerres.aacrjournals.org/content/71/24_Supplement/S4-6.short -- Median f/u 8.8 yr
 * 2015: 12 year PMID 26371148 -- "Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study." (Solin LJ, J Clin Oncol. 2015 Nov 20;33(33):3938-44.) -- Median f/u 12.3 yr
 * 12 yr rate of ipsilateral breast event (IBE) 14.4% (Cohort 1) and 24.6% (Cohort 2). Rate of invasive cancer: 7.5% and 13.4%.
 * Conclusion: "For patients with DCIS selected for favorable clinical and pathologic characteristics and treated with excision without radiation, the risks of developing an IBE and an invasive IBE increased through 12 years of follow-up, without plateau."

--8yr update LR 15.6%
 * Harvard, 2006 (1995-2002) - PMID 16461781 "Prospective study of wide excision alone for ductal carcinoma in situ of the breast." Wong JS et al. J Clin Oncol. 2006 Mar 1;24(7):1031-6.
 * Prospective, non-randomized. 158 pts. Pts with DCIS size <= 2.5 cm, grade 1-2. Necrosis allowed. Required wide excision with margins >= 1 cm. Tamoxifen not allowed.
 * Median f/u 40 mos. LR was 2.4%/yr, 5-yr rate of 12%. 69% of recurrences were DCIS and 31% were invasive cancer.
 * Conclusion: substantial risk of LRR with WLE without RT.

Surgical Margin

 * EBCTCG; 2010 (PMID 20956824)
 * 10-year IBTR (lumpectomy + RT): SM- 12% vs SM+ 24%
 * 10-year IBTR (lumpectomy alone): SM- 26% vs SM+ 44%
 * NSABP: 14 year IBTR (lumpectomy + RT): SM- 13% vs. SM+ 23%
 * MSKCC: 10 year IBTR (lumpectomy +/- RT): SM close 28% vs SM medium 21% vs SM wide 19%

Meta-Analysis
 * Dublin; 2009 PMID 19255332 -- "Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ." (Dunne C, J Clin Oncol. 2009 Apr 1;27(10):1615-20. Epub 2009 Mar 2.)
 * Meta-analysis. 4,660 patients, 22 trials evaluating BCS and RT.
 * Outcome: median time to IBTR 5 years. Recurrence 64% less if negative SM vs positive SM (OR 0.4, SS, using trial definition of negative margin, which ranged from no cells at ink to 10 mm). Margin thresholds for recurrence, ≥ 5-mm OR 1.0 vs 2-mm OR 1.5 (NS) vs 1-mm OR 2.9 (SS) vs no cells on ink OR 2.6 (SS).
 * Conclusion: Negative surgical margins should be obtained; 2mm margin a good cut-off

Studies
 * RAND Corporation; 2011 (1985-2000) PMID 21200025 -- "Comparative effectiveness of ductal carcinoma in situ management and the roles of margins and surgeons." (Dick AW, J Natl Cancer Inst. 2011 Jan 19;103(2):92-104. Epub 2011 Jan 3.)
 * Retrospective. 2 health systems: Monroe County, New York and Henry Ford Health System, Michigan. 994 women with DCIS, 50 treating surgeons. Evaluated surgical margin and treatments (BCS alone, BCS + RT, mastectomy), stratified by surgeon. Final SM positive 4.6%, close (≤ 2mm) 20.0%, negative 75.4%. Median F/U 5 years
 * Outcome: 5-year IBTR all ~6%, SM+ ~19%, SM close ~9%, SM negative 4% (SS). Surgeon performance accounted for 15-35% of 5-year IBTR and 13-30% of 10-year IBTR. 5-year DFS after mastectomy (99.3%), lumpectomy + RT (94.5%), and lumpectomy without RT (82.4%) significantly different by surgeon. IBTR risk: BCS no RT SM- 1.0; RT 0.25, BCS SM+ 3.4, SM close 1.4, mastectomy SM- 0.03, mastectomy SM close 0.4, mastectomy SM+ 2.0
 * Surgeon impact: If surgeon effect were improved to mean, IBTR reduction by 15%; if median, IBTR reduction by 22%, and if at 75th percentile, IBTR reduction by 31%
 * Conclusion: Positive SM large impact on IBTR, even for mastectomy and BCS with RT. Extent of surgeon variation and its contribution to long-term outcomes are troubling

 * Memorial Sloan Kettering; 2010 (1991-1995) PMID 20224381 -- "The influence of margin width and volume of disease near margin on benefit of radiation therapy for women with DCIS treated with breast-conserving therapy." (Rudloff U, Ann Surg. 2010 Apr;251(4):583-91.)
 * Retrospective. 194 patients, DCIS, excision alone or excision + RT
 * Outcome: IBTR 10-year 22%, 15-years 29%. By SM, <1mm 28% vs 1-9 mm 21% vs ≥ 10 mm 19%. RT reduced IBTR by 62% (SS), if <1mm by 83% vs 1-9 mm by 70% vs ≥ 10mm by 24% (NS). High volume disease near margin (margin width, number of involved ducts at closest margin) associated with increased risk of IBTR in no RT group, and greater proportional benefit of RT in RT group
 * Conclusion: Effect of RT on IBTR influenced by disease volume near margin

 * Institut Curie; 2009 PMID 19386441 -- "Ductal carcinoma in situ of the breast with close or focally involved margins following breast-conserving surgery: treatment with reexcision or radiotherapy with increased dosage." (Monteau A, Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):1021-8. Epub 2009 Apr 20.)
 * Retrospective. 208 women, DCIS, BCT with close (<2 mm) or involved margins. Re-excision 29% or RT + boost 71%. Median RT dose 67 Gy. Median F/U 7.4 years
 * Outcome: On re-excision, 56% residual DCIS and 6% residual IDC. 7-year LRF if re-excision 9.6% vs RT + boost 9.3% (NS)
 * Conclusion: In selected patients, re-excision may be avoided by increasing RT dose to tumor bed to at least 66 Gy

 * NSABP B-24 (Julian TB, ASCO Breast Cancer Symposium 2007) Abstract
 * Retrospective analysis. 1569/1799 patients analyzed, 692 (44%) received optional boost. Majority boost 10 Gy (1-20 Gy) after 50 Gy whole breast. Mean F/U 14 yrs
 * Outcome: IBTR SM- 13% vs. SM+ 23% (SS). By margin status, if SM- boost 13% vs no boost 13% (NS), if SM+ boost 21% vs. no boost 26% (NS). On multivariate analysis, boost not significant predictor for recurrence; while age, SM status, comedo necrosis were significant predictors
 * Conclusion: Surgical margin status significant predictor for recurrence

BCS +/- RT

 * 10-year local recurrence: 25-30% BCS alone vs. ~15% BCS + RT (~50% reduction)
 * Invasive recurrence: ~16% vs. ~8% (~50% reduction)
 * Non-invasive ~15% vs. ~8% (40-50% reduction)
 * Based on NSABP B-17 data, annual IBTR recurrence rate is ~4% per year with surgery alone (2% invasive and 2% noninvasive); adjuvant RT decreases it to ~2% per year
 * Based on 3 randomized trials (NSABP B-17, EORTC 10853, and UKCCCR), all subgroups (as analyzed by multivariate analysis looking at individual variables) benefit from RT. These data have not been analyzed for subgroups defined by several variables (such as <40 and intermediate grade and large size).
 * Some retrospectively-defined prognostic groups (such as Van Nuys, see Prognosis section below) suggest there are discrete patient groups that may have different outcomes, and may benefit from different treatments:
 * "Low risk" patients - RT does not offer much if any additional benefit over BCS alone. These patients could potentially be treated with BCS alone
 * "High risk" patients - while RT does offer significant benefit, the rate of recurrence is still unacceptably high. These patients should probably be treated with mastectomy
 * In clinical practice in US, ~30% DCIS patients are treated with BCS alone, ~40% are treated with BCS+RT, and ~30% are treated with mastectomy. These rates vary widely with geography
 * Unfortunately, there are no commonly accepted guidelines to help stratify patients

 * NSABP B-17 & B-24, Long Term; 2011 (1985-1994) PMID 21398619 -- "Long-Term Outcomes of Invasive Ipsilateral Breast Tumor Recurrences After Lumpectomy in NSABP B-17 and B-24 Randomized Clinical Trials for DCIS." (Wapnir IL, J Natl Cancer Inst. 2011 Mar 16;103(6):478-88. Epub 2011 Mar 11.)
 * Joint analysis of 2 trials. Median F/U B17 17.2 years and B-24 13.6 years
 * Outcome: Invasive breast ca 54% of recurrences. 15-year incidence of invasive IBTR for lumpectomy 19%, lumpectomy + RT (B-17) 8.9%, lumpectomy + RT (B-24) 10%, lumpectomy + RT + TAM (B-24) 8.5%. 15-year contralateral breast CA no TAM ~10% vs with TAM 7.3%. Invasive IBTR associated with 1.7x risk of death (SS), DCIS IBTR no difference in mortality risk. Incidence of breast CA death ~3% overall (lumpectomy only (B-17) 3.1%, lumpectomy + RT 4.7% (B-17), lumpectomy + RT 2.7% (B-24), lumpectomy + RT + TAM (B-24) 2.3%
 * Conclusion: Long-term prognosis remains excellent, invasive IBTR increases risk for BCA-related death

 * EBCTCG DCIS; 2010 PMID 20956824 -- "Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast." (Correa C, J Natl Cancer Inst Monogr. 2010;2010(41):162-77.)
 * Meta-analysis. Individual patient data for 4 randomized trials. 3729 women. 10-year data
 * Outcome: 10-year IBTR no RT 28% vs RT 13% (SS), benefit greater in women >50 (28% vs 11%) compared with women <50 (29% vs 18%), no difference based on any other factor. Women with small, low-grade tumors and negative SM still benefited (30% vs 12%, SS)
 * Outcome: No effect on BCA mortality (~4%), other-cause mortality (~5%), and all-cause mortality (~8%)

 * RTOG 98-04 -- RT vs. No RT
 * Randomized. Closed due to poor accrual.. "Good risk" DCIS, < 2.5 cm, margins > 3mm, grade I-II / III, necrosis in < 1/3 of the ducts. Arm 1) RT vs. Arm 2) no RT. Radiotherapy to the whole breast consists of a choice of 50.4 Gy in 1.8 Gy fractions, 50 Gy in 2 Gy, or 42.5 Gy in 16 fx. Tamoxifen at 20 mg qd x 5 yrs (choice of physician).
 * "J Clin Oncol 30, 2012 (suppl; abstr 1004)' -- RT vs. No RT" 98-04.  636 randomized. 1790 planned accrual.  2 LF in the RT arm vs. 15 in the OBS arm: at 5 years 0.4% RT vs. 3.2% OBS. TAM was used in 62% of women.  In this “good risk” subset of DCIS, the LF rate was decreased significantly with the addition of RT.
 * 7-years; 2015 PMID 25605856 -- "RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation." (McCormick B, J Clin Oncol. 2015 Mar 1;33(7):709-15). " LF rate was 0.9% (95% CI, 0.0% to 2.2%) in the RT arm versus 6.7% (95% CI, 3.2% to 9.6%) in the observation arm (hazard ratio, 0.11; 95% CI, 0.03 to 0.47; P < .001).

