A 66-year-old man with pancreatic acinar cell carcinoma developed a hepatic metastasis that enlarged to 6.6 cm despite neoadjuvant FOLFIRINOX, pancreaticoduodenectomy, adjuvant chemoradiotherapy, and gemcitabine plus cisplatin. CT showed a heterogeneously hypoenhancing mass in the periphery of segment VI, an enhancement pattern predicting insufficient coverage by conventional chemoembolization alone. In a single session, 15 mL of an ethanol–doxorubicin–ethiodized oil mixture (1:2) was infused into the segment VI hepatic artery, and the resulting ethiodized oil deposition served as a fluoroscopic target for MWA guided by ultrasonography and fluoroscopy. A purulent perihepatic collection with pneumoperitoneum developed and resolved after percutaneous drainage. Complete response was sustained on follow-up CT, indicating that combined transarterial and thermal ablation can eradicate a large chemotherapy-refractory metastasis.