AIM:To evaluate the effectiveness and safety of percutaneoushepatic cryoablation in combination with percutaneousethanol injection (PEI) in patients with unresectablehepaocellular carcinoma (HCC).METHODS:A total of 105 masses in 65 HCC patientsunderwent percutaneous hepatic cryoablation.Thecryoablation was performed with the Cryocare system(Endocare,Irvine,CA,USA) using argon gas as a cryogen.Two freeze-thaw cycles were performed,each reaching atemperature of-180 ℃ at the tip of the probe.PEI wasgiven in 36 patients with tumor masses larger than 6 cmin diameter 1-2 weeks after cryoablation and then onceper week for 4 to 6 sessions.The efficacy was evaluatedwith survival,change of tumor size and alpha-fetoprotein(AFP) levels.RESULTS:During a follow-up duration of 14 months inaverage with a range of 5 to 21 months,33 patients (50.8 %)were free of tumors,22 patients (33.8 %) alive with tumorrecurrence:two had bone metastases,three were found tohave lung metastases,and the remaining 17 recurrencesoccurred in the liver,of whom only 3 developed a cryositerecurrence.Among the 41 patients who were followed upfor more than one year,32(78 %) were alive despite oftumor recurrence.Seven patients (10.8 %) died due todisease recurrence.Three patients (4.6 %) died due to somenoncancer-related causes.Among the 43 patients who hada CT scan available for review,38 (88.4 %) had a shrinkageof tumor mass.Among the 22 patients who received biopsiesof cryoablated tumor mass,all biopsies except one,showedonly dead or scar tissues.Of the patients who had anincreased AFP preablatively,91.3 % had a decrease of AFPto normal or nearly normal levels during postablative 3-6months.Complications of cryoablation included liver capsularcracking in one patient,transient thrombocytopenia in 4patients and asymptomatic right-sided pleural effusions in2 patients.Two patients developed liver abscess attheprevious cryoablation site at 2 and 4 months,respectively,following cryoablation,and was recovered after treatedwith antibiotics and drainage.CONCLUSION:percutaneous Cryoablation offers a safeand PoSSibly CuratiVe treatment oPtion for Patients With HCCthat eannot be surgically removed,and its integration with PEI,may serve as an alternative to Partial Iiver resection inselective Patients. AIM: To evaluate the effectiveness and safety of percutaneous hepatic cryoablation in combination with percutaneousethanol injection (PEI) in patients with unresectablehepaocellular carcinoma (HCC). METHODS: A total of 105 masses in 65 HCC patientsunderwent percutaneous hepatic cryoablation. The cryoablation was performed with the Cryocare system (Endocare, Irvine, CA, USA) using argon gas as a cryogen. Two freeze-thaw cycles were performed, each reaching a temperature of-180 ° C at the tip of the probe. PEI was given in 36 patients with tumor masses larger than 6 cmin diameter 1-2 weeks after cryoablation and then onceper week for 4 to 6 sessions. The efficacy was evaluated with survival, change of tumor size and alpha-fetoprotein levels (AFP) levels .RESULTS: During a follow-up duration of 14 months inaverage with a range of 5 to 21 months, 33 patients (50.8%) were free of tumors, 22 patients (33.8%) alive with tumorrecurrence: two had bone metastases, three were found to have lung metastases, and the remaining 17 r ecurrencesoccurred in the liver, of whom only 3 developed a cryositerecurrence. Amm the 41 patients who were followed upfor more than one year, 32 (78%) were alive despite of tumor recurrence. Seven patients (10.8%) died due todisease recurrence.Three patients (4.6%) died due to some noncancer-related causes. Amse the 43 patients who hada CT scan available for review, 38 (88.4%) had a shrinkage of tumor mass. Among the 22 patients who received biopsies of cryoablated tumor mass, all biopsies except one , showedonly dead or scar tissues. Of the patients who had an incremental 5% AFP preablatively, 91.3% had a decrease of AFPto normal or nearly normal levels during postablative 3-6 months. Complications of cryoablation included liver capsularcracking in one patient, transient thrombocytopenia in 4patients and asymptomatic right-sided pleural effusions in2 patients. Two patients developed liver abscess attheprevious cryoablation site at 2 and 4 months, respectively, following cryoablation, and was recovered af ter treatedwith antibiotics and drainage. CONCLUSION: Percutaneous Cryoablation offers a safe and PoSSibly CuratiVe treatment oPtion for Patients With HCC, eannot be surgically removed, and its integration with PEI, may serve as an alternative to Partial Iiver resection inselective Patients.