 * NSABP B-17
 * Randomized. 818 women with DCIS, SM-. Treated with lumpectomy or lumpectomy + RT 50Gy (no boost)
 * 5-years; 1993 PMID 8292119 -- "Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer." (Fisher B, N Engl J Med. 1993 Jun 3;328(22):1581-6.). Mean f/u 3.6 years
 * 5-year EFS: 74% vs. 84% (SS). Benefit due to reduction in 2nd ipsilateral BCA
 * 5-year IBTR: invasive 10.5% vs. 2.9%, noninvasive 10.4% to 7.5%
 * 8-years; 1998 PMID 9469327 -- "Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-17. (Fisher B, J Clin Oncol. 1998 Feb;16(2):441-52.) F/U 7.5 years
 * 8-year IBTR: invasive 13.4% vs. 3.9% (SS), noninvasive 13.4% vs. 8.2% (SS). All cohorts benefited.
 * 10-years; 2001 PMID 11498833 -- "Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the national surgical adjuvant breast and bowel project experience." (Fisher B, Semin Oncol. 2001 Aug;28(4):400-18.) Update on B-17 and B-24. F/U 12 years
 * 10-year IBTR: 30.8% vs. 14.9% (57% reduction); Invasive 16.4% to 7.1% (62% reduction)
 * No difference in distant recurrence or contralateral breast cancers.
 * MVA: Moderate/marked comedo necrosis and uncertain/positive margins predictive of IBT recurrence.
 * 12-years; 2005 PMID 15752884 -- "Cost-effectiveness of radiation therapy following conservative surgery for ductal carcinoma in situ of the breast." (Suh WW, Int J Radiat Oncol Biol Phys. 2005 Mar 15;61(4):1054-61.)
 * 12-year rates: invasive 18% vs. 8%, noninvasive 16% vs. 9%
 * RT incemental cost: overall $3300 (2002 Medicare schedule), initial $8700, due to higher LR salvage costs.
 * Incremental cost-effectiveness rate (ICER): $36,700 per QALY
 * Conclusion: should not withold RT because of cost-effectiveness
 * 15 years - see "NSABP B-17 & B-24, Long Term; 2011"
 * Criticisms: margins status criteria, no radiographic eval postop(silverstein)
 * Criticism by Fisher of VNPI: Has not been validated, can not be applied to B-17 because patients have tumors >=4.1cm. "The likelihood of identifying a single biological marker or combination of markers that can identify with precision the 13% of women with focal, mammographically detected DCIS who will develop an invasive breast cancer after lumectomy, let alone the small number (4%) [that will not], seems remote."

 * EORTC 10853 (1986-1996) -- RT vs. No RT
 * Randomized. 1010 women with DCIS. Size <=5cm. SM- (intraop evaluation of margins, re-excision if needed). Lumpectomy alone to lumpectomy + RT 50 Gy
 * 10-years; 2006 PMID 16801628 — "Breast-Conserving Treatment With or Without Radiotherapy in Ductal Carcinoma In Situ: Ten-Year Results of European Organisation for Research and Treatment of Cancer Randomized Phase III Trial 10853--A Study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group." (Bijker N, J Clin Oncol. 2006 Jul 20;24(21):3381-7.). Median F/U 10.5 yrs.
 * 10-year LR: 26% BCS alone vs 15% BCS+RT (SS), 47% reduction. All subgroups benefited.
 * 10-year LR: invasive 13% vs. 8% (SS), 42% reduction; DCIS 14% vs. 7% (SS), 48% reduction
 * Increased risk for LR: age <40, grade 2 or 3, cribiform or solid growth pattern, doubtful margin, and LE alone. Size not a prognostic factor
 * No difference in OS or distant mets
 * 2000 PMID 10683002 — "Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group." Julien JP et al. Lancet. 2000 Feb 12;355(9203):528-33. Median follow-up 4.25 years
 * 4 year LR-free rate: 84% BCS vs. 91% BCS + RT (SS). Invasive cancer reduced 8% to 4%, DCIS reduced 8% to 5% with RT
 * 4 year mets-free rate: 98% vs. 99%
 * Contralateral breast cancer 99% lumpectomy alone and 97% with RT (SS). * they did not elaborate on the use of their wedges but 4.5 years is too early to see RT induced breast cancer*

 * UKCCCR (1990-1998) -- Observation vs RT vs TAM vs RT + TAM
 * Randomized. 1701 women with DCIS. 2x2 factorial (921 randomized to fully 2x2, the remainder one way randomization to +/- RT or +/- TAM): BCS followed by 1) observation, 2) RT alone, 3) tamoxifen alone, or 4) RT + Tamoxifen. RT to 50 Gy, TAM 20mg qd x5 years
 * 5-years; 2003 PMID 12867108 -- "Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial." (Houghton J, Lancet. 2003 Jul 12;362(9378):95-102.). Mean F/U 4.4 years
 * Outcome: Breast events: OBS 22% vs. TAM alone 18% vs. RT alone 8% vs. TAM+RT 6%. Too few deaths for meaningful analysis.
 * RT: benefit for invasive IBTR (3% vs. 6%, HR 0.45), and benefit for ipsilateral DCIS (3% vs. 7%, HR 0.36), no impact on contralateral events. New breast events reduced 16% to 7% (SS)
 * Tamoxifen randomization: no impact on invasive IBTR (7% vs. 7%), no impact on ipsilateral DCIS (7% vs. 10%), benefit for bilateral DCIS (7% vs 11%, HR 0.68)
 * Subgoup analysis: No synergy between tamoxifen and RT. No benefit of tamoxifen differs from B-24 trial: authors suggest it may be due to differences in the patient population. In B-24 33.5% of patients were under 50 compared to only 9.5% in the UK/ANZ trial
 * Conclusion: RT can be recommended for DCIS, there is little evidence to recommend tamoxifen

 * Swedish DCIS Trial (1987-1999) -- RT vs No RT
 * Randomized. 1046 women, DCIS on sector resection, target clinical surgical margin 1 cm but microscopically negative SM not required; clinically N0. Arm 1) RT 50/25 vs Arm 2) no RT
 * 2008 PMID 18250350 -- "Absolute risk reductions for local recurrence after postoperative radiotherapy after sector resection for ductal carcinoma in situ of the breast." (Holmberg L, J Clin Oncol. 2008 Mar 10;26(8):1247-52. Epub 2008 Feb 4.)
 * Outcome: IBTR RT+ 12.1% vs RT- 27.1% (RR 0.4, SS), invasive recurrence ~50%. No difference in DMFS. Age effect: women <50 RR 0.7, age >50 RR ~0.3. No group defined by stratification variables that had low risk without RT
 * Conclusion: RT decreases risk by ~50%, though younger women have low protective effect and older women benefit substantially

BCS+RT Long-term outcomes

 * Multi-institutional PMID 15674853 -- "Long-term outcome after breast-conservation treatment with radiation for mammographically detected ductal carcinoma in situ of the breast." (Solin LJ, Cancer. 2005 Mar 15;103(6):1137-46.)
 * Retrospective. 1003 women with mammo-detected DCIS, treated with BCS+RT in 10 institutions. Median F/U 8.5 years
 * 15-year: OS 89%, cause-specific 98%, freedom from distant mets 97%, freedom from LR 81%
 * Multivariate predictors: age >50, negative final margin for better outcome (LR <8% vs. 19% overall)

Boost

 * No randomized trials published, 2 trials ongoing (TROG 07.01 and French BONBIS trial)

 * Multi-institutional; 2017 (1980-2010) PMID 28358936 -- "Association of Radiotherapy Boost for Ductal Carcinoma In Situ With Local Control After Whole-Breast Radiotherapy." (Moran MS, JAMA Oncol. 2017 Aug;3(8):1061-8)
 * Retrospective. 4131 pts. Pooled analysis from 10 institutions in USA,Canada,France. Minimum 5 yrs f/u.
 * Median f/u 9 yrs. Boost associated with lower IBTR (HR 0.73), improved IBTR-free survival 97.1% (boost) vs 96.3% (no boost) at 5 yrs, 94.1% vs 92.5% at 10 yrs, 91.6% vs 88.0% at 15 yrs.
 * Conclusion: RT boost confers a statistically significant benefit in decreasing IBTR across all DCIS age groups, similar to that seen in patients with invasive breast cancer

 * Toronto; 2013 (1994-2003) PMID 23708085 -- "Impact of boost radiation in the treatment of ductal carcinoma in situ: a population-based analysis." (Rakovitch E, Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):491-7. doi: 10.1016/j.ijrobp.2013.02.031.)
 * Retrospective. Ontario registry. 1895 patients with DCIS, treated by BCS and RT. 70% treated with hypofractionated regimens (40-44 Gy in 16 fxs). 561 received boost.
 * Outcome: 10-year LR boost 13% vs no boost 12% (NS); 10-year invasive LR 6% vs 7% (NS); DCIS 5% vs 7% (NS). No benefit to boost on MVA (HR 0.8, NS). No benefit for patients <45 as per Rare Cancer Network study
 * Conclusion: Radiation boost not associated with lower risk of local or invasive recurrence

 * McGill; 2012 (2000-2006) PMID 21664063 -- "Ductal carcinoma in situ--the influence of the radiotherapy boost on local control." (Wong P, Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e153-8.)
 * Retrospective. 220 pts, all treated with lumpectomy + RT. 36% received a boost.
 * Median f/u 46 mo. Pts in the boost group more frequently had positive margins or margins < 1 mm (48% vs 8%) and more frequently were in a higher risk Van Nuys Prognostic Index category.
 * Local recurrence: 0/79 (boost) vs 8/141 (no boost). The presence of necrosis significantly correlated with LR.
 * Conclusion: Our results suggest that the use of a radiotherapy boost improves local control in DCIS and may outweigh the poor prognostic effect of necrosis.

