Since preoperative radiation therapy combined with chemotherapy (CTRT) was first performed in 1986 for patients with pancreatic adenocarcinoma, there have been several reported experiences with varying drugs and radiotherapy regimens. We describe those experiences and contrast them to a series of patients treated at our institution with resectional surgery before CTRT. Finally, the current role of preoperative CTRT in the therapy of pancreatic adenocarcinoma is proposed.