Percutaneous ethanol injection treatment, introduced ten years ago as palliative therapy for patients with inoperable hepatocellular carcinoma, can now be used with a curative intent to treat small tumours with results comparable to surgical resection. This progress, made possible by sophisticated radiological techniques, makes percutaneous ethanol injection the treatment of choice for patients with poor liver function in whom resection is not possible and local control of the disease is desirable either for prolonged palliation or in view of liver transplantation. For patients with large tumours, or in case of recurrence after previous surgical treatment, a therapeutic approach combining transarterial lipiodol chemoembolisation and percutaneous ethanol injection has shown promising results and deserves further investigation.