Patients with borderline, unresectable, and resected (adjuvant) pancreatic cancer typically receive chemoradiation (CRT) with concurrent 5-FU or gemcitabine. More patients are receiving 2-6 months of chemotherapy prior to CRT in an attempt to treat micrometastatic disease and select those patients who are more likely to benefit from CRT. Several institutions are evaluating either dose escalated IMRT or fractionated stereotactic body radiation therapy in an attempt to improve local progression free survival and response rates. This session will review current and future multimodality treatment strategies in this controversial disease. At the conclusion of this activity, the learner will be able to do the following: 1. Discuss current treatment strategies and approaches of pancreatic cancer: adjuvant and neoadjuvant treatment approaches with surgery, definitive chemoradiation, chemotherapy-alone approaches. 2. Summarize the future of treatment: newer randomized trials, alternative treatment strategies and integration of novel agents and controversies surrounding radition approaches in this disease.