Stereotactic Body Radiation Therapy and Capecitabine before Surgery in Treating Patients with Pancreatic Cancer That Can Be Removed by Surgery

Inclusion Criteria

• Histologically or cytologically confirmed carcinoma of exocrine pancreatic head amenable to oncological surgical resection per findings on a pancreatic-specific computed tomography (CT) scan/MRI scan; tumors of the body that allow a surgical approach similar to pancreatic head tumors are acceptable
• Must be deemed a surgical candidate by the surgical oncology service
• Eastern Cooperative Oncology Group (ECOG) performance score of =< 2
• Signed informed consent document(s)
• Patients with no evidence of distant metastatic disease based on CT scan of the chest/abdomen/pelvis; diagnostic laparoscopy, is recommended but not required and is at the discretion of the surgical oncologist; peri-pancreatic or regional lymphadenopathy that does not preclude a surgical resection is acceptable
• Absolute neutrophil count (ANC) >= 1,500 cells/mm^3
• Platelet count >= 100,000 cells/mm^3
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 times the upper limit of normal
• Total bilirubin =< 3 times the upper limit of normal if patient had recent biliary stenting and a falling trend in bilirubin is demonstrated such that capecitabine treatment is deemed feasible per the treating medical oncologist, total bilirubin =< 1.5 times the upper limit of normal if no biliary stenting was done
• Serum creatinine within normal range with a creatinine clearance >= 30 ml/min
• Neoadjuvant chemotherapy will be permitted prior to the initiation of SBRT radiation therapy on this clinical trial; there must be a minimum of 2 weeks between the completion of any neoadjuvant chemotherapy and the beginning of SBRT radiation therapy; furthermore, restaging must be done prior to registration to ensure that patients remain resectable

Exclusion Criteria

• Patients with primary ampullary, biliary or duodenal cancer would be excluded
• Patients with tumors primarily of the tail of the pancreas requiring a distal pancreaticoduodenectomy would be excluded; tumors of the body that require a surgical approach similar to pancreatic head tumors are acceptable
• History of (H/o) Crohn’s disease/ulcerative colitis/scleroderma
• History of prior allergic reactions attributed to compounds of similar chemical or biologic composition as capecitabine
• History of prior allergic reactions attributed to compounds of CT/MRI contrast that cannot be managed with appropriate pre-medication prophylaxis and thereby preclude use of baseline/ follow-up or radiation planning imaging
• Any prior external beam radiation will be evaluated to determine radiation field overlaps and appropriateness of protocol radiation, any invasive cancer in the last 5 years (except for a diagnosis of low-risk prostate cancer, treated non-melanoma/melanoma skin cancer, appropriately treated ductal carcinoma in situ or early stage invasive carcinoma of breast and appropriately treated in-situ/early stage cervical/endometrial cancer)
• Pregnant or nursing women; women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) from the point of study entry and for the duration of all active treatments; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
• Treatment with a non-approved or investigational drug within 28 days of study treatment
• History of having MRI non-compatible metal (injury- or treatment-related) in the body will be an exclusion criteria specific to the MRI sub-study
• Subjects with known severe claustrophobia or with body habitus not compatible with the bore (> 300 lbs, body mass index [BMI] > 40) may also have to be excluded
• Subjects unable to maintain blood glucose less than 200 mg/dl may not be suitable for the PET/MRI substudy