Image-guided percutaneous local and regional modalities are major treatments for hepatocellular carcinoma. Patients having better liver function and performance are usually eligible and can gain significant survival benefit, especially with more limited tumor burden. The most common local therapies are ethanol and radiofrequency ablation, with the latter providing better local tumor control and survival. Radiofrequency ablation has also occasionally been found to be equivalent to surgical resection for appropriate tumors, with additionally lower morbidity. Chemoembolization is the prevalent transarterial therapy and has been shown to increase survival compared with conservative management. Chemoembolization using drug-eluting beads and radioembolization with β-emitting yttrium-90 microspheres seems to reduce side effects and expand the pool of eligible patients, whereas controversy remains regarding the role of bland particle embolization. Combinations of local and regional therapies may be appropriate for treating a particular tumor or different tumors over time and they may be combined with surgical and medical options.