Pancreatic cancer is he fourth most common cause of tumor-related death in industrialized countries; only 10- 20% are eligible for curative resection at the time of diagnosis, with 5-year overall survival rates of 20-30%. The tumor has to be considered both a local and a systemic disease. Therefore, we need multimodality approaches to improve survival rates. The current standard approach is adjuvant chemotherapy with 5-FU or gemcitabine, which shows a tendency towards better survival with less adverse events. Currently, addition of interferon-a, cisplatin and/or radiation to standard scheme is being evaluated in clinical studies, and in selected cases, 5-year overall survival rates of up to 50% may be reached. Radiation cannot be generally recommended. Some studies even suggest a negative influence on overall survival rates, although selected patients (e.g. R1-resected patients) might profit. Neoadjuvant treatment remains a case-to-case decision, and possible advantages will have to be evaluated in randomized controlled trials as there is no standard recommendation even for primary irresectable cancer. Novel agents ('targeted therapy') are under investigation in the palliative setting. As for adjuvant and neoadjuvant treatment, there is the need to establish measures by which patients can be identified to be eligible for selected treatment courses in an interdisciplinary approach.