Low-dose Radiotherapy Plus Chemotherapy With Gem-based Doublets and Stereotactic Radiotherapy for Advanced Pancreatic Cancer

Inclusion Criteria:

• Pathologically confirmed adenocarcinoma of the pancreas
• Patients with unresectable disease based on institutional standardized criteria ofunresectability or patients whose disease appeared potentially resectable on axial CTimaging but were found unresectable at surgery
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Age ≥ 18
• Patients with biliary or gastroduodenal obstruction must have drainage or surgicalbypass prior to starting treatment
• Patients with radiographically assessable disease
• Adequate bone marrow, hepatic and renal function: -Hemoglobin >10.0 g/dL, absoluteneutrophil count > 1.5 x 10^9/L, platelet count > 100 x 10^9/L. -Aspartatetransaminase (AST or SGOT) and alanine transaminase (ALT or SGPT) should be ≤ 3 xupper limit of normal (ULN). -Total bilirubin < 2 mg/dL. Patients with elevatedbilirubin due to obstruction should be stented and their bilirubin should decrease to < 2 mg/dL prior to study entry. - Creatinine < 3 mg/dL or Creatinine clearance > 40mL/min (calculated according to Cockroft and Gault)

Exclusion Criteria:

• Evidence of metastatic disease in the major viscera or peritoneal seeding or ascites
• Gastric or duodenal obstruction
• Previous peripheral neuropathy
• Previous irradiation to the planned field; previous chemotherapy for pancreatic cancer
• Malignancy (within the past two years) except non-melanomatous skin cancer orcarcinoma in situ of the cervix, uterus, or bladder