Although pancreatic cancer (PC) continues to be a formidable disease, numerous treatment strategies are evolving and it is hoped that these will result in improved patient survival. Only surgical resection offers the opportunity for cure, but the prognosis of resected patients remains unfavorable because of postoperative recurrence. Accordingly, to improve the survival of PC patients, it is essential to develop effective non-surgical treatments for this disease. Radiotherapy (RT) alone does not have a significant clinical impact in PC, but when combined with chemotherapy (CHT), it provides a survival benefit in both locally unresectable and adjuvant settings of PC. However, to establish optimal methods of combining RT with CHT, newer approaches, such as specialized RT techniques and new CHT agents, are actively being pursued. CHT for PC has only limited value in clinical practice, because of the lack of any agent with a truly high level of activity. The identification of more effective new agents is therefore a high priority, and the enrollment of PC patients with metastatic disease into well designed clinical trials is essential. The novel nucleoside analog, gemcitabine, appears to have the potential to produce better results than those achieved over the last 35 years with 5-fluorouracil (5-FU). Moreover, increased understanding of the biology of PC should facilitate the development of entirely novel treatment options. We must continue to actively search for more effective non-surgical treatments for PC.