Stereotactic Body Radiation Therapy in Treating Patients with Pancreatic or Ampulla of Vater Cancer That Cannot Be Removed by Surgery

Inclusion Criteria

• Patients must have histologically confirmed, unresected cancer of the pancreas or ampulla; the cancer may include any invasive histology (e.g. adenocarcinoma, neuroendocrine carcinoma); patients with lymph node involvement or distant metastasis may be included if it is felt that local control of the primary site of disease would help reduce, or prevent the development of, local symptoms
• Patients must have measurable radiographic disease; patients with previous complete resection are only eligible if there is measurable radiographic disease which is clearly felt to represent locally recurrent disease
• Patients may receive any number of cycles of chemotherapy prior to treatment with SBRT, but not within 2 weeks of the first fraction of radiotherapy (RT); patients are not required to receive any chemotherapy to be eligible for study enrollment
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
• Life expectancy of greater than 3 months
• Absolute neutrophil count (ANC) >= 1,800 cells/mm^3
• Platelets >= 100,000 cells/mm^3
• Hemoglobin >= 8.0 g/dl
• Creatinine =< 2 X institutional upper limit of normal
• Total bilirubin =< 2.5 X institutional upper limit of normal
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) or alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X institutional upper limit of normal
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Concurrent investigational therapy delivered over the period of treatment or observation (28 days post-RT) for dose limiting toxicity
• Prior radiation therapy to the abdominal area which would overlap with the proposed area of treatment
• Pregnancy
• Primary disease > 7.5 cm in largest diameter as measured by computed tomography (CT) or magnetic resonance imaging (MRI)
• Gross extension of tumor into the lumen of the duodenum
• Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Use of bevacizumab or vascular endothelial growth factor inhibitor chemotherapy within 3 months before RT or 6 months after RT