Multi-Modality Therapy for Untreated Patients With Resectable or Marginally Resectable Pancreatic Cancer

For resectable patient; surgery with Intraoperative Radiation Therapy (IORT). Radiation
Therapy within 6-8 weeks after surgery followed by FOLFIRINOX every 2 weeks starting within
12 weeks of surgery.

For marginally resectable patients; the patients will have 2-3 cycles of neoadjuvant
chemotherapy of FOLFIRINOX and then restaged, undergo surgery with IORT within 2-4 weeks
following chemotherapy. Then radiation therapy starting within 6-8 weeks. Followed by
FOLFIRINOX every 2 weeks starting within 12 weeks of surgery for a total of 2-4 cycles.

Inclusion Criteria:

- Histologically proven Exocrine Adenocarcinoma of the pancreas

- Clinically resectable or marginally resectable disease

- No prior radiation or chemotherapy for carcinoma of the pancreas

- ECOG performance status of 0-1

- Patients must be medically able to undergo surgical resection

- Patients of child bearing potential must follow study specific precautions

- Women that are lactating will not be excluded on the condition that they dispose
their breast milk.

- Adequate hematologic and biochemical parameters.

Exclusion Criteria:

- Prior treatment for pancreatic cancer.

- Concurrent investigational treatments.

- Unresectable pancreatic mass.

- Neuroendocrine Histological pancreatic cancer

- Distant Metastatic disease

- Any condition that, in the option of the investigator, would compromise the well
being of the patient or anything that would prevent the patient from meeting or
performing study requirements