Phase I Study of Stereotactic Body Radiation Therapy and FOLFIRINOX in the Neoadjuvant Therapy of Pancreatic Cancer

Inclusion Criteria: Patients eligible must have:

* Histologic or cytologic diagnosis of pancreatic adenocarcinoma.
* Radiographically resectable or borderline resectable disease as reviewed by an experienced surgical oncologist at Emory.
* Age 21 years or older.
* Not received prior chemotherapy or radiation for pancreatic cancer.
* ECOG performance status of 0-1 on the Eastern Cooperative Oncology Group (ECOG) scale.
* Adequate bone marrow function: absolute neutrophil count \> 1,500/cmm, platelet count \> 100,000/cmm.
* Understanding and be informed of the investigational nature of this study and must give written informed consent prior to the receiving of treatment per this protocol.

Exclusion Criteria: Patients who are not eligible have

* Histologies including endocrine tumors or lymphoma of the pancreas.
* A tumor which is less than 3 mm from the duodenum as measured by either CT or MRI.
* History of central nervous system (CNS) metastases.
* Liver dysfunction, including total bilirubin \> 1.5 mg/dL; aspartate transaminase (AST) and alanine amino transferase (ALT) \> 5 times upper limit of the institutional normal.
* Creatinine ≥ 1.5 mg/dL.
* Albumin ≤ 2.5 g/dL.
* International Normalized Ratio (INR) ≥ 1.5 (in the absence of ongoing treatment with warfarin).
* Breast feeding.
* Serious active infection.
* Serious concurrent systemic disorders incompatible with participating in the study (at the discretion of the investigator).
* An active second primary malignancy (except in situ carcinoma of the cervix, or adequately treated basal cell carcinoma of the skin) within less than one year of enrollment into this study.
* Clinical evidence of distant metastatic disease.