The effectiveness of transcatheter arterial embolization (TAE) combined with percutaneous ethanol injection (PEI) was investigated in 18 patients with advanced hepatocellular carcinoma (HCC), and compared with 18 patients with HCC treated by TAE therapy alone. In both groups, patients had multiple lesions or a single lesion larger than 3 cm. The pretreatment characteristics of the patients in the two groups showed that serum bilirubin in the TAE-PEI group was significantly higher than that in the TAE-only group, but that the patients in the two groups were comparable in all other respects. The cumulative survival rate of the TAE-PEI group estimated by the Kaplan-Meier method was 100% for 10 months, 82% for 20 months, 53% for 30 months and 18% for 40 months, whereas that of the TAE-only group was 75% for 10 months, 50% for 20 months, 30% for 30 months and 30% for 40 months. The survival rate in the TAE-PEI group was significantly higher than that in the TAE group. Moreover, the survival rate of patients whose main tumor was 4 cm or larger, was significantly higher in the TAE-PEI group than that in the TAE-only group. The average survival period of these patients in the TAE-PEI group was five times as long as that in the TAE-only group. The survival rate of Child's B and C patients in the TAE-PEI group was significantly higher than that in the TAE-only group.(ABSTRACT TRUNCATED AT 250 WORDS)