Pancreatic adenocarcinoma is one of the most lethal malignancies, with an overall 5-year disease-free survival rate on the order of 1% to 2%. Most pancreatic cancers are not diagnosed until they are locally advanced or until regionally disseminated disease has developed that is not amenable to curative surgical resection. Chemotherapy and radiation therapy are of only modest benefit in this disease, and typical survival is on the order of 6 months. Of those patients with apparently resectable disease who undergo surgical exploration, between 20% and 40% are found to have unresectable lesions. Even those patients in whom a margin-negative resection has been achieved have a 5-year disease-free survival rate of less than 30%, and in approximately half of the patients surviving 5 years, the cancer will recur between years 6 and 10. Thus, the treatment of pancreatic cancer remains a challenge to the surgical, radiation, and medical oncologist.