A 5 5-year-old woman was admitted to our hospital for pancreatic cancer with liver metastasis. We performed pancreatoduodenectomy, D2 dissection, and partial liver resection. Tissue from a resected liver metastasis was submitted to a chemosensitivity test. Based on the test results, we performed systemic chemotherapy with paclitaxel and hepatic artery infusion with gemcitabine for lung and liver metastasis after surgery. Furthermore, we added stereotactic body radiation therapy(SBRT)(48 Gy/4 Fr)for 3 liver metastases that showed enlargement after chemotherapy. Effective control of recurrent tumors was possible for 2 years and 5 month, and she maintained normal daily activities. She died of peritoneal dissemination 3 years and one month after surgery. Combined modality therapy with anticancer agents based on a chemosensitivity test and SBRT may be one useful therapy for pancreatic cancer with distant metastases.