Palliative Stereotactic Radiation for Pancreatic or Adenocarcinoma

• GI toxicity [ Time Frame: 1 year from treatment start ] [ Designated as safety issue: Yes ]
  Grade 2 or greater late gastritis, fistula, enteritis, ulcer, or late grade 3-4 gastrointestinal toxicity at one year
  
  

• Acute GI toxicity [ Time Frame: 1 year from start of treatment ] [ Designated as safety issue: Yes ]
  Acute grade 2 or greater gastritis, fistula, enteritis, or ulcer or any other grade 3-4 gastrointestinal toxicity within 3 months of treatment.
  
  
• Local progression free survival [ Time Frame: 3, 6, and 12 months after start of treatment ] [ Designated as safety issue: Yes ]
  Local progression free survival rate at 3, 6, and 12 months..
  
  
• Metastasis free and overall survival. [ Time Frame: 3, 6, and 12 months after start of treatment and then annually thereafter ] [ Designated as safety issue: Yes ]
  Metastasis free and overall survival
  
  
• Tumor size imaging [ Time Frame: 3, 6, and 12 months after start of treatment and then annually thereafter ] [ Designated as safety issue: No ]
  Change in pancreatic or periampullary tumor volume with FDG-PET (18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose) compared to CT
  
  
• Quality of Life (QoL) [ Time Frame: 3, 6, and 12 months after start of treatment ] [ Designated as safety issue: No ]
  Health-related quality of life (QoL) before and after SBRT.
  
  
• Utility of FDG-PET/CT (18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose) for tumor assessments [ Time Frame: 3, 6, and 12 months after start of treatment ] [ Designated as safety issue: No ]
  Utility of FDG-PET/CT (18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose)scans for assessment of tumor response and progression.
  
  

No standard treatment option has yet been established for patients who develop locally progressive disease after definitive treatment of pancreatic cancer or periampullary cancers (duodenal, ampullary, bile duct) with standard of care or protocol combined modality therapy. Stereotactic body radiation therapy (SBRT) administered in 1-3 fractions has been shown to be an effective treatment option for patients with unresectable, locally advanced pancreatic adenocarcinoma, achieving local control rates of 84-92% at one year. Associated late gastrointestinal toxicity rates have been reported to be 22-25% at 1 year. The investigators hypothesize that similarly excellent local control rates (80-90% at one year) with a reasonable rate of toxicity (≤ 20%) can be achieved using SBRT delivered as 5 Gy x 5 for patients with local failure after previous treatment with conventional chemoradiation therapy (CRT) with or without surgery and as 6.6 Gy x 5 for radiation-naïve patients with local failure after previous treatment with surgery and/or chemotherapy. The toxicities of note for this trial are grade 2 and greater gastritis, fistula, enteritis, or ulcer and any grade 3-4 GI toxicity.