Approximately 40% of patients with pancreatic cancer present with locally advanced disease. The median survival for this group of patients, untreated or with only palliative surgery, is 3-5 months. Radiation treatment has no major impact on median or long term survival, but it appears to provide symptomatic palliation. Because of the localized nature of the disease, the combination of chemotherapy with radiation treatment has been used. With this combined approach a median survival of 8 to 14 months is obtained. Combined modality treatment might thus offer the best palliative results, and is therefore the subject of further study.