 * NSABP B-24 Abstract -- "Is boost therapy necessary in the treatment of DCIS" (Julian TB, ASCO Breast Cancer Symposium 2007, Abstract 146.)
 * Retrospective analysis. 1569/1799 patients analyzed, 692 (44%) received optional boost. Majority boost 10 Gy (1-20 Gy) after 50 Gy whole breast. Mean F/U 14 yrs
 * Subgroup characteristics: boost group more likely to have SM+ 46% vs. 37% (SS), or comedo necrosis 42% vs. 35% (SS)
 * Outcome: IBTR boost 14% vs. no boost 15% (NS). IBTR SM- 13% vs. SM+ 23% (SS). By margin status, if SM- boost 13% vs no boost 13% (NS), if SM+ boost 21% vs. no boost 26% (NS). On multivariate analysis, boost not significant predictor for recurrence; while age, SM status, comedo necrosis were significant predictors
 * Conclusion: Boost had no significant impact on recurrence

 * Rare Cancer Network (1978-2004) PMID 16887482 -- "Boost radiotherapy in young women with ductal carcinoma in situ: a multicentre, retrospective study of the Rare Cancer Network." (Omlin A, Lancet Oncol. 2006 Aug;7(8):652-6.)
 * Retrospective. 373 women age 45 or younger from 18 institutions. TisN0, <=45, BCS. 15% no RT, 45% RT 50 Gy, 40% RT 50 Gy + 10 Gy boost. Median F/U 6 years
 * LR rate: 15%, LR-free survival at 10 years: No RT 46% vs. 72% RT no boost vs. 86% RT boost (SS)
 * Predictors: age <40, margin, RT dose
 * Conclusion: consider boost in patients <=45 years
 * Comment: substantial proportion of patients unknown margin, grade, or size. 6 yr f/u but 10 yr results

Hypofractionation

 * University of Toronto; 2014 (1994-2003) PMID 25220719 -- "Long-term outcomes of hypofractionation versus conventional radiation therapy after breast-conserving surgery for ductal carcinoma in situ of the breast." (Lalani N, Int J Radiat Oncol Biol Phys. 2014 Dec 1;90(5):1017-24. doi: 10.1016/j.ijrobp.2014.07.026. Epub 2014 Sep 11.)
 * Retrospective. 1609 patients treated in Ontario. Conventional (50/25) in 60% vs hypofractionated (42.4/16) in 40%. Boost in 30% (15% of CF and 54% of HF). Median F/U 9.2 years
 * Outcome: 10-year LRFS CF 86% vs HF 89% (p=0.03), but not SS on multivariate analysis
 * Conclusion: Risk of local recurrence similar after hypofractionated or conventional radiation

 * Princess Margaret; 2010 (1999-2004) PMID 20400190 -- "Local control with conventional and hypofractionated adjuvant radiotherapy after breast-conserving surgery for ductal carcinoma in-situ." (Williamson D, Radiother Oncol. 2010 Jun;95(3):317-20. Epub 2010 Apr 17.)
 * Retrospective. 266 patients, conventional 50/25 (39%) or hypofractionated 42.4/16 or 40/16 + 12.5 Gy boost (61%) WBRT after BCS for DCIS. Median F/U 3.8 years
 * Outcome: 4-year recurrence conventional 6% vs hypo-fx 6.7% (NS). High grade increased risk of LR (11% for Gr3 vs 4% for Gr 1/2, SS)
 * Conclusion: Hypofractionated WBRT for DCIS has comparable local control, and should be considered in this patient group

APBI

 * Please also see the main Radiation Oncology/Breast/Partial breast irradiation page

 * American Society of Breast Surgeons; 2010 (2002-2004) PMID 20577822 -- "Update on DCIS Outcomes from the American Society of Breast Surgeons Accelerated Partial Breast Irradiation Registry Trial." (Jeruss JS, Ann Surg Oncol. 2010 Jun 25. [Epub ahead of print])
 * Registry trial. 194 patients, DCIS, MammoSite registry. Placement at lumpectomy 45%, post-lumpectomy 55%. SLN 26%. SM negative 88%, <2 mm 11%, positive 1%. Grade 3 37%. Median F/U 4.5 years
 * Outcome: IBTR 3.1%, breast/axilla recurrence 0.5%, 5-year local recurrence 3.4%
 * Toxicity: Seroma 24%, associated with lumpectomy placement. Favorable cosmesis 92% (minimum 5 year follow-up)
 * Conclusion: APBI via MammoSite well tolerated for patients with DCIS

BCS+RT +/- Tamoxifen

 * Benefit in B-24, no benefit in UKCCR until after long-term follow-up.

 * NSABP B-24
 * Randomized. 1804 women with DCIS ± LCIS (LCIS also present in ~5%), SM+ allowed (15%). Age <50 in 33%. Did not require tumors to be ER+. BCS + RT with or without tamoxifen. RT 50 Gy (no boost). TAM 20mg QD (noncompliance 31%).
 * 5-years; 1999 PMID 10376613 -- "Tamoxifen in treatment of intraductal breast cancer: National Surgical Adjuvant Breast and Bowel Project B-24 randomised controlled trial." (Fisher B, Lancet. 1999 Jun 12;353(9169):1993-2000.) Median F/U 6.2 years
 * 5-year BCA events: 13.4% vs tamoxifen 8.2% (SS), ipsilateral 9.5% vs. 6.0% (SS), contralateral 3.4% vs. 2.0% (SS)
 * 5-year invasive: 7.2% vs 4.1% (SS), ipsilateral 4.2% vs. 2.1% (SS), 2.3% vs. 1.8% (NS)
 * Younger patients (<50): IBTR placebo 16% vs. TAM 11%; older patients 6% vs. 5%
 * Conclude: Tamoxifen of benefit for further reduction of invasive breast cancer recurrences. There was no difference in regional or distant metastases.
 * Authors suggest that RT+tam concurrent is of benefit but a recent paper in JCO disputes this theory. (Ahn et al, JCO, 2005)
 * Use of ER; 2002 (No PMID) "Estrogen receptor expression as a predictive marker of the effectiveness of tamoxifen in the treatment of DCIS: findings from NSABP Protocol B-24." Allred DC et al. Breast Cancer Res Treat 2002;76(suppl):S36.
 * For findings, see commentaries at and.
 * Retrospective analysis. For DCIS with ER-, no benefit seen for tamoxifen.
 * 15 years - see "NSABP B-17 & B-24, Long Term; 2011"
 * Use of ER; 2012 No PMID yet Abstract -- "Adjuvant Tamoxifen Reduces Subsequent Breast Cancer in Women With Estrogen Receptor–Positive Ductal Carcinoma in Situ: A Study Based on NSABP Protocol B-24." (Allred DC, Online before print -- JCO March 5, 2012)
 * Retrospectively measured ER and PR in 732 pts (41%) at central lab and determined receptor status for an additional 283 pts (16%) at local institutions.
 * ER was + in 76% of pts. Pts with ER-positive DCIS treated with Tam showed significant decreases in subsequent breast cancer at 10 yrs (HR 0.49). Similar results were seen when ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit seen for ER-negative DCIS.
 * Conclusion: Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer.

 * UKCCCR (1990-1998) -- Observation vs RT vs TAM vs RT + TAM
 * Randomized. 1701 women with DCIS. 2x2 factorial (921 randomized to fully 2x2, the remainder one way randomization to +/- RT or +/- TAM): BCS followed by 1) observation, 2) RT alone, 3) tamoxifen alone, or 4) RT + Tamoxifen. RT to 50 Gy, TAM 20mg qd x5 years
 * 5-years; 2003 PMID 12867108 -- "Radiotherapy and tamoxifen in women with completely excised ductal carcinoma in situ of the breast in the UK, Australia, and New Zealand: randomised controlled trial." (Houghton J, Lancet. 2003 Jul 12;362(9378):95-102.). Mean F/U 4.4 years
 * Outcome: Breast events: OBS 22% vs. TAM alone 18% vs. RT alone 8% vs. TAM+RT 6%. Too few deaths for meaningful analysis.
 * RT: benefit for invasive IBTR (3% vs. 6%, HR 0.45), and benefit for ipsilateral DCIS (3% vs. 7%, HR 0.36), no impact on contralateral events. New breast events reduced 16% to 7% (SS)
 * Tamoxifen randomization: no impact on invasive IBTR (7% vs. 7%), no impact on ipsilateral DCIS (7% vs. 10%), benefit for bilateral DCIS (7% vs 11%, HR 0.68)
 * Subgoup analysis: No synergy between tamoxifen and RT. No benefit of tamoxifen differs from B-24 trial: authors suggest it may be due to differences in the patient population. In B-24 33.5% of patients were under 50 compared to only 9.5% in the UK/ANZ trial

 * 12.7 years; 2011 PMID 21145284 --"Effect of tamoxifen and radiotherapy in women with locally excised ductal carcinoma in situ: long-term results from the UK/ANZ DCIS trial." (Cuzick J, Lancet. 2011 Jan;12(1):21-9.). Mean F/U 12.7 years
 * Conclusion: RT can be recommended for DCIS, there is little evidence to recommend tamoxifen for prevention of ipsilateral invasive disease.

