How do you manage patients with pancreatic adenocarcinoma who progress during neoadjuvant FOLFIRINOX, such that borderline resectable disease is now unresectable but still localized?

Great question; this area is rapidly evolving. I hope some of the ViewRay crowd will see this and chime in.

We give ablative doses of radiation (~100Gy BED). That results in survival that is similar to surgery in patients like this (inoperable in an aggressive surgery practice at MSKCC, MSS in prepa...

I agree with @Dr. First Last and have in the past few years transitioned to ablative SBRT since moving to an institution with a ViewRay MRIdian Linac, based on the dose intensification data from MD Anderson that Dr. Crane mentioned (Krishnan et al., IJROBP 2016) and some of the early ViewRay data fr...

Proceed with regional radiotherapy with adjuvant chemotherapy.