Stereotactic Radiation Therapy and Combination Chemotherapy in Treating Patients Undergoing Surgery for Locally Advanced Pancreatic Cancer

You may be eligible if

• DISEASE CHARACTERISTICS:
• Histologically or cytologically confirmed adenocarcinoma of the pancreas or intrapancreatic bile duct carcinoma
• * Overall view of image morphology and CA19-9 (\< 500 U/L) demonstrating pancreatic cancer allowed if histologic/cytologic confirmation is unavailable
• Locally advanced disease, meeting 1 of the following criteria:
• * Uncertain R0 resectability dependant on relation to portal vein, sinus confluens, superior mesenteric artery, and superior mesenteric vein (e.g., contact with portal vein, superior mesenteric vein, or arterial vessels, but \< 180° encasement)
• * Unresectable pancreatic cancer (e.g., contact with portal vein, superior mesenteric artery or arterial vessels, \> 180° encasement)
• Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 1 cm by spiral CT scan or MRI
• * Patients with no measurable disease may be assessed for feasibility only
• No distant metastases
• PATIENT CHARACTERISTICS:
• ECOG performance status (PS) 0-1 OR Karnofsky PS 80-100%
• WBC ≥ 3,000/mm³
• Granulocyte count ≥ 2,000/mm³
• Platelet count ≥ 100,000/mm³
• Creatinine clearance \> 30 mL/min
• Bilirubin ≤ 3.0 times upper limit of normal
• AST and ALT ≤ 2.5 times normal
• Alkaline phosphatase ≤ 2.5 times normal
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No secondary malignancy within the past 5 years that was not curatively treated
• No known intolerance to any of the study drugs
• No preexisting polyneuropathy \> grade 1
• No active uncontrolled infection
• No cardiac insufficiency despite optimal medication
• No New York Heart Association class III or IV congestive heart failure
• LVEF ≥ 50% OR shortening fraction ≥ 25%
• No angina pectoris (at rest or under stress) unexplained by interventional cardiology within the past 6 months
• No myocardial infarction within the past 6 months
• No uncontrolled diabetes mellitus
• No other existing serious medical impairments that would preclude study compliance
• PRIOR CONCURRENT THERAPY:
• No prior chemotherapy
• No prior radiotherapy to the abdomen