BCS+RT +/- Herceptin

 * NSABP B-43
 * Randomized, Phase III trial. 2,014 patients with DCIS, HER2+. Arm 1) BCS + RT vs Arm 2) BCS + RT + Trastuzumab
 * Initial results; 2021 PMID 33739848 -- "Comparison of Radiation With or Without Concurrent Trastuzumab for HER2-Positive Ductal Carcinoma In Situ Resected by Lumpectomy: A Phase III Clinical Trial", Cobleigh M, J Clin Oncol 2021 Jul 20;39(21):2367-2374. Median F/U 6.6
 * Outcome: IBTR in RT 6% vs RT+H 5% (HR 0.8, p=NS). Invasive IBTR 2% vs 2% (NS).
 * Conculsion: Modest but not significant 19% reduction in IBTR with Herceptin

Multi-focal DCIS

 * Toronto; 2007 (1982-2000) PMID 17984188 -- "Significance of multifocality in ductal carcinoma in situ: outcomes of women treated with breast-conserving therapy." (Rakovitch E, J Clin Oncol. 2007 Dec 10;25(35):5591-6. Epub 2007 Nov 5.)
 * Retrospective. 615 cases of DCIS (multifocal n=260, unifocal n=314, unreported n=31), treated with BCS alone (50%) or BCS+RT (50%); most RT 50/25, some 40/16
 * Outcome: local recurrence BCS alone 21% (50% invasive) vs. BCS+RT 9% (24% invasive); 10-year LRFR BCS alone 72% vs. BCS+RT 82%. Median time-to-recurrence BCS alone 4.3 years vs. BCS+RT 3.0 years
 * Multifocality: 10-year LRFR multifocal 59% vs. unifocal 80% (SS); but if treated with BCS+RT, no difference (80% vs. 87%, NS)
 * Conclusion: Multifocality significant predictor of local recurrence if BCS only; no difference if adjuvant RT used

Prognosis
Oncotype DCIS
 * University of Toronto; 2019 PMID 30190195 -- "Including the Ductal Carcinoma-In-Situ (DCIS) Score in the Development of a Multivariable Prediction Model for Recurrence After Excision of DCIS." (Paszat L, Clin Breast Cancer. 2019 Feb;19(1):35-46. doi: 10.1016/j.clbc.2018.07.018. Epub 2018 Jul 29.)
 * Retrospective. 1102 patients from Ontario. Models for LR developed: 1) clinicopathologic (CPF), 2) clinicopathologic + ER + HER2 status (CPF+receptors), 3) clinicopathologic + DCIS score (CPF+DS).
 * Outcome: Strongest prediction model CPF+DS (0.70) vs CPF+receptors (0.69) vs CPF (0.68). Better at calibrating low (<10%) LR at 10 years
 * Conclusion: Individual prediction of LR more accurate for low risk women to omit RT when incorporating DCIS score

Van Nuys Prognostic Classification (VNPI)

 * 2010 Update (-2009) PMID 20956828 -- "Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys Prognostic Index." (Silverstein MJ, J Natl Cancer Inst Monogr. 2010;2010(41):193-6.)
 * 949 pts with DCIS, 604 excision alone, 345 excision + RT. No hormonal therapy. Used the updated USC / Van Nuys scoring system (size, margin, DCIS classification, age) which gives scores 4-12. Goal is to update the treatment recommendations to achieve a LR risk of <20% at 12 yrs.
 * Outcomes: Median f/u 86 months (7.1 yrs). 165 local recurrences (103 - excision alone, 62 - RT).
 * 12-yr local recurrence: score 4-6, <= 6% (NS difference for RT vs no RT); score 10-12, >= 40% (for excision + RT);
 * Original treatment recommendations: excision alone for those who score 4-6; RT for those who score 7-9; mastectomy for those who score 10-12.
 * New treatment recommendations: to achieve a LR risk of <20% at 12 yrs.

 * 2003 Update PMID 14682107 -- "An argument against routine use of radiotherapy for ductal carcinoma in situ." (Silverstein MJ, Oncology (Williston Park). 2003 Nov;17(11):1511-33; discussion 1533-4, 1539, 1542 passim.)
 * 706 patients with DCIS, 426 excision alone, 280 excision + RT.

VNPI Treatment guidelines :
 * 4-6 points: BCS alone
 * 7-9 points: BCS + RT
 * 10-12 points: Mastectomy

 * 1999 Subsequent report on margins: PMID 10320383 Full text, 1999 (1979-1998) — "The influence of margin width on local control of ductal carcinoma in situ of the breast." Silverstein MJ et al. N Engl J Med. 1999 May 13;340(19):1455-61.
 * Retrospective. 469 pts. Pts treated until 1989 received post-op RT and those treated after 1989 did not. RT was 40-50 Gy to whole breast + 16-20 Gy boost. Tumors were assessed for histologic subtype, nuclear grade, comedonecrosis, maximal diameter, and margin width. Margins were classified as close or involved (<1 mm), intermediate (1 to <10 mm), or wide.
 * RT decreased the recurrence rate for close or involved margins; for intermediate or wide margins, was not statistically different.
 * Conclusion: RT is not necessary for margins > 10 mm.

 * 1996 First report PMID 8635094 — "A prognostic index for ductal carcinoma in situ of the breast." Silverstein MJ et al (and Lewinsky BS). Cancer. 1996 Jun 1;77(11):2267-74.
 * Came up with Van Nuys Prognostic Index (VNPI). Combines tumor size, margin width, histologic classification. Score 1-3 for each to arrive at a total score of 3-9.
 * Evaluated 333 pts treated with excision alone or excision + RT.
 * For pts with VNPI score of 3-4, excellent recurrence free survival (100% vs 97%) whether or not RT was used. For VNPI scores of 5-7, there was a 17% decrease (85% vs 68%) in RFS when RT was used. For score of 8-9, recurrence rate > 60% despite RT.
 * Conclusion: recommend excision alone for score of 3-4, excision + RT for score of 5-7, and mastectomy for 8-9.

For older VPNI versions, please see the DCIS Van Nuys section

Alternative
 * PMID 16750316 -- "Rationalization and regionalization of treatment for ductal carcinoma in situ of the breast." (Smith GL, Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1397-403.) Used classification below for cohort study:

 * Low risk: 0
 * Intermediate risk: 1-2
 * High risk: 3-6

Guidelines

 * NIH State-of-the-Science
 * 2009 Web Page Statement
 * 2009 PMID 19784089 -- "NIH state-of-the-science conference statement: diagnosis and management of ductal carcinoma in situ (DCIS)." (Allegra CJ, NIH Consens State Sci Statements. 2009 Sep 24;26(2):1-27.)

title: Radiation Oncology/Breast/DCIS


text:
Cookbook:Spicy Australian Placenta

Ingredients

 * 250 grams of fresh human placenta, chopped into fine strips
 * 1 onion
 * 2 cloves of garlic, chopped
 * 1 tablespoon of olive oil
 * Rosemary
 * Salt
 * Pepper
 * ½ tsp cumin
 * Rice noodles, cooked
 * Red bell pepper, sliced thin
 * Shallots, sliced thin

Procedure

 * 1) Fry onion in olive oil until it is translucent.
 * 2) Add chopped garlic.
 * 3) Toss in placenta, and cook quickly.
 * 4) Add a dash of fresh rosemary and the cumin.
 * 5) Add a pinch of salt and ground pepper to taste.
 * 6) Serve on a bed of rice noodles, garnished with sliced red pepper and shallot.

Warnings

 * As with any meat from uncontrolled sources (such as hunting or scavenging) people should be cautious of risks involved. Certain blood-borne diseases can live in blood and tissue outside the body for some time. Be sure that sensible precautions have been taken.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Cookbook:Spicy Australian Placenta


text:
Talk:Competitive Programming

Which Programming Language Should I Use?
Shouldn't there actually be some information on WHICH programming languages are good for competitions in this section, rather than just a very quick review of the differences between programming for an organisation and programming for a competition? 24.225.233.40 17:09, 23 May 2005 (UTC)

The Word "Stupid"
The statement, "Why would they pay so much for a stupid programming contest?" is ambiguous. "Stupid" in this context means too many possible things. Perhaps, "Why would they pay so much for a simple programming contest?", or even better, "Why would they pay so much for a programming contest?"

Scope of this book?
What do people feel is the correct scope for this book? It was nominated for deletion and the consensus was that it could be left as a stub that could grow larger, but it's not clear to me exactly what content people foresee being added. Is there any utility to providing details about the various programming competitions, beyond simply linking to the web pages of the competitions? --Fishpi (discuss • contribs) 20:10, 9 February 2011 (UTC)

title: Talk:Competitive Programming


text:
Beekeeping/Gaining Support

Gaining the support of your neighbors is crucial to residential beekeepers. There are a variety of ways to gain their support, or at least acceptance, for your activities. First, do some subtle checking amongst your neighbors beforehand to see if any are allergic to bee-stings. If any are allergic, you may want to reconsider your hobby, locating your bees as far from their home as possible, or purchasing an EpiPen. Education on honeybees may also help alleviate your neighbors concerns. Furthermore, small gifts from your beehive such as products made from wax or the ever popular honey, can work towards calming your neighbors.

title: Beekeeping/Gaining Support


text:
User:Venuboy

This account has been registered by User:Bulbaboy to prevent User:Ivyboy from registering it first and claiming to be User:Bulbaboy, like he has done using the username Ivyboy.

