Abstract: Objective To compare the efficacy and adverse effects of transcatheter hepatic arterial chem oembolization(TACE) combined with high intensity focused ultrasound(HIFU) and TACE combined with three-dimensional conformal radiotherapy(3-DCRT) on patients with portal vein tumor thrombosis (PVTT). Methods Data of hospitalized 65 patients with hepatocellular carcinoma(HCC) combined with PVTT were retrospectively analyzed. They were divided into two groups randomly, Group A, 34 cases received TACE combined with HIFU, and Group B, 31 cases received TACE combined with 3-DCRT. Response rate, overall survival and adverse effects were evaluated between two groups. Results The total response rate was 70.59%(24/34) in Group A and 67.74%(21/31) in Group B, with no significant difference (P=0.804). The overall survival rates at 0.5, 1 and 2 years were 91.12%(31/34), 61.76%(21/34) and 20.59%(7/34) in Group A, and 87.10%(27/31), 64.52%(20/31) and 16.13%(5/31) in Group B. The median survival time were 13.4 months (range: 3.8-25.6) in Group A and 12.6 months (range: 4.3-24.8) in Group B, with no significant difference(P=0.167). The occurance rates of adverse effects in Group B were much higher than those in Group A. Conclusion TACE combined with HIFU and 3-DCRT separately are both safe and effective approaches in the treatment of PVTT patients, while HIFU was superior to 3-DCRT on adverse effects.