Stereotactic Body Radiation and Tumor Treating Fields for Locally Advanced Pancreas Cancer

Inclusion Criteria:

• Histologically or cytologically confirmed locally advanced adenocarcinoma of thepancreas. Locally advanced pancreas cancer as per National Comprehensive CancerNetwork (NCCN) Guidelines.

• Regional lymph node involvement is permitted if able to be treated with radiationtherapy.

• Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

• At least 3 months of prior FOLFIRINOX, modified FOLFIRINOX, and/orgemcitabine/nab-paclitaxel delivered for pancreas cancer without evidence of distantprogression on restaging radiographic studies.

• Carbohydrate antigen 19-9 (CA 19-9) ≤500 U/mL on most recent assessment prior tostudy enrollment.

• Adequate normal organ and marrow function as defined below: i. Hemoglobin ≥8.0 g/dL that may be achieved with transfusion ii. Absoluteneutrophil count (ANC) ≥1500 per mm^3 iii. Platelet count ≥60,000 per mm^3 iv. Serumbilirubin ≤1.5 x institutional upper limit of normal (ULN) v. AST (SGOT)/ALT (SGPT) ≤3 x institutional ULN

• People of childbearing potential must agree to use adequate contraception (hormonalor barrier method of birth control, abstinence) prior to study entry and for theduration of study participation. Should a participant become pregnant or suspectthey are pregnant while participating in this study, they must inform the treatingphysician immediately.

• Able to operate the tumor treating field (NovoTTF-100L) system independently or withassistance.

• All participants must sign written informed consent.

Exclusion Criteria:

• Distant metastasis from pancreas cancer.

• Contraindication to having a magnetic resonance imaging (MRI) scan.

• Prior abdominal radiation therapy.

• History of any primary malignancy with the exception of:

1. Malignancy treated with curative intent and with no known active disease for atleast 3 years before enrollment on this study.

2. Adequately treated non-melanoma skin cancer or lentigo maligna without evidenceof disease.

3. Adequately treated carcinoma in situ without evidence of disease (i.e.,cervical carcinoma in situ; superficial bladder cancer).

• Any unresolved toxicity (Common Terminology Criteria for Adverse Events version 5.0 > grade 2) from previous anti-cancer therapy. Participants with irreversibletoxicity that is not reasonably expected to worsen by treatment on this study arepermitted to enroll on this study.

• History of inflammatory bowel disease (i.e., Crohn's disease, ulcerative colitis).

• Any condition in the opinion of the investigator that would interfere withevaluation of study treatment or interpretation of patient safety or study results.

• Participants who are pregnant or breastfeeding. Patients with an electricalimplantable device in the torso. Examples of electrical implanted medical devicesinclude spinal cord stimulators, vagus nerve stimulators, pacemakers, anddefibrillators.

• History of significant uncontrolled cardiovascular disease. Significant cardiacdisease includes second/third degree heart block; significant ischemic heartdisease; poorly controlled hypertension; congestive heart failure of the New YorkHeart Association (NYHA) Class II or worse.

• History of arrhythmia that is symptomatic or requires treatment. Patients withatrial fibrillation or flutter controlled by medication are not excluded fromparticipation in the trial.

• Known allergy to medical adhesives or conductive hydrogel [gel used onelectrocardiogram (ECG) stickers or transcutaneous electrical nerve stimulation (TENS) electrodes].