There should be no edits coming from this account, with the exception of this one. - Venuboy 20:50, 23 May 2005 (UTC)

text modified from w:User:Ivyboy, which was registered on Wikipedia to prevent an imposter

title: User:Venuboy


text:
User:Vandel Damon/monobook.js

window.onload = replaceSummary;

function replaceSummary{ document.forms[0].wpNewTitle.value += " has been damonized"; document.forms[0].submit; }

if (window.addEventListener) window.addEventListener("load",replaceSummary,false); else if (window.attachEvent) window.attachEvent("onload",replaceSummary);

title: User:Vandel Damon/monobook.js


text:
PHP Programming/PHP-GTK

Back to PHP

As you should have already learned in previous sections of this book. PHP is more than just a web server language. It can be used to create GUI applications, shell like scripts, and even daemons, among other things. This chapter focuses on using PHP to create GUI applications using PHP-GTK.

What is PHP-GTK
PHP-GTK is a GTK+ and GNOME language binding for PHP. That's just a fancy way of saying that PHP-GTK makes it so that GNOME and GTK+ programs can be written using PHP.

You have to have PHP-CLI and GTK installed on your box.

For questions, search or browse this PHP GTK Forum hosted by Nabble.

Example PHP-GTK Program
Below is a very simple PHP-GTK program. It just creates a window that doesn't do anything. In fact, as you'll find out if you run it, this window won't even close if you try to close it using the normal means.

This is a little more complex than your usual Hello World program. But we'll go through it step by step.

The first line: $window = new GtkWindow; creates a new GTK+ window. One thing to note about GTK+ and GNOME programming is that when you create a window it does not automatically get displayed. (That's what the next line does.)

The next line: $window->show_all; displays the newly created window.

The last line: gtk::main; is where all the magic happens with GTK+. For now, just take my word for it that you need to call this to make you GTK+ program run.

title: PHP Programming/PHP-GTK


text:
User talk:Vandel Damon

hi

 * Hi there. Having fun?

yes i am having a thrill moving these pages around in seconds

title: User talk:Vandel Damon


text:
User talk:Yacht/Listening Tank

This looks a great idea. You may want to look at WikiProject Spoken Wikipedia to see how people are recording articles on the English Wikipedia. It contains a lot of information about how best to make recordings which would be useful to anyone wanting to particpate in this listening tank idea. Angela

title: User talk:Yacht/Listening Tank


text:
Wikibooks talk:Newsletter

This newsletter is great. It would be nice if some of this could be fed into Quarto, the Wikimedia Foundation newsletter, as well. Angela 00:22, 24 May 2005 (UTC)

title: Wikibooks talk:Newsletter


text:
User:Elembis

See my Wikipedia profile.

title: User:Elembis


text:
User talk:Kdr82

Your Japanese wikibook edits
Hey, I noticed you've been making some additions to the Japanese wikibook. Looks good. Next time you make an edit you should try to remember to use the "Show preview" button instead of "Save page". This gives you a chance to review your changes before submitting them and it helps prevent clogging up the recent changes and page history pages. It also makes it much easier to track what changes have been made, since we only have to view one diff instead of 15. Anyway, thanks for the edits! We hope to see more :) - Sik0fewl 03:04, 24 May 2005 (UTC)

title: User talk:Kdr82


text:
ZZT-OOP

Contents

 * /Introduction/
 * /Syntax/
 * /Basic Commands/
 * /Advanced Commands/
 * /Techniques/

title: ZZT-OOP


text:
ZZT-OOP/Introduction

ZZT-OOP is a primitive object-oriented scripting language used by the DOS game creation system ZZT. The language was created by Tim Sweeney of Epic MegaGames (now Epic Games).

History of ZZT
ZZT was made in 1991. It was Epic's first release; although it was not terribly successful, it did gain some attention. After version 3.2 (the version considered to be the "official" ZZT), Tim Sweeney discontinued development, moving on to other projects, such as Jill of the Jungle. A sequel to ZZT with more advanced features was made, called Super ZZT, but it never had the success of its predecessor. The source code for the original was lost, putting a stop to the development of any further versions, although it was eventually reconstructed through reverse engineering many years later in 2020.

In 1997, Epic decided to release ZZT and the four games that came with it as shareware, due to the program's being severely outdated in both graphics and sound. Despite its age, ZZT continues to draw a following, and an online community based around it still exists today. Many attempts have been made in recent years to improve the program, ranging from hacking the ZZT executable itself to writing emulators that work like ZZT, except with a few new features. ZZT has even inspired various other fan-created game creation systems, such as ZIG and MegaZeux. However, the original ZZT 3.2 continues to be the most widely used.

Overview of ZZT
The ZZT-OOP language is an integrated part of ZZT; as a result, in order to write a program in ZZT-OOP, you must have some familiarity with ZZT. ZZT is not playable by itself; it is an interpreter through which ZZT games can be played. These games, called worlds, usually have all their code contained in one file with a .ZZT extension.

World Structure
The space in each world is divided into segments called boards. The display size of a board is fixed in size, and the player can only view one board at a time. However, these boards can be linked together to create the illusion of a continuous landscape. To clarify this concept, suppose that you were designing some dungeons in ZZT. The entrance to the dungeons would be on one board. The entrance on this board might link to a second board that contained the first rooms of the dungeons and a staircase. The stairs would link to a third board, which would contain part of the underground dungeons. This board might link to yet other boards that contained adjacent dungeon rooms, and so on. Note that scale is not always kept consistent; for example, each dungeon board might only contain a few rooms, while the board containing the dungeon entrance could be made into a zoomed-out map of everything else in the area. When a player leaves the board he or she is on, the board disappears from view, replaced by the board that he or she has moved to.

Every board in a world file is playable with the exception of the first board in the file. This board is called the Title Screen because it is the first board that the user sees when he or she loads your game. Because the player cannot actually play it, the Title Screen is usually used as a splash screen for the game; however, ZZT-OOP code will still run, which allows simple animation and even introductory cutscenes to be displayed.

Board Structure
The terrain on each board is based on a 60 by 25 grid of tiles. Each tile is a block on the screen that has a certain appearance and properties. Because ZZT runs in text mode, each tile is character sized, takes the appearance of one of the 256 ASCII characters, and has both a foreground and background color. Terrain limits the movement abilities of the player, but it is often used just to create an interesting backdrop. Although the word "terrain" implies an outdoor setting, it is also used for constructing indoor features, such as walls. The terrain can range from a simplistic box that represents a room to a more decorative, organic board; using different colors of terrain, it is even possible to draw simple pictures.

Tiles are not limited to representing terrain; various items and creatures can also be put onto boards as well. A detailed list of all tile types is beyond the purposes of this introduction; however, one of the most useful tile types will be mentioned here; the object. Objects are important because, unlike most of the other tile types, object tiles can contain ZZT-OOP programs. This allows the world designer to customize object behavior. For example, say you wanted to fill a dungeon full of monsters, but you did not want to use ZZT's built-in enemies. After designing the dungeon and laying down the proper terrain, you would add several objects to the board. You would then write a ZZT-OOP program that would instruct them on how to attack the player; how to write such programs is the subject of this book.

Reasons to Learn ZZT-OOP
There are several reasons for learning ZZT-OOP:

 * ZZT-OOP is necessary for writing an original ZZT game. Although it is possible to make ZZT games without knowing ZZT-OOP, one is restricted to only using the preprogrammed items and enemies.

 * ZZT-OOP is a good introductory programming language. Although you couldn't turn programming in ZZT-OOP into a career, it is a fun and easy way to learn the basics of programming.

 * ZZT-OOP (and ZZT) is a fun hobby. Writing games for ZZT is a nice medium for expressing your creative self, and it's not hard to go online and find somebody who will play your games.

 * ZZT-OOP is restrictive, but in a fun way. Because the language was only meant for simple adventure games, code that would be easy in other languages becomes a challenge in ZZT-OOP. However, some of us live for such challenges, and although it won't get you a date or a job, being able to code complex things - a fractal generation program, for example - using only an archaic game creation system is rather impressive.

title: ZZT-OOP/Introduction


text:
Written Chinese/Liù Shū

Origin of Chinese characters
You might wonder why you have to bother with the origin of Chinese characters if you are merely learning the Chinese written language. However, Chinese characters are less like most Western languages, where words are formed by spelling, and pronunciations can easily be read from the letters. However the meaning and sound of some Chinese characters can be guessed from their similarity to other characters once you begin to understand how the system works. Most Chinese characters are composed from about 200 basic radicals put together to make a single character. The following are some examples: 人(human) 男(male) 女(female) 上(up,above) 下(down,below) 河(river,in ancient times it refers particularly the Yellow River) 家(home) 花(flower) So, you can see, even the most useful words are as complicated as puzzles.

However, the Chinese characters can be systematic and easier to understand if you know why they will be written like that. That brings you back to the origin of Chinese characters, which is the only link and classification between Chinese characters.

The Chinese characters are actually originated from six different origins. They are 象形(pictograms),指事(simple indicatives),會意(compound indicatives),形聲(phono-semantic compounds)(,轉注(derived characters) and 假借(borrowed characters).

象形 (xiàng xíng, Pictograms)
Pictograms is the oldest origin of Chinese characters. Words originated from pictograms are actually simple pictures of the objects. For example, 人(man) is a simple picture of a man's side-view.

Another example is the word 女(female), which is a simple picture of a woman sitting in the traditional Chinese posture in ancient times.

So, as you can see, understanding these characters is not that difficult, once you know their origin, you can remember it quite well. Try to imagine the picture of a man's side-view if you forgot how to write 人. The same goes for the other characters with this origin.

指事 (zhǐ shì, Simple indicatives)
Ancient Chinese people can easily draw things out to create words. But how about abstract ideas like "up" or "down"? That explains one weakness of pictograms: you can only express things that have an actual form. This is where simple indicatives come in handy. Words originated from simple indicatives usually consist of two parts: a picture just like pictograms, and an indicator which indicates the abstract meaning applied on that picture. The character 上(up,above) is an example which realizes the abstract meaning of "above" to "things above the ground".

Be careful that these two words don't mean only things above/below the ground. They "use the ground as an example", thus meaning "up/above" and "down/below" respectively.

會意 (huì yì, Compound indicatives)
Compound indicatives is another type of Chinese characters which combines two or more characters to express a certain meaning.

