Hepatic metastasis from bile duct cancer of the ampulla is effectively controlled by multidisciplinary treatment including S-1, gemcitabine and bevacizumab: A case report.

The liver is the most common site for recurrent metastases from bile duct cancer (BDC) in the ampullary area. However, the optimal chemotherapy regimen for recurrent hepatic metastases has not yet been established. An oral combined fluoropyrimidine drug, S-1 (tegafur, gimeracil and oteracil), has recently been introduced alone or in combination with gemcitabine for BDC. A 67-year-old man underwent a pancreaticoduodenectomy (PD) for early stage distal BDC in the ampullary area. A small hepatic metastasis developed 8 months after the PD. Combined chemotherapy of S-1 (80 mg/m(2)) and gemcitabine (1000 mg/m(2)) was started after radiofrequency ablation (RFA) of the hepatic tumor. Although complete response was achieved and maintained for 4 months with chemotherapy, there was regrowth of the tumor. We performed hepatic segmentectomy for radical treatment. Fourteen months after the hepatectomy, metastasis developed again in the remnant liver. Bevacizumab was added to the combination chemotherapy with S-1 and gemcitabine, since the cancer seemed resistant to the chemotherapy alone. The patient has been well managed for 3 years by a multidisciplinary treatment with surgery, RFA and the combination chemo-therapy on an outpatient basis. This case indicates that distal BDC even in an early stage has a more malignant potential than anticipated. The multidisciplinary treatment including surgery, RFA and combination chemotherapy of S-1, gemcitabine and bevacizumab was effective for BDC with hepatic metastasis. This chemotherapy is feasible on an outpatient basis and may be one of the treatment options for metastatic BDC.