Preoperative, Proton- Radiotherapy Combined With Chemotherapy for Borderline Resectable Pancreatic Cancer

Inclusion Criteria:

• Patients with histologically or cytologically confirmed diagnosis of pancreatic cancer
• Diagnosis of borderline resectable cancer according to the international consensusdefinition 2017.
• Negative staging for distant metastasis
• Blood test within the following limits absolute neutrophil count > 1,500 cells/mm³,platelet count > 100,000 cells/mm³, Aspartate Aminotransferase (AST) and AlanineAminotransferase (ALT) < 2.5 times the upper limit of normal, total bilirubin < 2.5times the upper limit of normal if patient had recent biliary stenting, totalbilirubin < 1.5 times the upper limit of normal if no biliary stenting was done, serumcreatinine within normal range (0.6-1.5 mg/dl) with a creatinine clearance > 30 ml/min (as estimated by Cockroft Gault equation)
• Age > 18 years
• Karnofsky index ≥ 70
• No tumor infiltration of stomach or duodenum
• The patient is informed of the diagnosis and is able to give informed consent (Abilityof subject to understand character and individual consequences of the study protocol)
• Women of fertile age must have adequate conception prevention measures and must notbreast feed
• Signed Informed Consent (must be available before study inclusion)

Exclusion Criteria:

• Non-exocrine tumors
• Major medical or psychiatric comorbidities that contraindicate radiation therapy,chemotherapy or surgery
• Presence of distant metastasis
• Pregnancy or unwilling to do adequate conception prevention
• Lactating and unwilling to discontinue lactation
• Men of childbearing potential not willing to use effective means of contraception
• Known allergic/hypersensitivity reaction to any of the components of study treatments
• Previous diagnosis of another neoplasm with worse prognosis as compared with the onein this study
• Metallic prosthesis or other condition that prevent an adequate imaging for targetvolume definition
• Loco-regional conditions that contraindicate radiotherapy e.g. active infections inthe area
• Previous abdominal radiotherapy
• Prior systemic treatment for pancreatic cancer
• Hypersensitivity to PACLitaxel, albumin, gemcitabine or to any of the excipients ofthe chemotherapy
• Severe hepatic impairment
• Baseline Neutrophil Counts < 1.5 x 10^9/L
• Baseline Grade ≥ 2 sensory or motor neuropathy
• Patient refusal