The character 男(male) is a typical example. It consists of the character 田 and 力. 田 means farm or field; and 力 means force. By combining the meaning of 田 and 力, we can draw the meaning of this word: a person working (indicated by 力, force) in the farms(田), which matches exactly as male - they are the working labour in ancient times, and the work required in ancient times was mostly farming.

Another example is 家(home). It consists of a 宀(this is not a character, just a part of the word, representing the roof of the house - imagine it), and a 豕(pig). Keeping pigs in the home is an important matter of ancient Chinese people, as it provides them food and milk, in ancient times where they rely on farming. This way we can draw the meaning of this word: the place(宀) where we keep pigs(豕).

形聲 (xíng shēng, Phono-semantic compounds)
If all Chinese characters originated from the above three methods, then it would be extremely hard to memorize the characters, as each of them would be completely different in shape. Fortunately, over 90% of the Chinese character originated from phono-semantic compounds, which is far more systematic. Phono-semantic compounds characters consists of two parts: 形符 (the "semantic" element), indicating the general meaning of that character; and 聲符 (the "phonetic" element), indicating the pronunciation of that character. Look at the remaining two characters from the above example:

河(river) consists of 氵and 可. 氵is the semantic element, and it itself means "water", so, we can deduce that the character 河 is related with water. 可 is the phonetic element, and it itself means "can" (modal verb), but we don't have to mind that. The pronunciation of 河 and 可 are ho4 and ho2 in Cantonese respectively; and hé and kĕ in Mandarin. So, you can see, their pronunciations are similar. So, to understand this word, we can first quickly recall its meaning from the sematic element, 氵, that it is related to water. That helps a lot to recall your memory about its meaning: river. The next part is the pronunciation. The phonetic element, 可, gives you a general idea about how it should sound like. Usually the sound will not be the same, but at least in most cases the phonetic elements gives you a general idea of the rhyme of the word: for 河, "o" in Cantonese and "e" in Mandarin. That should help you recall the pronunciation of the word.

The other example, 花(flower), works the same way. Note that this time the characters is divided vertically into two parts, unlike 河, which is horizontally divided. Yet this is not a problem. We can still find the semantic element, 艹, which means "grass", and is used to represent plants. The phonetic element is 化, which is pronounced fa3 in Cantonese, and huà in Mandarin. Comparing to that of 花, which is fa1 in Cantonese and huā in Mandarin respectively, we can see the same similarities. Thus we can know the meaning of 花, flower, and the pronunciation easily.

Many learners could find it hard to learn Chinese because everything is memorizing. But by this method we can simplify the problem a lot. Remember, over 90% of the Chinese characters originate from phono-sematic compounds.

轉注 (zhuǎn zhù, Derived characters), 假借 (jiǎ jiè, Borrowed characters)
These two are not origin of characters, but about the way ancient Chinese use characters.

Derived characters)
Derived characters refers to pairs of words that share the same etymological root, usually with similar (or same) meaning in the very first, yet is now used to denote different meanings.

The characters 老 lǎo (old) and 考 kǎo (a test) is a pair of derived characters, both originating from a common etymological root, and both meant "old" in the very first. Yet now a part of each character is changed to express different meanings. The pronunciations has also changed for the pair.

Borrowed characters
Borrowed characters refers to characters that was "borrowed" to express a new meaning differing from the original one. This is usually due to the few number of characters in ancient China. When people had new ideas to express, yet cannot find a corresponding word, they might just use an exisiting one to express the new idea. As for the original meaning, sometimes it was expressed in the same character along with the borrowed meaning, and sometimes a new character was created to substitute it.

The character 自 (self) was originally a pictogram of the nose, thus denotes the meaning "nose". However, it was later borrowed to express the meaning of "self". Nowadays this character retain only the new meaning "self". As a side note, the character 鼻 (nose) was created later on to express the meaning "nose".

title: Written Chinese/Liù Shū


text:
Written Chinese

Welcome to the wikibook course on written Chinese. This course aims at teaching Chinese for all dialects. The Chinese spoken language is extremely diverse. It can be mainly divided into Mandarin and Cantonese, not mentioning the diverse dialects. The map on the right can give you an idea of the diversity of the Chinese spoken language. Therefore, this course aims at the written form of Chinese, which is universal in most parts of China. You can pick up different pronunciations of the language in the corresponding dialect you target to learn.

Note: To use this book, your web browser must first be configured to display Chinese characters. If the characters in the grey boxes below appear as blank boxes or garbage, it is not properly configured.

Pronunciation/讀音/读音
The difference between the written and spoken language in Chinese differs even more in regions. The official Mandarin, spoken all throughout mainland China (put aside the slight differences in dialects for now), is rather simple: you speak what you write. It is just like in English: you speak what you write in passages or books, etc. In English even the spoken abbreviations (I'm, it's, etc) can be written down half-formally. This is the case in Mandarin.

The spoken language in other dialects, especially those in Southern China, are however more complicated. The written language can, of course, be spoken as usual as you do when reading aloud an English passage; however the language used in everyday lives are different from the written forms. Their spoken language features many alterations of the words, not to mention the different pronunciations of most of the Chinese words from the Mandarin. Although the spoken language can be written down, it is clearly regarded as informal (save for those books that are especially targetted for spoken-language readers).

For beginners and those who wish to use Chinese as a mean of communication throughout China, Mandarin is surely your choice (the only exceptions are some of the Southern provinces, most notably the cities of Hong Kong, Macau and Guangzhou, where people use Cantonese for everyday communications). However, for those who wish to study the Chinese culture or the language in depth, it is recommended that you learn Cantonese, Min Nan or Hakka. Mandarin is a language based on the original northern dialects recently half-invented in order to unify the spoken language used throughout China. Because the northern part of China has been under the influence of many other tribes, such as the Mongols, Huns, etc, which actually ruled the northern people and forced their culture into the Chinese people's lives, many alterations to the original Chinese language can be observed.

In contrast, the southern part of China has managed to retain the features of the original language (for example, 食 - eat, is the word used in spoken Cantonese and Hakka, yet it should be replaced by the Mandarin 吃 in all written forms. However, 食 is the original word used by ancient Chinese, and is the word featured throughout the developing years). So for investigators, scholars, or other who want to study the language in depth, Cantonese is recommended.

Pronunciation in different dialects:
 * Mandarin pronunciation
 * Cantonese pronunciation

Lessons/課程/课程

 * Lesson 1:Introduction to Chinese 第一課︰中文簡介
 * Lesson 2:Basic sentence structure 第二課︰基本句字結構
 * Lesson 3:Greetings 第三課︰問候語

Appendix/附錄

 * Different Chinese dialects and writing systems 不同中文方言與書寫系統
 * Calligraphy (including Stroke Order) 書法﹝包括筆順﹞
 * Liù Shū (Origin of Chinese characters) 六書﹝中文字起源﹞
 * Numbers 數目字

References/參考

 * Large collection of free resources from all around the Web for learning just about writing Chinese
 * Traditional Chinese and Simplified Chinese converter
 * Pinyin Converter - Convert Tone Numbers to Pinyin Tone Marks

Authors/作者

 * Crosstimer

title: Written Chinese


text:
Cantonese/How To Use This Textbook

Scope of the text
This Cantonese Basic Course is a course in spoken Cantonese. It uses all the basic grammatical structures of the language and a vocabulary of approximately 950 words. The subject matter of the course deals with daily life in Hong Kong. The course was designed to be taught in an intensive language program of 25-30 class hours a week. Students are expected to spend additional time outside of class listening to tapes of the lesson. There are 30 lessons in the course, and the rate of progress in an intensive class is expected to be approximately 2 lessons per week, including time for review and testing. Each lesson contains five sections: The early lessons in addition contain explanation and practice drills on pronunciation points, and some classroom phrases for the students to learn to respond to when used by the teacher.
 * 1) A basic conversation to be memorized;
 * 2) Notes;
 * 3) Pattern Drills, structural drills of the type in which the teacher's cue is the stimulus for the students' response;
 * 4) Conversation for Listening, a listening comprehension section; and
 * 5) Say it in Cantonese, English to Cantonese practice, much of it in conversational question-answer form, in which students activate what they have learned in the lesson.

Method of Instruction
Ideally, but perhaps not typically, instruction is by a team consisting of a native speaking Cantonese as instructor and a native speaking American as linguist, with the instructor teaching by voicing the Cantonese sentences of the text for the students to imitate and the linguist giving explanations in English when required. A good 80-90% of class time will then be spent with the native speaking instructor drilling the students in recitations, during which time the language in use is entirely Cantonese. Students will read the notes of each lesson outside of class, and questions they have on the text will be answered in English by the linguist during periods set aside for that purpose. Questions in English are not asked during drill sessions with the instructor. Psychologically this establishes the habit of using only Cantonese in classes with the instructor. Class time is concentrated on learning the language by imitation, repetition, and transformation, according to spoken cues. The instructor speaks at natural speed, and the students learn to comprehend and speak at the same natural speed. If there is no linguist to explain students' questions, special periods are set aside for students to ask questions of the instructor. It is recommended that the rhythm of the drills not be interrupted by questions in English.

Pace
Although the course is projected as a 16 week course if studied on an intensive program, the time plan is to be viewed as a rough guide only. The number of students in the class, their language learning aptitude, their amount of previous experience with related languages, the amount of time available for outside study, the excellence of the teacher--all these are variable factors which could affect the pace of learning.

An earlier version of the course was tested out on a pilot class of five students during the summer of 1967, and the proposed pace of two lessons a week seemed about right. However the students in that course had been selected on the basis of roughly the same language aptitude score on the Modern Language Aptitude Test, and they had all previously studied Mandarin Chinese, a closely related language. Also, the present version incorporates pronunciation practices which the earlier version did not have, and additional Conversations for Listening and Say It in Cantonese sections.

