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Both transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection therapy (PEI) have proven their efficacy in patients with unresectable hepatocellular carcinoma (HCC): TACE mainly in large lesions or disseminated disease and PEI in solitary lesions smaller than 3 cm. Although severe complications have been observed with both methods, their incidence is low. In 1991, the combination therapy of initial TACE followed by multiple sessions of PEI was introduced, allowing the repeated percutaneous treatment of lesions larger than 4 cm. This approach has been shown to be more effective than TACE alone in lesions up to 8 cm in diameter. An increased incidence of serious side-effects compared to either method alone has not been reported so far.