Abstract: ObjectiveTo compare the efficacy and side effects of high-intensity focused ultrasound (HIFU) with anhydrous alcohol injection guided by ultrasound on patients with portal vein tumor thrombosis (PVTT). Methods 86 patients with primary liver cancer (PLC) combined with PVTT in our hospital were retrospectively analyzed.Liver lesions were basically treated with transcatheter arterial chemoembolization (TACE), and HIFU or percutaneous anhydrous alcohol injection were sued as complimentary treatment to 52 cases (group A) and 34 cases (group B),respectively.Response rate (RR), clinical beneficial response (CBR), overall survival (OS) and side effects were evaluated between two groups. Results RR in group A and B were 40.38% vs. 41.18% (P=0.1493), CBR were 48.08% vs. 23.53%(P=0.0102)， median OS were 12.3 months (range：3.6~23.5) vs. 11.5 months (range： 4.2~21.3) (P=0.1504).Main side effects occurred in group A was upper gastrointestinal(GI) hemorrhage and liver area pain, while fever and hemorrhage under liver capsule occurred in group B.The occurance rates of side effects in group B were much higher than those in group A (P=0.0051). Conclusion HIFU and percutaneous anhydrous alcohol injection guided by ultrasound are both safe and effective approaches for therapy of PVTT.The short-term and long-term response was similar in two groups, while HIFU was superior to anhydrous alcohol injection on CBR and side effects.HIFU maybe a good choice patients with disordered liver function, ascites and intolerable to other methods.