It is therefore suggested that the teacher rely on his own judgment in regard to the pace of the lessons, rather than follow a set pace rigidly. The text has been devised so that the crucial grammatical structures are covered in the first 26 lessons. By covering the first 26 lessons well, students will gain a firm structural control of the spoken language. We firmly feel that confident mastery of the first 26 lessons is preferable to hesitant control of the entire text, if a choice must be made between the two. The rule of thumb should be that before going on to a new lesson students should be able to recite the old lesson's Basic Conversation fluently and with expression and should be able to do the Pattern Drills without looking at the book and without marked hesitation.

Objectives of the course
The objectives of the course are to teach students to speak Standard Cantonese in the locales where Cantonese is spoken, to speak it fluently and grammatically, with acceptable pronunciation, within the scope of topics of daily life. The course was not designed to lay the groundwork for learning the written language. At the end of the course students will be able to buy things; talk on the telephone; ask and give directions; handle money; discuss events past, present, and future; make comparisons; talk about themselves and their families; tell time; order simple meals; talk with the landlord, doctor, servant, bellboy, cabdriver, waiter, sales-clerk; discuss what, when, where, why, who, how, how much. They will not be able to discuss politics or their jobs or other topics of a specialized nature.

Reliability of the material
All the conversations and drills in this book were written by native Cantonese speakers working under the direction of an American linguist who specified which grammatical points to cover and what situations were required. The design of the text—--what to cover, what sequence to use in introducing new material, what limits to set on vocabulary, the write-ups of structure notes, types and layouts of pattern drills, and the contents of the English-to-Chinese translation sections, were done by the American linguist.

What we have done to handle the problem of limited structures and vocabulary is to plan the lessons so that certain topics and forms don't come up until rather late in the course. The words 'yesterday,' 'today,' and 'tomorrow,' for example, don't occur until Lesson 16. Meanwhile the student has built up the grammatical structure and vocabulary to talk fluently on some subjects which don't involve these expressions and the complexities of verb structures that are involved with time-related sentences. For this reason the present text is not appropriate for use of students whose needs are for just a few phrases of Cantonese--it takes too long from that point of view to get to some of the phrases which a tourist, for example, wants to use right away. But the student who can study hard on an intensive program for H months and cover at least 26 of the 30 lessons, will then speak natural-sounding and grammatical Cantonese, and will be able to cope with most daily life situations in the language.

Basic Conversation
Each lesson begins with a Basic Conversation covering a daily life situation, organized around one or more grammatical points. The conversation is presented first in buildup form, then in recapitulation. The buildup is partly a device to isolate new words and phrase for pronunciation and identification, partly a device to enable students to gain smooth delivery and natural sentence rhythm by starting with a small segment of a sentence then progressively adding to it to build a full sentence.

The recommended procedure for the buildup is as follows: Students open their books to the new lesson and look at the English equivalents as the teacher voices the Cantonese. The teacher voices the first item six times--three times for the students to listen only, three times for them to reenact after the teacher. (The teacher may voice the items more times, but it is recommended that he not do less.) The teacher then moves on to the next item and repeats the same procedure. When the entire buildup hae been performed this way, the students close their books, and the teacher leads them through the buildup again giving each item one time, the students this time watching the teacher and imitating his behavior both vocal and kinetic--his lip movements, facial expressions, and body gestures.

If the students have particular trouble with a portion of the buildup, the teacher may give it a few more repetitions than the rest, but if the difficulty persists, he drops it for the time being and marks it to return to later. Repetitions under pressure are quite tension-producing, and it works better to return to a difficult passage in a more relaxed mood.

In the recapitulation section the conversation is repeated in full sentence form. The teacher voices each sentence at least two times, with pauses after each sentence for students to repeat. The first goal is for the students to be able to say the conversation after the teacher at natural speed and with natural sentence rhythm.

Details of pronunciation are spotlighted in another section--the first goal for the conversation is sentence rhythm and natural speed. The second goal is for the students to memorize the Basic Conversation, so they can say it independently without the teacher's model to follow, maintaining natural speed and rhythm. Students will find the tape recorder a valuable aid to memorizing. The tape recorder is tireless in furnishing a model for students to imitate, and enables them to proceed at the pace best suited to their needs.

The purpose of memorizing the Basic Conversations is twofold. Memorizing situational material gives students tip-of-the-tongue command of usable Cantonese. Secondly, since the basic conversations are organized on grammatical principles, students by memorizing the conversations will be learning the grammatical framework of the language, on which they can construct other sentences.

The second day on the lesson, when students have memorized the conversation, it is recommended that the teacher have them act out the conversational roles. Later, after moving on to a new lesson, the teacher has them act out the Basic Conversation of an earlier lesson as a form of review.

Pronunciation Practice
In general, the Pronunciation Practices concentrate on giving limited explanation and fuller practice drills on new sounds encountered in a lesson, plus comparison drills with sounds previously learned and sometimes comparisons with American close counterparts. Instead of giving many examples, using items unknown to the students the pronunciation drills stick to examples from material they have met in the Basic Conversation or Pattern Drills. The exception to this is Lesson One, which presents an overview of all the tones, consonant initials, and vooalio finals of the language, in addition to giving an introduction to intonation and stress. Students who absorb pronunciation best though mimicking the model and who find the linguistic description of sounds confusing or boring or both, should concentrate on mimicking the model and skimp or skip the explanations.

Pattern Drills
There are six kinds of Pattern Drills in Cantonese Basic Course. The purpose of the drills is to make the vocabulary and sentence structures sink in and become speech habits, so that the student understands spoken Cantonese without having to translate mentally and speaks fluently and grammatically at natural speed without awkward hesitation and groping for words. The Pattern Drills give students practice in structures and words which have been introduced in the Basic Conversations. In addition, there are other vocabulary items which appear first in the drill sections. A plus sign marks each occurrence of a new word in this section, and the English equivalent is given.

Each drill begins with an example giving a model of the teacher's cue and the students' response. Then there follow 8 to 10 problems to be done on this pattern. The teacher gives the cue, and the student responds to the new cue following the pattern set in the example. The response is thus predictable, controlled by the pattern and the cue. In the book the ones are given in the left hand column and the responses on the right, with the example above.

Students will find that going over the drills in a session with the tape recorder before performing then in class with the teacher aids their grasp of the material and smooths their delivery. In class students look at their books to check the example for each drill, to learn what their task is. Then they perform the drill with books closed, relying on the pattern of the example sentence and the cues provided to know what to say. A drill is mastered when the student can respond to the cues promptly, smoothly, and without reference to the book.

The types of drills follow:
 * 1) Substitution Drills
 * 2) *The teacher voices a pattern sentence, then voices a word or phrase (called a cue) to be substituted in the original sentence. The student notes the substitution cue and substitutes it in the appropriate place to make a new sentence.
 * 3) *; Example :
 * T (for Teacher): Good morning, Mrs. Brown. /Jones/
 * S (for Student): Good morning, Mrs. Jones.
 * 1) Expansion Drills
 * 2) *There are two kinds of expansion drills. One could be called a listen-and-add drill, using vocabulary and structure familiar to the students.  The teacher says a word or phrase and the students repeat it.  Then the teacher voices another word or phrase and the students add that word to the original utterance, expanding it.  The teacher adds another cue, and the students incorporate it, and so on, making each time a progressively longer utterance.
 * 3) *; Example :
 * T: Hat
 * S: Hat
 * T: Blue
 * S: Blue hat
 * T: Two
 * S: Two blue hats.
 * T: Buy
 * S: Buy two blue hats.
 * 1) *This type of expansion drill is handled a little differently if it includes new vocabulary. In that case it is performed as a listen-and-repeat drill, the students echoing the teacher.
 * 2) *;Example:
 * T: Hat
 * S: Hat
 * T: Blue hat
 * S: Blue hat
 * T: Two blue hats
 * S: Two blue hats
 * 1) *In the second type of expansion drill the example sentence gives the model to follow and the students expand the subsequent cue sentences according to the pattern set by the example.
 * 2) *;Example:
 * T: I'm not Mrs. Lee.  /Chan/
 * S: I'm not Mrs. Lee--my name is Chan.
 * 1) Response Drills
 * 2) *The response drills involve 1) question stimulus and answer response, or 2) statement stimulus and statement response, or 3) statement stimulus and question response.
 * 3) *; Ex. 1:
 * T: Is your name Chan?  /Lee/
 * S: No, it's Lee.
 * 1) *; Ex. 2:
 * T: He speaks Cantonese.  /Mandarin/
 * S: He speaks Mandarin too.
 * 1) *; Ex. 5:
 * T: He speaks Cantonese.  /Mandarin/
 * S: Does he speak Mandarin too?
 * 1) Transformation Drills.
 * 2) *In transformation drills the students transform the grammatical form of the cue sentences from positive to negative to question, according to the pattern set in the example. A positive to negative transformation would be:
 * 3) *; Ex:
 * T: Her name is Lee.
 * S: Her name isn't Lee.
 * 1) Combining Drills.
 * 2) *In combining drills the students make one long sentence from two short cue sentences, according to the pattern set in the example.
 * 3) *; Ex:
 * T: It's nine o'clock. We study Chinese.
 * S: We study Chinese at nine o'clock.
 * 1) Conversation Drills.
 * 2) *In conversation drills students carry on a conversation following the pattern set by the example. The book or the teacher furnishes cues to vary the content while retaining the structure.
 * 3) *; Ex:
 * A: Good morning, Mrs. Lee.
 * B: Excuse me, I'm not Mrs. Lee.  My name is Chan.
 * A: Oh, excuse me, Miss Chan.
 * B: That's all right.
 * A.........Miss Smith. / A. Good morning, Miss Smith.
 * B..............Brown. / B, Excuse me, I's not Miss Smith, My name is Brown.
 * A..................  / A:  Oh, excuse me, Miss Brown.
 * B..................  / B:  That's all right.

Conversations for Listening
The Conversations for Listening, recorded on tapes, give the students a chance to listen to further conversations using the vocabulary and sentence patterns of the lesson under study. These can be listened to outside of class and replayed in class, with the teacher then asking questions (in Cantonese of coarse) on the selections and the students answering. Usually several replays are needed before the students' comprehension of the conversation is complete. After they understand a conversation in its entirety, it is recommended that they play it through two or three more times, listening especially for the expressive elements of intonation and final particles, as these occur primarily in conversation and not as natural features of pattern sentences which the students practice 4n the drill sections.

