Image-guided percutaneous ablation is currently accepted as the best therapeutic option for nonsurgical patients with early-stage hepatocellular carcinoma. Ethanol injection is the seminal technique for local tumor treatment, and may achieve 50% 5-year survival in selected Child A patients. Radiofrequency ablation constitutes the most assessed alternative technique. On the basis of the identified evidence, radiofrequency ablation seems to reach higher recurrence-free survival rates compared with ethanol injection. Further randomized trials are needed to establish the clinical efficacy of radiofrequency ablation with respect to other percutaneous treatments and to devise an unbiased therapeutic strategy