Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment that holds the potential of cure, a minority of patients are surgical candidates. Despite surgery, the overall survival rates remain low. Neoadjuvant treatment has been investigated both in the setting of resectable disease at diagnosis, or in an attempt to downstage locally advanced disease for resection. Single institution studies of neoadjuvant chemoradiation have demonstrated favourable outcomes, compared to similar series of patients treated with surgery with or without adjuvant therapy. For unresectable disease, partial or complete responses have been observed which have allowed some patients to subsequently undergo resection. The reports of neoadjuvant therapy for pancreatic cancer are heterogeneous with regards to patient population, treatment methods and modalities, making comparisons of different regimens inherently flawed. To date, no randomized controlled trials of neoadjuvant therapy have been conducted, however given the positive outcomes of single institutional series of neoadjuvant therapy this approach is worthy of further study.