The level of evidence is more limited to guide treatment decisions for ampullary/peri-ampullary adenocarcinoma compared to the neighboring pancreas. However, I have generally approached this situation similarly to locally advanced or inoperable pancreas cancer starting with systemic therapy and if t...

Adding on here that NCCN now has an ampullary cancer guideline (disclosure: I was part of the writing team) so you can review primary references and level of data support for treatment options. There is a write up here https://www.onclive.com/view/nccn-establishes-standards-of-care-in-ampullary-aden...