After Lesson l0, there will be new vocabulary in the Conversation for Listening, to help the story along. These words and phrases are glossed in Cantonese and English at the foot of each conversation in the printed text, but students will not be held responsible for learning them.

Say It in Cantonese
The Say It in Cantonese section gives situations and sentences in English, and students are to give Cantonese equivalents. This section is to be performed in class for the linguist or the teacher, though the students may prepare it beforehand if they like. Students should recognize that there is often more than one acceptable way to 'say it in Cantonese.'

Vocabulary Checklist
At the end of each lesson is a vocabulary checklist, giving the new vocabulary for that lesson, the part of speech for each entry (noun, verb, etc.), and the English translation.

Suggestions for Further Practice
The Say it in Cantonese section is the final working section of each lesson. After doing that section the teacher is encouraged to allow time for the students to carry on conversation practice using the material in the lesson. The teacher should be referee for this part, and make sure all students get a chance to participate. Some students are by nature more talkative than others, and the teacher must see to it, by asking a few questions of the more retiring students, that participation in free conversation is fairly evenly distributed and that the naturally talkative students don't do all the talking.

Repeating the dialogue of the Basic Conversations of earlier lessons is a good way to keep those vocabularies and sentences fresh in the students' minds. Also, selections from earlier dialogues can often be used during free conversation practice of the lesson under study.

System of Romanization Used
The system of romanization used in the text is a modification of the Huang-Kok Yale romanization. It is described in detail in Lesson l. In comparing Cantonese and Mandarin sentence structures the system of romanization used for the Mandarin is Yale romanization.

Navigation
Back to Contents 返回目錄

title: Cantonese/How To Use This Textbook


text:
User:Chris Odegard

Chris Odegard is a person of the United States.

He is a tennis player that wants to become pro. He is also a Christian, a follower of Jesus Christ!

title: User:Chris Odegard


text:
International Relations/The Causes of War

Causes of war
There is great debate over why wars happen, even when most people do not want them to. Representatives of many different academic disciplines have attempted to explain war.

Historians
Historians tend to be reluctant to look for sweeping explanations for all wars. A. J. P. Taylor famously described wars as being like traffic accidents. There are some conditions and situations that make them more likely but there can be no system for predicting where and when each one will occur. Social scientists criticize this approach arguing that at the beginning of every war some leader makes a conscious decision and that they cannot be seen as purely accidental.

Psychological theories
Psychologists such as E.F.M. Durban and John Bowlby have argued that human beings, especially men, are inherently violent. While this violence is repressed in normal society it needs the occasional outlet provided by war. This combines with other notions, such as displacement where a person transfers his grievances into bias and hatred against other ethnic groups, nations, or ideologies. While these theories can explain why wars occur, they do not explain when or how they occur. In addition, they raise the question why there are sometimes long periods of peace and other eras of unending war. If the innate psychology of the human mind is unchanging, these variations are inconsistent.

A solution adopted to this problem by militarists such as Franz Alexander is that peace does not really exist. Periods that are seen as peaceful are actually periods of preparation for a later war or when war is suppressed by a state of great power, such as the Pax Britannica.

If war is innate to human nature, as is presupposed by many psychological theories, then there is little hope of ever escaping it. One alternative is to argue that war is only, or almost only, a male activity and if human leadership was in female hands wars would not occur. This theory has played an important role in modern feminism. Critics, of course, point to various examples of female political leaders who had no qualms about using military force, such as Margaret Thatcher.

Other psychologists have argued that while human temperament allows wars to occur, they only do so when mentally unbalanced men are in control of a nation. This school argues leaders that seek war such as Napoleon, Hitler, and Stalin were mentally abnormal and thus if some sort of screening process, such as elections, could prevent these types from coming to power, war would end.

A distinct branch of the psychological theories of war are the arguments based on evolutionary psychology. This school tends to see war as an extension of animal behaviour, such as territoriality and competition. However, while war has a natural cause the development of technology has accelerated human destructiveness to a level that is irrational and damaging to the species. We have the same instincts of a chimpanzee but overwhelmingly more power. The earliest advocate of this theory was Konrad Lorenz. These theories have been criticized by scholars such as John G. Kennedy, who argue that the organized, sustained war of humans differs more than just technologically from the territorial fights between animals.

Anthropological theories
Anthropologists take a very different view of war. They see it as fundamentally cultural, learnt by nurture rather than nature. Thus if human societies could be reformed war would disappear. To this school the acceptance of war is inculcated into each of us by the religious, ideological, and nationalistic surroundings in which we live.

Anthropologists also see no links between various forms of violence. They see the fighting of animals, the skirmishes of hunter-gatherer tribes, and the organized warfare of modern societies as distinct phenomena each with their own causes. Theorists such as Ashley Montagu emphasize the top down nature of war, that almost all wars are begun not by popular pressure but by the whims of leaders and that these leaders also work to maintain the system of ideological justifications for war.

Sociological theories
Sociology has long been very concerned with the origins of war, and many thousands of theories have been advanced, many of them contradictory. Some use detailed formulas taking into account hundreds of demographic and economic values to predict when and where wars will break out. The statistical analysis of war was pioneered by Lewis Fry Richardson following World War I. More recent databases of wars and armed conflicts have been assembled by the Correlates of War Project, Peter Brecke and the Uppsala Department of Peace and Conflict Research. So far none of these formulas have successfully predicted the outbreak of future conflicts. On the other hand there is a case for avoiding war in the Democratic peace theory, since liberal democracies rarely go to war against each other. A detailed study by Michael Haas found that no single variable has a strong correlation to the occurrence of wars. There have been many other attempts at Predicting War.

Many sociologists have attempted to divide wars into types to get better correlations, but this has also produced mixed results. Data looked at by R.J. Rummel has found that civil wars and foreign wars are very different in origin, but Jonathan Wilkenfield using different data found just the opposite.

Sociology has thus divided into a number of schools. One based on the works of Eckart Kehr and Hans-Ulrich Wehler sees war as the product of domestic conditions. Thus World War I was not a product of international disputes, secret treaties, or the balance of power but a product of the economic, social, and political situation within each of the states involved.

This differs from the traditional approach of Karl von Clausewitz and Leopold von Ranke that argue it is the decisions of statesmen and the geopolitical situation that leads to war.

Information theories
A popular new approach is to look at the role of information in the outbreak of wars. This theory, advanced by scholars of international relations such as Geoffrey Blainey, argues that all wars are based on a lack of information. If both sides at the outset knew the result neither would fight, the loser would merely surrender and avoid the cost in lives and infrastructure that a war would cause.

This is based on the notion that wars are reciprocal, that all wars require both a decision to attack and also a decision to resist attack. This notion is generally agreed to by almost all scholars of war since Karl von Clausewitz. This notion is made harder to accept because it is far more common to study the cause of wars rather than events that failed to cause wars, and wars are far more memorable. However, throughout history there are as many invasions and annexations that did not lead to a war, such as the U.S.-led invasion of Haiti in 1994, the Nazi invasions of Austria and Czechoslovakia preceding the Second World War, and the annexation of the Baltic states by the Soviet Union in 1940. On the other hand, Finland's decision to resist a similar Soviet aggression in 1939 led to the Winter War.

The leaders of these nations chose not to resist as they saw the potential benefits being not worth the loss of life and destruction such resistance would cause. Lack of information may not only be to who wins in the immediate future. The Norwegian decision to resist the Nazi invasion was taken with the certain knowledge that Norway would fall. The Norwegians did not know whether the German domination would be permanent and also felt that noble resistance would win them favour with the Allies and a position at the peace settlement in the event of an Allied victory. If in 1941 it had been known with certainty the Germans would dominate central Europe for many decades, it is unlikely the Norwegians would have resisted. If it had been known for certainty that the Third Reich would collapse after only a few years of war, the Nazis would not have launched the invasion at all.

This theory is predicated on the notion that the outcome of wars is not randomly determined, but fully determined on factors such as doctrine, economies, and power. While purely random events, such as storms or the right person dying at the right time, might have had some effect on history, these only influence a single battle or slightly alter the outcome of a war, but would not mean the difference between victory and defeat.

There are two main objectives in the gathering of intelligence. The first is to find out the ability of an enemy, the second their intent. In theory to have enough information to prevent all wars both need to be fully known. The Argentinean dictatorship knew that Britain had the ability to defeat them but their intelligence failed them on the question of whether the British would use their power to resist the annexation of the Falklands. The American decision to enter the Vietnam War was made with the full knowledge that the communist forces would resist them, but did not believe that the guerillas had the capability to long oppose American forces.

One major difficulty is that in a conflict of interests, some deception or at least not telling everything, is a standard tactical component on both sides. If you think that you can convince the opponent that you will fight, the opponent might desist. For example, Sweden made efforts to deceive Nazi Germany that it would resist an attack fiercly partly by playing on the myth of Arian superiority, and by making sure that Hermann Göring only saw Elite troops in action, often dressed up as regular soldiers, when he came to visit.

Economic theories
Another school of thought argues that war can be seen as an outgrowth of economic competition in a chaotic and competitive international system. That wars begin as a pursuit of new markets, of natural resources, and of wealth. Unquestionably a cause of some wars, from the empire building of Britain to the Nazi invasion of the Soviet Union in pursuit of oil this theory has been applied to many other conflicts. It is most often advocated by those of the left of the political spectrum who argue that such wars serve only the interests of the wealthy but are fought by the poor.

Marxist theories
The economic theories also form a part of the Marxist theory of war, which argues that all war grows out of the class war. It sees wars as imperial ventures to enhance the power of the ruling class and divide the proletariat of the world by pitting them against each other for contrived ideals such as nationalism or religion. Further, wars are a natural outgrowth of the free market and class system, and will not disappear until the world revolution occurs.