Neoadjuvant Gemcitabine, Docetaxel, and Capecitabine in Combination With Stereotactic Radiosurgery

Inclusion Criteria:

* Patients must have histologically or cytologically confirmed pancreatic adenocarcinoma that is borderline resectable disease. Borderline resectable lesions are defined as:

  * circumferential tumor abutment with the superior mesenteric vein (SMV) or portal vein (PV) or SMV/PV confluence over \< 180o.
  * circumferential tumor abutment with the superior mesenteric artery (SMA) over \< 180o.
  * Short segment encasement (360o) of the PV or SMV that is amenable to partial vein resection and reconstruction.
  * encasement of the gastroduodenal artery up to the origin of the hepatic artery
* Patients must have measurable disease.
* No previous chemotherapy or radiation to the pancreas.
* Eastern Cooperative Oncology Group (ECOG) performance status \<2 (Karnofsky \>60%.
* Patients must have normal organ and marrow function as defined below:

  * leukocytes \>3,000/μL
  * absolute neutrophil count \>1,000/μL
  * platelets \>100,000/μL
  * creatinine within normal institutional limits - OR - creatinine clearance \>60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal
  * total bilirubin \< institutional upper limit of normal (ULN). Patients may have biliary stents or drains to lower total bilirubin to this range.
  * Aspartate Aminotransferase (AST) serum glutamic oxaloacetic transaminase(SGOT) / alanine aminotransferase (ALT) serum glutamic pyruvic transaminase(SGPT) AST and ALT may be up to 2.5 times ULN if alkaline phosphatase \< ULN; or alkaline phosphatase may be up to 4 times ULN if AST and ALT are \< ULN.
* Has a negative serum or urine pregnancy test within 7 days prior to initiation of therapy (female patients of childbearing potential). Postmenopausal women must have been amenorrheic for at least 12 months to be considered of non-childbearing potential. Patients will agree to continue contraception for 30 days from the date of the last study drug administration.
* Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

* Patients with metastatic disease are ineligible. Patients who have had prior chemotherapy for pancreatic adenocarcinoma.
* Patients who have received prior radiation to an abdominal site are not eligible.
* Prior malignancy in the last 3 years, except basal cell carcinoma, squamous cell or in-situ cervical cancer.
* Patients with peripheral neuropathy \> grade 2.
* Patients with a history of severe hypersensitivity reaction to Taxotere (docetaxel), other drugs formulated with polysorbate 80, gemcitabine, or capecitabine.
* Patients may not be receiving any other investigational agents.
* ECOG PS 3-4
* Pregnant women are excluded from this study because gemcitabine, capecitabine, and docetaxel are Class D agents with the potential for teratogenic or abortifacient effects.
* Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* creatinine clearance \< 30 ml/min (Cockcroft-Gault method).
* Patients must not have any comorbid inflammatory conditions of the bowel such as Crohn's Disease.